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Bone Pathology I Non-Neoplastic Lesions of Bones and Joints

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Metabolic Bone Diseases Osteoporosis Osteomalacia and Rickets Hyperparathyroidism Osteoporosis Metabolic disease characterized by diffuse skeletal lesions due to a ... – PowerPoint PPT presentation

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Title: Bone Pathology I Non-Neoplastic Lesions of Bones and Joints


1
Bone Pathology I Non-Neoplastic Lesions of Bones
and Joints
  • Richard Anderson, MD
  • President, Associated Pathology Consultants, S.C.
  • Edward Hospital Elmhurst Memorial Hospital
  • Clinical Instructor, Department of Pathology, UIC
    College of Medicine
  • Chairman of the Board, Heartland Blood Centers

UIC M2 Pathology - 2004
2
Metabolic Bone Diseases
  • Osteoporosis
  • Osteomalacia and Rickets
  • Hyperparathyroidism

3
Osteoporosis
  • Metabolic disease characterized by diffuse
    skeletal lesions due to a decreased mass of
    normally mineralized bone
  • Post-menopausal females
  • Increased bone resorption (osteoblastic activity
    is normal)
  • Estrogen may lead to increased secretion of IL-1,
    IL-6, TNF and MCSF by stromal cells which will
    stimulate osteoclasts

4
Osteoporosis
  • Primary osteoporosis
  • Some genetic basis
  • Dependent upon levels of Ca and vitamin D
  • Exercise
  • Secondary osteoporosis
  • Corticosteroid excess (endogenous or exogenous)
  • Hyperthyroidism
  • Hypogonadism
  • Multiple myeloma
  • PTH-secreting tumors
  • Malabsorption
  • Alcoholism

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Osteomalacia and Rickets
  • Accumulation of unmineralized bone matrix
    resulting from a diminished rate of
    mineralization
  • Causes
  • Dietary deficiency in vitamin D
  • Defective bone mineralization
  • Congenital or acquired defects in vitamin D or
    phosphate metabolism
  • Malabsorption (most common cause in US)
  • Crohns disease
  • Celiac disease
  • Cholestatic liver disease
  • Biliary obstruction
  • Chronic pancreatitis

8
Hyperparathyroidism
  • Increased bone resorption secondary to increased
    PTH
  • Classic pathologic change referred to as osteitis
    fibrosa cystica
  • Replacement of marrow by fibrous tissue
  • Numerous microfractures
  • Hemosiderin-laden macrophages
  • Eventually cystic degeneration and classic gross
    appearance referred to as brown tumor

9
Pagets Disease of Bone
  • Initial osteoclastic activity due to defective
    remodeling followed by disorganized hyperplastic
    bone formation
  • Etiology uncertain (viral infection?)
  • M gt F
  • Most patients gt 55 years
  • Most commonly involves lumbosacral spine, pelvis
    and skull very rare in ribs
  • Usually polyostotic
  • Pain

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Complications of Pagets Disease
  • Fractures
  • Degenerative arthritis
  • Bone tumors (osteosarcoma, fibrosarcoma,
    chondrosarcoma and GCT)
  • High-output cardiac failure

15
Osteogenesis Imperfecta
  • Group of autosomal dominant disorders of
    connective tissue caused by mutations in the gene
    for type 1 collagen
  • Patients suffer from repeated fractures
  • Blue sclera (except in subtype IV)

16
Bone Fractures
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Bone Fractures
Organization with neovascularization (2-3 days)
Hematoma
Pluripotential mesenchymal cells give rise to
osteoblasts to synthesize woven bone
Intramembranous bone growth (7 days)
Endochondral ossification
Remodeling (months)
Lamellar bone
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Osteopetrosis (marble bone disease,
Albers-Schönberg disease)
  • Inherited lysosomal defect
  • Most severe form (autosomal recessive) is severe
    and often lethal
  • Death secondary to anemia, cranial nerve
    entrapment, hydrocephalus and infection
  • Dense bones weighing 2-3 times normal
  • TX with BMTx and IFN-?

21
Osteomyelitis
  • Bacterial infection of bone
  • Coagulase-positive Staph (70-90 of cases)
  • Klebsiella
  • Pseudomonas (tennis shoe osteo)
  • Neisseria
  • Salmonella (SCD)
  • TB
  • Local, exogenous or hematogenous infection
  • Dead bone (sequestrum) is surrounded by new
    bone formation (involucrum)
  • Chronic osteomyelitis often requires surgery

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Fibrous Dysplasia
  • Non-neoplastic condition
  • Monostotic variety
  • Older children and young adults
  • May involve rib, femur, tibia and skull
  • Polyostotic variety
  • Unilateral distribution associated with endocrine
    dysfunction, precocious puberty in females and
    areas of cutaneous hyperpigmentation
    (McCune-Albright syndrome)

25
Misshapen bony trabeculae interspersed with
fibrous tissue
26
Woven bone NEVER is transformed to lamellar bone
27
Fibrous Dysplasia
  • May be complicated by malignancy
  • Osteosarcoma, chondrosarcoma and MFH
  • Treat with surgical curettage and repair of
    fractures

28
Pathology of Joints and Synovial Membranes
  • Osteoarthritis
  • Rheumatoid arthritis
  • Spondyloarthropathies
  • Gout
  • Pseudogout

29
Osteoarthritis
  • Most common form of joint disease
  • Slowly progressive
  • Elderly or status post trauma
  • Cartilage attrition may be due to IL-1

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Rheumatoid Arthritis
  • Chronic systemic disease of unknown etiology
  • Joints of hands and feet nearly always involved
    may involve elbows, knees, ankles, hips, spine
    and TMJ
  • F gt M (31)
  • 4th to 6th decade
  • Prevalence 0.5 1
  • Strongly associated with HLA-DR4 and several
    non-MHC genes

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Rheumatoid Arthritis
  • Rheumatoid Factor
  • Positive in 70-80 of patients with classic RA
  • Autoantibodies of IgM, IgG or IgA class that
    react with Fc region of IgG
  • Not specific for RA
  • Circulating complexes bind complement
  • Synovial hyperplasia driven by IL-1

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Rheumatoid nodules are present in 25 of patients
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Spondyloarthropathies
  • Ankylosing spondylitis
  • Vertebral column and sacro-iliac joints
  • Reiter syndrome
  • Post-venereal
  • Urethritis, conjunctivitis and seronegative
    polyarthritis
  • HLA-B27

46
Gout
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