Femoral head

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Femoral head. (WC)

The femoral head is a common ditzel in surgical pathology at centres which have orthopaedic surgeons.

Many of these can be "gross only".

Gross

Features to comment on:[1]

  • Laterality (on requisition).
  • Dimensions of head and neck.
  • Shape of head (round? deformed?).
  • Resection margin (irregular?).
  • Cartilage (thinning/eburnation? separation from the cartilage).
  • Bone (subchondral cysts? subchondral sclerosis?).
  • Presence of soft tissue.
  • Other (osteophytes? pannus?).

Notes:

  • Some advocate the use of cardboard when cutting[2] -- weird.

Criteria for gross only

Must be fulfilled:

More stringent - in addition to the above:

  • No history of cancer.

Diagnoses to consider

Specific diagnoses

Avascular necrosis of the femoral head

  • AKA avascular necrosis, abbreviated AVN.

Osteoarthritis

See Osteoarthritis.

Infection

See Osteomyelitis.

Rheumatoid arthritis

Fracture of bone due to metastatic carcinoma

Pathologic fracture redirects here, as the underlying cause is usually a carcinoma.

General

  • Uncommon ~ 10 of 90 suspected cases.[3]
    • Usually in patients with a known malignancy and bony metastases.
  • Should not be missed.
  • Classically in older individuals.

Gross

Features:

  • Irregular resection margin.†
  • Focal, irregular, tan-white discolouration at the fracture site, i.e. margin, and in the marrow space.

Note:

  • † Non-fracture resections have a flat resection margin, as they were cut by the surgeon.

Image:

Microscopic

Features:

DDx:

Sign out

FEMORAL HEAD, LEFT, HIP ARTHROPLASTY: 
- METASTATIC SMALL CELL CARCINOMA.

Non-pathologic fracture of the femoral neck

Hip fracture, traumatic hip fracture and traumatic fracture of the femoral neck redirect here.

General

Gross

  • Irregular/jagged femoral neck margin - important.
  • Hemorrhage.

Microscopic

Features:

  • Non-vital bone.
    • Loss of osteocytes.

DDx:

Commonly concurrent pathologies:

Sign out

FEMORAL HEAD AND SURROUNDING TISSUE, RIGHT, HIP ARTHROPLASTY:
- BONE WITH CHANGES CONSISTENT WITH FRACTURE.
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE.
- NEGATIVE FOR MALIGNANCY.
FEMORAL HEAD AND SURROUNDING TISSUE, LEFT, HIP ARTHROPLASTY:
- NON-VITAL BONE CONSISTENT WITH FRACTURE.
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE.
- NEGATIVE FOR MALIGNANCY.

With degenerative joint disease

FEMORAL HEAD AND SURROUNDING TISSUE, RIGHT, HIP ARTHROPLASTY:
- BONE WITH CHANGES CONSISTENT WITH FRACTURE.
- DEGENERATIVE JOINT DISEASE.
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE.
- NEGATIVE FOR MALIGNANCY.

See also

References

  1. Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 225. ISBN 978-0443066450.
  2. Dimenstein, IB. (Jun 2008). "Bone grossing techniques: helpful hints and procedures.". Ann Diagn Pathol 12 (3): 191-8. doi:10.1016/j.anndiagpath.2007.06.004. PMID 18486895.
  3. Ramisetty, NM.; Pynsent, PB.; Abudu, A. (May 2005). "Fracture of the femoral neck, the risk of serious underlying pathology.". Injury 36 (5): 622-6. doi:10.1016/j.injury.2004.08.034. PMID 15826621.
  4. URL: http://www.path.utah.edu/casepath/ms%20cases/ms%20case%205%20comp/case%205.htm. Accessed on: 11 October 2012.
  5. Blain, H.; Chavassieux, P.; Portero-Muzy, N.; Bonnel, F.; Canovas, F.; Chammas, M.; Maury, P.; Delmas, PD. (Nov 2008). "Cortical and trabecular bone distribution in the femoral neck in osteoporosis and osteoarthritis.". Bone 43 (5): 862-8. doi:10.1016/j.bone.2008.07.236. PMID 18708176.