Ap 50 11-12 1 orthopedic pathology

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  • 5 phases:Phase 1= osteoclastic resorption; phase 2=mononuclear resorption; phase 3=preosteoblastic and differentiation into osteoblasts; phase 4=osteoblastic matrix formation; phase 5= mineralization; phase 6= end product of remodeling in cancellous bone
  • Ap 50 11-12 1 orthopedic pathology

    1. 1. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    2. 2. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Orthopaedic Pathology Bone, cartilage Soft tissue nearby Synoviu mTendon Bursa Fibrous tissueMuscle
    3. 3. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    4. 4. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    5. 5. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Fig. 28 A synovial joint, on section.
    6. 6. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Rigid endoskeleton - Supports the body - Protects viceral organ - Provides attachments for muscles Metabolism of calcium and other minerals Contains hematopoietic marrow Function of Bone
    7. 7. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Fig. 2.1 Embryonic development of a long bone during the first six months
    8. 8. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    9. 9. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    10. 10. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    11. 11. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    12. 12. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    13. 13. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    14. 14. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    15. 15. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Normal Rickets
    16. 16. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    17. 17. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    18. 18. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    19. 19. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    20. 20. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    21. 21. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    22. 22. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Bone marrow hematopoieti c lineage Bone marrow stromal cell lineage BONEBONE
    23. 23. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Bone marrow hematopoietic lineage CFM-GM ( colony forming unit granulocyte-macrophage ) monobl ast promonocy te mon ocyte Tissue macropha ge osteoclast
    24. 24. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Bone marrow stromal cell lineage ( mesenchymalstem cell )CFU-F(Colony forming unit fibroblast) Stromal osteoblast precursor cell Transitory osteoblast Secretory osteoblast Osteoblast ( bone lining cell )
    25. 25. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. ( Receptor activator for nuclear factor Kappa B) ( Rank ligands ) Osteobl ast- osteocla st interacti on
    26. 26. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    27. 27. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    28. 28. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    29. 29. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    30. 30. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Osteoblasts •Secrete interleukin-6 & 11 •Tissue growth factor β •Activated by parathyroid hormone; 1,25 vitamin D, interleukin 1, TNF
    31. 31. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Parathyroid hormone -collagen type 1 -Fibronectin -Alkaline phosphatase -Osteocalcin -sialoprotein Osteoblast Estrogen interleukin 6
    32. 32. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    33. 33. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    34. 34. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    35. 35. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Osteoclast • Calcitonin-receptor • Vitronectin receptor • Tartrate-resistant acid phosphatase • Cytoplasmic carbonic anhydrase • Osteopontin
    36. 36. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Osteoclast calcitonin Integrins cadherins N-cam Vitronectin Cytoplasmic carbonic anhydrase calcitonin Integrins calcitonin Integrins calcitonin Integrins cadherins N-cam Vitronectin calcitonin Integrins cadherins N-cam Vitronectin calcitonin IntegrinsIntegrins calcitonin Tartrate resistant acid phosphatase selectin osteopontin
    37. 37. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    38. 38. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Histology of Synovium •Intimal layer: A thin layer of synovial cells or synoviocytes •Subintimal layer: arterioles, fat and other connective tissue cells such as fibroblasts,
    39. 39. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    40. 40. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    41. 41. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    42. 42. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Congenital anomalies Developmental abnormalities: complex, variable, genetic based and manifest during
    43. 43. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Developmenta l anomalies1) Defect in nuclear proteins and transcription factor ( dysostosis) 2) Mutations in the hormone and signal transduction ( dysplasia ) 3) Defect in extracellular structural proteins
    44. 44. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    45. 45. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    46. 46. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    47. 47. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    48. 48. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    49. 49. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. OSTEOGENESIS IMPERFECTA A group of distinct clinical syndromes with various modes of inheritance and having in common an increased propensity to fracture.
    50. 50. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    51. 51. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Osteogenesis ImperfectaAbnormal secretion type I collagen Decreased synthesis type I collagen Decreased Deletion 1(I) gene Matrix
    52. 52. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    53. 53. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    54. 54. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    55. 55. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    56. 56. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    57. 57. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    58. 58. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Ehlers-Danlos syndrome
    59. 59. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Direct inoculations following compound fracture Osteomyelitis : caused by Hematogenous spreading (staphylococcus aureus, Salmonella)
    60. 60. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    61. 61. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. OsteomyelitisOsteomyelitis Involu crum: New bone formation i n periosteu m Seques trum: Dead bone
    62. 62. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    63. 63. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    64. 64. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    65. 65. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    66. 66. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    67. 67. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    68. 68. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    69. 69. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    70. 70. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Figure 231. Tuberculous osteomyelitis.Figure 231. Tuberculous osteomyelitis. A sagittal section of a portion of the vertebral column. Two vertebrae are involved an d have collapsed, causing kyphotic angulation w ith compression of the spinal cord.
    71. 71. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Spinal tuberculosis (Pott’s disease) Psoas abscess Disc destruction Vertebral collapse Paraplegia
    72. 72. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    73. 73. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    74. 74. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    75. 75. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Commonly affects the spine Spreads usually from pulmonary disease via blood stream Tuberculosis
    76. 76. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    77. 77. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. A B Figure 244. Congenital syphilis. A, There are radiolucent defects adjacent to the zones of provisional calcification and periosteal new bone around the diaphysis. The defect in the proximal tibia is symmetrical (Wimberger’s sign). B, Reexamination of the forearm three weeks later reveals evidence of healing of the metaphyseal lesions.
    78. 78. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    79. 79. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    80. 80. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Simple fracture Impacted fracture Comminuted fracture Stress fracture Greenstick fracture Trauma to normal bone
    81. 81. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Osteoporosis Osteomalacia Hyperparathyroidism Paget’s disease Osteogennesis imperfecta Tumors Pathological fracture
    82. 82. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    83. 83. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    84. 84. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Hema toma
    85. 85. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Granulation tissue
    86. 86. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Callus-formation Osseous callus Osteo- cartilaginous callus
    87. 87. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Sequence of bone healing in fracture •Hematom a •Granulatio n tissue •Callus
    88. 88. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Complication of fracture Delayed union Non- union pseudarthr osis Malunion
    89. 89. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    90. 90. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Avascular necrosis •Synonym: Aseptic necrosisosteonecr osis
    91. 91. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Cause of osteonecrosis • Idiopathic • Post fracture • Fat embolism • Legg-Calves Perthes disease • Steroid induce • Alcohol
    92. 92. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    93. 93. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    94. 94. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Legg-Calves Perthes
    95. 95. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    96. 96. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Rheumatoid arthritis • Self-perpetuating , inflammatory joint disease • Initially characterized by swelling in several joints and stiffness • Roentgenographically show a chronic inflammatory destruction of the joint • Laboratory findings: Rheumatoid factor, ESR
    97. 97. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    98. 98. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Terminology in Rheumatoid arthritis •Pannus: inflammed synovium attaching on articular cartilage
    99. 99. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Rheumatoid nodule
    100. 100. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. PATHOLOGY OF SYNOVIUM in rheumatoid arthritis
    101. 101. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Proposed mechanism for rheumatoid diseases Robbins and Cotran ( 7th . Ed) p. 137
    102. 102. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Inflammatory joint diseases Seropositive: 1) Rheumatoid arthritis 2) Juvenile rheumatoid arthritis Seronegative: 1) Ankylosing spondylitis 2) Psoriasis 3) Reactive arthritis ( Reiter’s syndrome )
    103. 103. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    104. 104. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Bone tumors• Primary bone tumors • Metastatic bone tumors
    105. 105. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    106. 106. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Histologic typing of bone tumorBone-forming tumorsCartilage forming tumorsGiant cell tumorsBone marrow tum ors
    107. 107. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Bone forming tumors •Benign : OSTEOMA • Malignant: OSTEOSARCOMA
    108. 108. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Cartilage-forming tumors • Benign : OSTEOCHONDROMA, ENCHONDROMA, CHONDROBLASTOMA, CHONDROMYXOID FIBROMA • Malignant : CHONDROSARCOMA
    109. 109. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Bone marrow- forming tumors • Ewing’s sarcoma
    110. 110. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    111. 111. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    112. 112. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    113. 113. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    114. 114. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    115. 115. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    116. 116. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    117. 117. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    118. 118. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    119. 119. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    120. 120. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    121. 121. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    122. 122. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Chicken-wire calcification
    123. 123. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    124. 124. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    125. 125. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    126. 126. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    127. 127. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    128. 128. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    129. 129. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    130. 130. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    131. 131. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    132. 132. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    133. 133. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Periosteal reaction
    134. 134. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Eosinophilic granuloma ( Langerhans cell granulomatosis, Langerhans cell histiocytosis )
    135. 135. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    136. 136. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    137. 137. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    138. 138. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    139. 139. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    140. 140. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    141. 141. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    142. 142. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    143. 143. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    144. 144. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Bone- remodeling unit
    145. 145. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    146. 146. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    147. 147. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    148. 148. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Metabolic bone diseases - Matrix - Mineralization - Deposition of waste product formation resorption
    149. 149. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Matrix formation defect - Osteogenesis imperfecta - Paget’s disease - Mucopolysaccharidosis
    150. 150. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Matrix resorption defect Hyperparath yroidism Osteopetrosi s
    151. 151. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    152. 152. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Osteitis fibrosa cystica
    153. 153. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    154. 154. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Osteomalacia Looser’s zone (pseudofractu re )Milk-man’s fracture
    155. 155. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    156. 156. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    157. 157. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    158. 158. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Rachitic rosaries
    159. 159. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Rickets Irregularity of growth plate Genu varusIrregularity of growth plate
    160. 160. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    161. 161. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    162. 162. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    163. 163. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    164. 164. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
    165. 165. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Table 1. Comparison of two types of involutional osteoporosis. From Riggs and Melton(1986)with permission. Type IType I Type IIType II Age (years) 51-75 > 70 Sex ratio (female : male) 6:1 2:1 Type of bone loss Mainly cancellous Cancellous and compact Rate of bone loss Accelerated Not accelerated Fracture site Vertebrae (crush) and Vertebrae (wedge) distal radius and hip Parathyroid function Decreased Increased Calcium absorption Decreased Decreased Metabolism of 25-OH-D to Secondary decrease Primary decrease 1.25(OH)2D Main causes Factors related to Factors related to menopause ageing 25-OH-D = 25-hydroxyvitamin D ; 1.25(OH)2D = dihydroxyvitamin D.
    166. 166. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. PATHOGENESIS OF OSTEOPOROSISPATHOGENESIS OF OSTEOPOROSIS ModelModel Figure 4. Conceptual model of the pathogenesis of fractures relate to osteoporosis. Modified from Riggs (1988).
    167. 167. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Deposition of waste product - Pseudo - gout - Gout - Oxalosis - Ochronosis
    168. 168. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. Gouty
    169. 169. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. PseudPseudCalcium pyrophosphate crystal
    170. 170. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. OchroOchro
    171. 171. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital….. ochro nosis

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