OSTEOGENESIS IMPERFECTA
Type 1 collagen Blue sclera Hearing loss: ossicles Dentin
OSTEOPETROSISMarble bone diseaseAlbers – Schonberg
Skeletal sclerosis Impaired osteoclast
function
Tx: BMT
Deficient osteoclast activityAbsence of medullary cavity
Erlenmeyer flask deformityBulbous ends of long bones
OSTEOPOROSIS
Porous bonesReduced bone mass
Fracture
PostmenopausalThin perforated trabecular plates
with loss of interconnections
SenileThinned cortex
Subperiosteal endosteal resorptionWidened Haversian systems
PAGET DISEASE
Osteolytic phase
mixed osteoclastic – osteoblastic stage
quiescent osteosclerotic stage
Osteitis deformans
Leontiasis ossea platybasia Chalkstick – type fracturesOsteosarcoma high – output CHF
PAGET DISEASE Osteitis deformans
MosaicJigsaw puzzle
irregular lamellae and cement lines Prominent osteoclast
Osteoblast
thicker weaker Irregular cement lines
PTH detected by osteoblasts osteoclastic activity
Osteitis fibrosa cysticVon Recklinghausen disease of bone area of reactive fbrous
tissue proliferation w admixed multinucleated giant cells
Brown tumor
HYPERPARATHYROIDISM
Dissecting osteitisRailroad track appearance of cancellous bone
Thinned cortices Subperiosteal periosteum
OSTEONECROSIS
Disruption of microcirculationInfarct
Avascular necrosis
Femur scaphoid digits
Legg – Calve – Perthes disease
Empty lacunar surr by necrotic adipocytesCreeping substitution: necrotic trabeculae as scaffolding for deposition of new bone
Absent osteocyte nuclei
PYOGENIC OSTEOMYELITIS
Bacteria hematogenous spreadS. Aureus
Salmonella sickle cellH. influenza, GB S neonates
E. coli, Pseudomonas, Klebsiella UTI, drug users
Subperiosteal abscess w draining sinusSequestrum: deadInvolucrum: newBrodie abscess: small intraosseous abscess
Inflammatory cells
fibrosis
Osteoblastoma > 2 cm
Metaphysis long bonescortex
10 – 30 y.o.
<2 cm
Oval masses of hemorrhagic gritty tan tissueHaphazardly interconnecting woven boneNidus formation: irreg reactive new woven bone formation
OSTEOID OSTEOMA
OSTEOSARCOMA
Metaphysis long bonescortex
10 – 25 y.o.
MC primary malignant bone tumor
50% knee, distal femur, prox tibia
Cystic degenerationLace – like patternSunburst pattern
Codman triangle: periosteum liftedCodman triangle
OSTEOSARCOMA
Metaphysis long bonescortex
10 – 25 y.o.
MC primary malignant bone tumor
50% knee, distal femur, prox tibia
Cystic degenerationLace – like patternSunburst pattern
Neoplastic pleomorphic cells makes pink osteoid
Osteoid production by a sarcoma is diagnostic of osteosarcomaOsteoid matrix vaguely resembles primitive woven bone
Metaphysis long bonescortex
10 – 30 y.o.
Benign bluish-white cartilaginous cap
overlying a bony cortex
Benign hyaline cartilage cap covered peripherally by perichondrium
OSTEOCHONDROMA
Exostosis: bony stalk
well-circumscribed nodules of hyaline cartilage containing cytomorphologically benign chondrocytes
Small bones of hand and feet30 – 50 y.o.
enchondroma chondrosarcoma
ENCHONDROMATOSIS, OLLIER DISEASE, MAFUCCI DISEASE: multiple endochondroma
CHONDROMA / ENCHONDROMA
Epiphysis of long bone10 – 20 y.o.
Chicken wire mineralization: dystrophic calcification of the cell membrane
Sheets of compact polyhedral chondrocytes
CHONDROBLASTOMA
2nd mc malignant bone tumor
CHONDROSARCOMA
salt and pepper popcorn
white to bluish-white cartilaginous tumor tissue eroding bone and extending outward from the residual bone
Extends from medulla through cortex into soft tissuesChondrocytes with increased cellularity and atypiaAnaplastic chondrocytesMalignant hyaline & myxoid cartilage
Pelvis, shoulder, axial, ribs40 – 50 y.o.
EWS gene chr 22
Diaphysis of long bone10 – 20 y.o.
Sheets of uniform small round cells
Onion skin appearance
EWING SARCOMA
Homer – Wright rosettes:Tumor cells arranged around a central fibrillary space
Can also be found in neuroblastoma
Localized developmental arrest of bone components
Shepperd’s crook
Chinese – character lookingCurvilinear trabeculae
FIBROUS DYSPLASIAMcCune – Albright
syndrome
Polyostotic fibrous dysplasia
Café – au – lait spots
Endocrinopathies (e.g. Cushing, precocious puberty)
Fibroblast between trabeculaeNo osteoblastic trimming
Expansile, lytic
Epiphysis of long bone20 – 40 y.o.
RANK/RANKL signaling pathway
GIANT – CELL TUMOROSTEOCLASTOMA
Multinucleated osteoclast type – giant cells with background of mononuclear stromal cells
done
….Created by Bryan Atas MD (WVSU 2015)Using texts and pictures from Robbins, Rubins, Netter, Topnotch materials
…
better faster stronger
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