Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Ap 50 11-12 1 orthopedic pathology

1,085 views

Published on

Published in: Health & Medicine, Education
  • Be the first to comment

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

×