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Tumours often spread to bone and occasionally arise in bone.  Bone tumours are dealt with in the ''[[bone tumours]]'' article.
Tumours often spread to bone and occasionally arise in bone.  Bone tumours are dealt with in the ''[[bone tumours]]'' article.


==Normal==
=Normal bone=
*Normal bone has osteocytes.
==Bone anatomy==
**If the osteocytes are missing... the bone is dead.
*Epiphysis = rounded end of the bone.
*Metaphysis = between epiphysis and diaphysis; contains ''epiphyseal plate'' - site of growth in childhood.
*Diaphysis = shaft, mid-portion, contains [[bone marrow]].


*Osteoblasts - make bone.
===Image===
*Osteoclasts - destroy bone.
<gallery>
Image:EpiMetaDiaphyse.jpg | Bone. (WC)
</gallery>
 
==Bone histology==
Two types (based on arrangement of collagen):
# Woven bone.
# Lamellar bone.
 
===Woven bone===
*Always abnormal in adults.
*Collagen arranged haphazardly - mechanically weak.
 
Images:
*[http://www.ajnr.org/cgi/content-nw/full/27/2/274/F4 Woven bone (ajnr.org)].<ref name=pmid16484391>{{cite journal |author=Lin DD, Gailloud P, McCarthy EF, Comi AM |title=Oromaxillofacial osseous abnormality in Sturge-Weber syndrome: case report and review of the literature |journal=AJNR Am J Neuroradiol |volume=27 |issue=2 |pages=274–7 |year=2006 |month=February |pmid=16484391 |doi= |url=}}</ref>
*[http://www.brown.edu/Courses/Digital_Path/systemic_path/bone/paget.html Woven bone (brown.edu)].
 
===Lamellar bone===
[[File:Lamella bone H&E and under polarised light.gif|thumb|Animated GIF showing a photomicrograph of lamellar bone. The layers are accentuated under polarised light.]]
*Collagen organized in layers (lamellae).
 
===Woven versus lamellar===
*Easiest way to differentiate: polarize; lamellar bone has well-defined layers.
 
==Bone cells==
*Osteocytes.
**Sit in lacunae.
***Empty lacunae = necrotic bone.
*Osteoblasts.
**Make bone.
*Osteoclasts.
**Destroy bone.
**Multinucleated.


Memory device: 'b' before 'c'.
Memory device: 'b' before 'c'.
==Hyperostosis frontalis interna==
*Extra-thick frontal bone.<ref>URL: [http://radiopaedia.org/articles/hyperostosis_frontalis_interna http://radiopaedia.org/articles/hyperostosis_frontalis_interna]. Accessed on: 29 September 2010.</ref>
*No clinical significance -- just has to be recognized as a "nothing".


==Bone marrow==
==Bone marrow==
{{Main|Haematopoiesis}}
{{Main|Haematopoiesis}}
*Fat content (%) ~= age (in years)<ref>IAV. 26 Feb 2009.</ref>
===General===
**e.g. 60 year old will have 60% fatty replacement.
*One of two ''[[primary lymphoid organs]]'' - the other one is the [[thymus]].<ref>URL: [http://www.life.umd.edu/classroom/bsci423/song/Lab1.html http://www.life.umd.edu/classroom/bsci423/song/Lab1.html]. Accessed on: 28 March 2012.</ref>
 
Bone marrow biopsy adequacy:<ref name=pmid16477878>{{Cite journal  | last1 = Rudzki | first1 = Z. | last2 = Partyła | first2 = T. | last3 = Okoń | first3 = K. | last4 = Stachura | first4 = J. | title = Adequacy of trephine bone marrow biopsies: the doctor and the patient make a difference. | journal = Pol J Pathol | volume = 56 | issue = 4 | pages = 187-95 | month =  | year = 2005 | doi =  | PMID = 16477878 }}</ref>
*10 intertrabecular spaces or 10 mm.


*Should see three cell lines.
===Microscopic===
**The cell lines:<ref>[http://emedicine.medscape.com/article/199003-overview http://emedicine.medscape.com/article/199003-overview]</ref>
One should see three cell lines:<ref>URL: [http://emedicine.medscape.com/article/199003-overview http://emedicine.medscape.com/article/199003-overview]. Accessed on: 28 March 2012.</ref>
***Erythroid (red cells),
#Erythroid (red cells).
***Myeloid (white blood cells),
#Myeloid (white blood cells).
***Megakaryocytic (platelets).
#Megakaryocytic (platelets).


Note: Lymphocytes are considered separately and typically spared in bone marrow failure.<ref>[http://emedicine.medscape.com/article/199003-overview http://emedicine.medscape.com/article/199003-overview]</ref>
Adipose tissue:
*Fat content (%) ~= age in years.<ref>IAV. 26 Feb 2009.</ref>
**e.g. 60 year old will have 60% fatty replacement.


Identifying the lines:<ref>[http://upload.wikimedia.org/wikipedia/commons/6/69/Hematopoiesis_%28human%29_diagram.png http://upload.wikimedia.org/wikipedia/commons/6/69/Hematopoiesis_%28human%29_diagram.png]</ref>
Identifying the cell lines:<ref>[http://upload.wikimedia.org/wikipedia/commons/6/69/Hematopoiesis_%28human%29_diagram.png http://upload.wikimedia.org/wikipedia/commons/6/69/Hematopoiesis_%28human%29_diagram.png]</ref>
#Megakaryocytes:
#Megakaryocytes:
#*Big cells ~ 3x the size of a RBC.
#*Big cells ~ 3x the size of a [[RBC]].
#Normoblasts (RBC precursors):
#[[Normoblast]]s (RBC precursors):
#*Hyperchromatic, i.e. blue, nucleus.
#*Hyperchromatic, i.e. blue, nucleus.
#Myeloid line:
#Myeloid line:
Line 38: Line 73:
#*Reniform nucleus, i.e. kidney bean shaped nucleus.
#*Reniform nucleus, i.e. kidney bean shaped nucleus.


Images:
Note:  
*[http://commons.wikimedia.org/wiki/File:Bone_marrow_WBC.JPG Myeloid line (WC)].
*Lymphocytes are considered separately and typically spared in bone marrow failure.<ref>[http://emedicine.medscape.com/article/199003-overview http://emedicine.medscape.com/article/199003-overview]</ref>
 
====Organization====
====Organization====
*Mature hematopoeitic cells at the centre (distant from bone).
*Mature hematopoeitic cells at the centre (distant from bone).
*Immature hematopoeitic cells adjacent to the bone.
*Immature hematopoeitic cells adjacent to the bone.


==Infectious==
Note:
===Osteomyelitis===
*Immediately adjacent to the bone (paratrabecular)... is where [[follicular lymphoma]] is classically found.<ref name=pmid17284114>{{Cite journal  | last1 = Iancu | first1 = D. | last2 = Hao | first2 = S. | last3 = Lin | first3 = P. | last4 = Anderson | first4 = SK. | last5 = Jorgensen | first5 = JL. | last6 = McLaughlin | first6 = P. | last7 = Medeiros | first7 = LJ. | title = Follicular lymphoma in staging bone marrow specimens: correlation of histologic findings with the results of flow cytometry immunophenotypic analysis. | journal = Arch Pathol Lab Med | volume = 131 | issue = 2 | pages = 282-7 | month = Feb | year = 2007 | doi = 10.1043/1543-2165(2007)131[282:FLISBM]2.0.CO;2 | PMID = 17284114 }}</ref>
General
**Image: [http://www.flickr.com/photos/euthman/5691578596/in/set-72057594114099781 Paratrabecular follicular lymphoma (flickr.com)].
===Images===
<gallery>
Image:Bone_marrow_WBC.JPG| Myeloid line. (WC)
</gallery>
 
===Sign out===
====Essentially normal====
<pre>
Bone Marrow, Posterior Superior Iliac Spine, Biopsy:
- Bone marrow with trilineage hematopoiesis.
- Cellularity within normal limits for age.
- Case will be sent to hematology for consultation and correlation
  with other testing.
</pre>
 
====Inadequate====
<pre>
Right Posterior Superior Iliac Spine, Bone Marrow Biopsy:
- Predominantly benign dense fibrous tissue with a small
  amount of laminar bone, and minute fragment of marrow (<2 mm).
- Case will be sent to hematopathology for further assessment.
</pre>
 
=Benign variants=
==Hyperostosis frontalis interna==
*Extra-thick frontal bone.<ref>URL: [http://radiopaedia.org/articles/hyperostosis_frontalis_interna http://radiopaedia.org/articles/hyperostosis_frontalis_interna]. Accessed on: 29 September 2010.</ref>
*No clinical significance -- just has to be recognized as a "nothing".
 
=Infections=
==Acute osteomyelitis==
===General===
Pathophysiology/entry:
*Hematogenous - often in children.
*Hematogenous - often in children.
*Direct entry (skin defect) - adults with diabetes.
*Direct entry (skin defect) - adults with diabetes.


====Microscopic====
===Microscopic===
*PMNs.
Features:
*[[PMN]]s.
*Micro-organisms - esp. cocci.
 
Image:
*[http://osteomyelitis.stanford.edu/pages/histo_002.html Acute osteomyeelitis (stanford.edu)].
 
===Stains===
*[[Gram stain]].


===Chronic osteomyelitis===
==Chronic osteomyelitis==
*Plasma cells.
===General===
Most common organism:
*''Staphylococcus aureus''.<ref name=pmid22046943>{{Cite journal  | last1 = Hatzenbuehler | first1 = J. | last2 = Pulling | first2 = TJ. | title = Diagnosis and management of osteomyelitis. | journal = Am Fam Physician | volume = 84 | issue = 9 | pages = 1027-33 | month = Nov | year = 2011 | doi =  | PMID = 22046943 | URL = http://www.aafp.org/link_out?pmid=22046943 }}</ref>
 
Risk factors:<ref name=pmid22046943/>
*[[Diabetes mellitus]].
*Peripheral vascular disease.
 
===Microscopic===
Features:
*Plasma cells - '''key feature'''.
**May be sterile, i.e. no organisms.
**May be sterile, i.e. no organisms.
*+/-Fibrosis.
*+/-Necrotic bone - bone with empty lacunae.
*+/-[[Amyloid]].
**~10% of patients in one series.<ref name=pmid2071276>{{Cite journal  | last1 = Alabi | first1 = ZO. | last2 = Ojo | first2 = OS. | last3 = Odesanmi | first3 = WO. | title = Secondary amyloidosis in chronic osteomyelitis. | journal = Int Orthop | volume = 15 | issue = 1 | pages = 21-2 | month =  | year = 1991 | doi =  | PMID = 2071276 }}</ref>
Image:
*[http://osteomyelitis.stanford.edu/pages/histo_001.html Chronic osteomyelitis (stanford.edu)].
===Sign out===
<pre>
LOWER LEG, RIGHT, BELOW KNEE AMPUTATION:
- ACUTE AND CHRONIC OSTEOMYELITIS.
- MODERATE ATHEROSCLEROSIS.
- SKIN ULCERATION.
- SOFT TISSUE SURGICAL MARGIN WITH FAT NECROSIS AND MUSCULAR ATROPHY.
- NEGATIVE FOR MALIGNANCY.
</pre>
<pre>
TRAPEZIUM, RIGHT HAND, REMOVAL:
- DEGENERATIVE JOINT DISEASE.
- MARROW SPACE WITH FIBROSIS AND SCATTERED LYMPHOCYTES AND PLASMA CELLS,
  COMPATIBLE WITH MILD CHRONIC OSTEOMYELITIS.
- NO MICROORGANISMS APPARENT WITH ROUTINE STAINS.
- NEGATIVE FOR MALIGNANCY.
</pre>


==Bone tumours==
=Bone tumours=
{{Main|Bone tumours}}
{{Main|Bone tumours}}
This is a big topic.  It is dealt with in a separate article.   
This is a big topic.  It is dealt with in a separate article.   
Line 64: Line 174:
The bone tumour article covers tumour mimics, e.g. brown cell tumour.
The bone tumour article covers tumour mimics, e.g. brown cell tumour.


==Fractures==
=Fractures=
{{Main|Forensic pathology}}
{{Main|Bone fractures}}
This is dealt with in the ''forensic pathology'' article.
This is dealt with in the ''forensic pathology'' article.


==See also==
=Others=
The following is a collection of stuff that doesn't really fit in another category or is just weird.
 
A general DDx for cystic bone lesions is found on ''radipedia.com''.<ref>URL: [http://radipedia.com/WikiMedia/index.php?title=Benign_cystic_bone_lesions http://radipedia.com/WikiMedia/index.php?title=Benign_cystic_bone_lesions]. Accessed on: 15 March 2011.</ref>
 
==Sequestrum==
{{Main|Sequestrum}}
 
==Osteoarthritis==
{{Main|Osteoarthritis}}
This keeps orthopaedic surgeons busy.
 
==Aneurysmal bone cyst==
{{Main|Aneurysmal bone cyst}}
 
==Myositis ossificans==
*[[AKA]] ''fibro-osseous pseudotumour of digits''.<ref name=Ref_WMSP607>{{Ref WMSP|607}}</ref>
 
===General===
Epidemiology:
*Young people.
*History of trauma - typically.
*Extremities - digits (fingers, toes).
 
Notes:
*Histologically "worrisome" (for malignancy) - due to high cellularity.<ref name=Ref_WMSP607>{{Ref WMSP|607}}</ref>
 
===Microscopic===
Features:<ref name=Ref_WMSP607>{{Ref WMSP|607}}</ref>
*High cellularity.
*Low mitotic activity.
*No atypical mitoses.
*No hyperchromasia.
 
Other features:<ref>IAV. 9 December 2010.</ref>
*Low power diagnosis:
**Lesion is well-circumscribed.
**Normal muscle is adjacent to the lesion - '''key feature'''.
 
DDx:
*[[Heterotopic ossification]] - bone, not cellular, no inflammation.
 
Images:
*[http://path.upmc.edu/cases/case72/micro.html Myositis ossificans (upmc.edu)].
 
==Paget disease of the bone==
{{Main|Paget's disease of the bone}}
 
==Fibrous dysplasia==
*[[AKA]] ''osteitis fibrosa''.
{{Main|Fibrous dysplasia}}
 
==Desmoplastic fibroma==
*'''Not''' to be confused with ''[[desmoplastic fibroblastoma]]''.
===General===
*Rare.
 
===Microscopic===
Features:<ref>URL: [http://www.bonetumor.org/tumors-fibrous-tissue/desmoplastic-fibroma http://www.bonetumor.org/tumors-fibrous-tissue/desmoplastic-fibroma]. Accessed on: 14 April 2011.</ref>
*Lamellar bone.
*Fibrotic marrow space with:
**Collagen.
**Low cellularity.
**Spindle cells without significant atypia.
 
DDx:
*[[Fibrous dysplasia]] - has woven bone.
*Low grade [[fibrosarcoma]].
 
==Gaucher disease==
{{Main|Gaucher disease}}
===General===
*May present as a fracture.
===Microscopic===
*Macrophages in the marrow space with a "crumpled tissue paper" appearance.
 
==Langerhans cell histiocytosis of bone==
*[[AKA]] ''eosinophilic granuloma of bone''.
{{Main|Langerhans cell histiocytosis}}
===General===
*Rare.
*Children.
===Microscopic===
Features:
*Eosinophils.
*Cerebriform and/or reniform macrophages.
 
==Giant cell reparative granuloma==
*[[AKA]] ''central [[giant cell]] granuloma'',<ref name=ijri>Shah UA, Shah AK, Kumar S. Giant cell reparative granuloma of the jaw: A case report. Indian J Radiol Imaging [serial online] 2006 [cited 2012 Feb 28];16:677-8. Available from: [http://www.ijri.org/text.asp?2006/16/4/677/32297 http://www.ijri.org/text.asp?2006/16/4/677/32297].</ref> abbreviated ''CGCG''.
*[[AKA]] ''solid [[aneurysmal bone cyst]]''.<ref name=pmid22285042>{{Cite journal  | last1 = Pan | first1 = Z. | last2 = Sanger | first2 = WG. | last3 = Bridge | first3 = JA. | last4 = Hunter | first4 = WJ. | last5 = Siegal | first5 = GP. | last6 = Wei | first6 = S. | title = A novel t(6;13)(q15;q34) translocation in a giant cell reparative granuloma (solid aneurysmal bone cyst). | journal = Hum Pathol | volume =  | issue =  | pages =  | month = Jan | year = 2012 | doi = 10.1016/j.humpath.2011.10.003 | PMID = 22285042 }}</ref>
===General===
*Lesion of the mandible and maxilla.<ref name=ijri/>
 
===Radiology===
*Lytic lesion.
 
===Microscopic===
Features:<ref name=ijri/>
*Giant cells.
*Fibroblasts.
*Osteoid.
*Hemosiderin-laden macrophages.
 
DDx:
*Peripheral giant cell granuloma - soft tissue counterpart of CGCG.
*[[Giant cell tumour of bone]].
 
====Images====
<gallery>
Image:Central_giant_cell_granuloma_-_intermed_mag.jpg | CGCG - intermed. mag. (WC/Nephron)
Image:Central_giant_cell_granuloma_-_high_mag.jpg | CGCG - high mag. (WC/Nephron)
</gallery>
===Molecular===
Recurrent [[chromosomal translocation]]:<ref name=pmid22285042/>
*t(16;17)(q22;p13).
 
==Osteopetrosis==
*[[AKA]] ''marble bone disease''.<ref name=pmid19232111>{{Cite journal  | last1 = Stark | first1 = Z. | last2 = Savarirayan | first2 = R. | title = Osteopetrosis. | journal = Orphanet J Rare Dis | volume = 4 | issue =  | pages = 5 | month =  | year = 2009 | doi = 10.1186/1750-1172-4-5 | PMID = 19232111 | PMC = 2654865 }}</ref>
===General===
*Rare.
*Genetic - may be autosomal dominant, autosomal recessive or X-linked.<ref name=pmid19232111/>
*Pancytopenias - due to oblieration of the marrow space.
*[[bone fractures|Fractures]].
*Radiologic diagnosis.
 
===Gross===
*Marbled appearance.
*Thickening with obliteration of the marrow space.
*Patchy (brown) surface due to vascularization/[[extramedullary hematopoiesis]].<ref name=Ref_AoGP469>{{Ref AoGP|469}}</ref>
 
Image:
*[http://www.uaz.edu.mx/histo/pathology/ed/ch_26/c26_s25.htm Osteopetrosis (uaz.edu.mx)].
 
===Microscopic===
Features:<ref name=pmid11264157/>
*Abundant irregular (pink) bony trabeculae with layers of (blue-gray) [[cartilage]].
 
Image:
*[http://bloodjournal.hematologylibrary.org/content/97/7/1947/F2.expansion.html Osteopetrosis (bloodjournal.hematologylibrary.org)].<ref name=pmid11264157>{{Cite journal  | last1 = McMahon | first1 = C. | last2 = Will | first2 = A. | last3 = Hu | first3 = P. | last4 = Shah | first4 = GN. | last5 = Sly | first5 = WS. | last6 = Smith | first6 = OP. | title = Bone marrow transplantation corrects osteopetrosis in the carbonic anhydrase II deficiency syndrome. | journal = Blood | volume = 97 | issue = 7 | pages = 1947-50 | month = Apr | year = 2001 | doi =  | PMID = 11264157 |URL = http://bloodjournal.hematologylibrary.org/content/97/7/1947.full }}</ref>
 
==Osteoporosis==
===General===
*Very common.
*Associated with [[bone fractures|fractures]], esp. wrist, [[traumatic hip fracture|hip]] & vertebra.<ref name=pmid22537071>{{Cite journal  | last1 = Lix | first1 = LM. | last2 = Azimaee | first2 = M. | last3 = Acan Osman | first3 = B. | last4 = Caetano | first4 = P. | last5 = Morin | first5 = S. | last6 = Metge | first6 = C. | last7 = Goltzman | first7 = D. | last8 = Kreiger | first8 = N. | last9 = Prior | first9 = J. | title = Osteoporosis-related fracture case definitions for population-based administrative data. | journal = BMC Public Health | volume = 12 | issue = 1 | pages = 301 | month = Apr | year = 2012 | doi = 10.1186/1471-2458-12-301 | PMID = 22537071 }}</ref>
*Radiologic diagnosis - bone mineral density.
 
Etiology:<ref name=Ref_PCPBoD8_617>{{Ref PCPBoD8|617}}</ref>
*Primary (senile).
*Secondary:
**Endocrine:
***Hyperparathyroidism.
**Gastrointestinal:
***Malabsorption, e.g. [[celiac disease]], [[cystic fibrosis]], [[Crohn's disease]].
***Starvation.
**Psychiatric:
***Anorexia nervosa.
***Bulimia nervosa.
**Neoplasia:
***[[Multiple myeloma]].
**Drugs:
***Systemic steroids.<ref name=pmid16243531>{{Cite journal  | last1 = Dalle Carbonare | first1 = L. | last2 = Bertoldo | first2 = F. | last3 = Valenti | first3 = MT. | last4 = Zenari | first4 = S. | last5 = Zanatta | first5 = M. | last6 = Sella | first6 = S. | last7 = Giannini | first7 = S. | last8 = Cascio | first8 = VL. | title = Histomorphometric analysis of glucocorticoid-induced osteoporosis. | journal = Micron | volume = 36 | issue = 7-8 | pages = 645-52 | month =  | year = 2005 | doi = 10.1016/j.micron.2005.07.009 | PMID = 16243531 }}</ref>
 
===Gross===
*Decreased numbers of, abnormally thin, bony spicules.
 
Images:
*[http://www.sciencephoto.com/media/260363/enlarge Osteoporosis (sciencephoto.com)].
*[http://library.med.utah.edu/WebPath/TUTORIAL/OSTEO/OST005.html Osteoporosis (utah.edu)].
 
===Microscopic===
Features (femoral neck):<ref name=pmid18708176>{{Cite journal  | last1 = Blain | first1 = H. | last2 = Chavassieux | first2 = P. | last3 = Portero-Muzy | first3 = N. | last4 = Bonnel | first4 = F. | last5 = Canovas | first5 = F. | last6 = Chammas | first6 = M. | last7 = Maury | first7 = P. | last8 = Delmas | first8 = PD. | title = Cortical and trabecular bone distribution in the femoral neck in osteoporosis and osteoarthritis. | journal = Bone | volume = 43 | issue = 5 | pages = 862-8 | month = Nov | year = 2008 | doi = 10.1016/j.bone.2008.07.236 | PMID = 18708176 }}</ref>
*Thinner cortex.
*Decreased trabecular thickness
*Decreased number of trabeculae.
 
Note:
*One study looking at iliac bone biopsies suggests trabeculae are no different in osteoporosis.<ref name=pmid3414359>{{Cite journal  | last1 = Chappard | first1 = D. | last2 = Alexandre | first2 = C. | last3 = Riffat | first3 = G. | title = Spatial distribution of trabeculae in iliac bone from 145 osteoporotic females. | journal = Acta Anat (Basel) | volume = 132 | issue = 2 | pages = 137-42 | month =  | year = 1988 | doi =  | PMID = 3414359 }}</ref>
 
=See also=
*[[Cartilage]].
*[[Chondro-osseous tumours]].
*[[Femoral head]].
*[[Spine]].
*[[Hematopathology]].
*[[Hematopathology]].
*[[Soft tissue lesions]].
*[[Soft tissue lesions]].
*[[Small round cell tumours]].
*[[Small round cell tumours]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Weird stuff]]
=External links=
*[http://www.medicalhistology.us/twiki/bin/view/Main/CartilageAndBoneAtlas08 Bone and cartilage histology (medicalhistology.us)].
 
[[Category:Bone]]
Mark
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