Cartilage

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Cartilage is a type of connective tissue that does not commonly come across the pathologist's desk.

It comes in three flavours:[1][2]

  1. Hyaline cartilage, e.g. trachea.
  2. Fibrocartilage, e.g. intervertebral disc.
  3. Elastic cartilage, e.g. epiglottis.

General

Features of cartilage:[3]

  • Avascular.
  • Extracellular matrix with bluish tinge.
  • Round cells.

Differential diagnosis

Cartilage - general for the site:[4]

Normal

Hyaline cartilage

Microscopic

Features:[5]

  • Chondrocytes within small pockets (lacunae) of extracellular matrix.
    • Chondrocytes:
      • Spherical nucleus.
      • Prominent nucleolus.
      • Clear cytoplasm.
    • Extracellular matrix:
      • Blue-white appearance on H&E stain -- key feature.

Image:

  • Hyaline cartilage - polarized. (WC)

Perichondrium

Microscopic

Features:

  • Around cartilage.
    • Increased cellular density.
    • Spindle cells with poorly defined cellular borders in an eosinophilic (fibrous) stroma.

Images:

Tumours

Main article: Chondro-osseous tumours

Tumours of cartilage are dealt with in the article chondro-osseous tumours together with bone tumours.

Specific diagnoses

Synovial chondromatosis

  • AKA synovial osteochondromatosis.

General

  • Benign.
    • Malignant transformation rare <5%.[7]
  • Classically location: knee.[7]
    • Hip next most common site.
  • Usually adults.
  • Prevalence: male > female.

Note:

  • This is a clinicoradiologic diagnosis.

Gross/radiology

  • Intraarticular calcifications.
  • Diffuse involvement of the joint.
  • +/-Loose bodies in the joint (AKA joint mice).

Image:

Microscopic

Features:[7]

  • Hyaline cartilage +/- lobular surface.
    • +/-Lacunae with binucleate cells.
    • +/-Nuclear atypia - moderate to severe.[8]
  • +/-Synovial hyperplasia - ribbon like tissue with an epithelium that has eosinophilic cytoplasm.
  • Bone.

DDx:

Images

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LOOSE BODIES, RIGHT ELBOW, REMOVAL:
- FRAGMENTS OF BONE WITH CARTILAGE AND SYNOVIAL TISSUE COMPATIBLE WITH LOOSE BODIES.

TISSUE, CAPSULE LEFT ELBOW, REMOVAL:
- DEGENERATIVE JOINT DISEASE.
- SYNOVIAL HYPERPLASIA WITHOUT SIGNIFICANT INFLAMMATION.
- ROUND BODIES CONSISTING OF BENIGN BONE WITH A FATTY MARROW, AND FIBROUS
  AND CARTILAGINOUS SURFACE, COMPATIBLE WITH LOOSE BODIES.
- NEGATIVE FOR MALIGNANCY.

LOOSE BODY, LEFT KNEE, REMOVAL:
- BENIGN BONE WITH FIBROTIC SYNOVIAL MEMBRANE, CONSISTENT WITH LOOSE BODY.

Micro

The sections show multiple fragments of tissue consisting of bone covered by hyaline cartilage and associated with synovial hyperplasia.

There is no appreciable nuclear atypia or mitotic activity.

See also

References

  1. ↑ Young, Barbara; Lowe, James S.; Stevens, Alan; Heath, John W.; Deakin, Philip J. (2000). Wheaters Functional Histology (4th ed.). Churchill Livingstone. pp. 173-5. ISBN 978-0004881973.
  2. ↑ URL: http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Cartilage/Cartil.htm. Accessed on: 2 January 2011.
  3. ↑ Cormack, David H. (2001). Essential Histology (2nd ed.). Lippincott Williams & Wilkins. pp. 178-9. ISBN 978-0781716680.
  4. ↑ Krenn, V.; Morawietz, L.; König, A.; Haeupl, T. (Nov 2006). "[Differential diagnosis of chronic synovitis].". Pathologe 27 (6): 402-8. doi:10.1007/s00292-006-0866-6. PMID 17031677.
  5. ↑ Cormack, David H. (2001). Essential Histology (2nd ed.). Lippincott Williams & Wilkins. pp. 178. ISBN 978-0781716680.
  6. ↑ URL: http://apbrwww5.apsu.edu/thompsonj/Anatomy%20&%20Physiology/2010/2010%20Exam%20Reviews/Exam%201%20Review/Ch04%20Mineralized%20Connective%20Tissues.htm. Accessed on: 19 September 2012.
  7. ↑ 7.0 7.1 7.2 Murphey, MD.; Vidal, JA.; Fanburg-Smith, JC.; Gajewski, DA.. "Imaging of synovial chondromatosis with radiologic-pathologic correlation.". Radiographics 27 (5): 1465-88. doi:10.1148/rg.275075116. PMID 17848703.
  8. ↑ URL: http://www.webpathology.com/image.asp?n=3&Case=369. Accessed on: 10 December 2012.
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