Transcript Musculoskeletal practical block

Musculoskeletal block
Pathology practical
Normal anatomy and histology
The overall structure of a long bone
Here is normal cancellous bone as seen under polarized light
microscopy, which highlights the lamellar structure. The
bony spicules are even, with occasional lacunae containing
osteocytes. Cellular marrow is seen between the spicules of
bone.
Gross pathology and
histopathology
Case no. 1
• A 22 years old male presented with localized
pain above his right knee joint with recurrent
fever. Later, he had a discharging sinuses from
the skin overlying the right knee.
What is the most likely diagnosis ?
This is chronic osteomyelitis. Note the fibrosis of the marrow
space accompanied by chronic inflammatory cells. There can be
bone destruction with remodelling. Osteomyelitis is very
difficult to treat.
Osteomyelitis
Case no. 2
• A 35 years old debilitated man presented to
the orthopedic clinic with back pain, low
grade fever, marked elevation of
sedimentation rate and recent kyphosis and
scoliosis .
• The patient has a history of coughing up
blood, fever, chills, night sweats, weight loss,
pallor, and often a tendency to fatigue very
easily.
Section of bone shows granuloma formation with epithelioid like cells , langhans-type
giant cells and rim of lymphocytes
2- Spinal TB - Potts Disease (Tuberculous
osteomyelitis)
Case no. 3
• A 40 years old woman complains of low grade
fever , malaise and stiffness in her joints each
morning .
Swollen and slightly
deformed interphalangeal
joints.
• Rheumatoid arthritis
affecting the head of
femur.
• The synovium becomes
edematous, thickened
and hyperplastic and
transforming its smooth
contour to one covered
by delicate and bulbous
fronds .
Section shows marked synovial hypertrophy with formation of villi
Section of
synovial tissue
showing
Hyperplastic
synovium which
is infiltrated by
dense chronic
inflammatory
cells including
many
lymphocytes and
plasma cells.
3- Rheumatoid arthritis
Case no. 4
• An obese 56 years old woman presented with
bilateral localized pain to her knees, hands
and difficulty in walking .
Progressive erosion of articular cartilage, eburnated articular surface ,
subchondral cyst and residual articular cartilage
Predisposing factors for osteoarthritis are marked obesity , previous
injuries to a joint , diabetes and deformed joint .
Mushroom-shaped osteophytes (bony outgrowths ) and splitting of
articular cartilage . There is absence of inflammation .
4- Osteoarthritis
Case no. 5
• A 16 years old male was found to have a small
swelling protruding from upper part of his leg
with local pain .
This is an osteochondroma of tibial bone. This lesion appears as a bony
projection (exostosis). Most are solitary, incidental lesions that may be excised if
they cause local pain.
There is a rare condition of multiple osteochondromatosis marked by bone
deformity and by a greater propensity for development of chondrosarcoma.
A bluish-white cartilagenous cap overlies the bony cortex.
These are probably not true neoplasms, but they are a mass lesion
that extends outward from the metaphyseal region of a long bone.
• The microscopic
appearance of an
osteochondroma displays
the benign cartilagenous
cap at the left upper and
the bony cortex at the
right lower.
• This bone growth, though
benign, can sometimes cause
problems of pain and
irritation that leads to
removal surgically.
• It is a benign tumor with very
rare incidence of malignant
transformation
Osteochondroma of bone.
5- Osteochondroma
(osteochondroma exostosis)
Case no. 6
• An 18 years old female presented to the
rheumatology clinic with 2 months history of
pain and swelling in her upper thigh with
weight loss .
Mass lesion involving
the upper end of the
tibial bone.
The mass show
pale, yellowish cut
surface with few
hemorrhagic areas.
Malignant osteoid, Malignant pleomorphic cells
showing abnormal mitoses
6-Osteosarcoma
Case no. 7
Case no. 7
• A 3 years old boy presented to
his pediatrician with complaint
of his parents from difficulty in
walking , poor balance , and
frequent falls . Laboratory
investigation shows elevated
creatine kinase . Muscle biopsy
show absence of dystrophin by
western blot analysis .
What is your provisional
diagnosis?
DMD showing variations in muscle fiber size , increased endomysial connective tissue ,
and regenerating fibers (blue hue) . Also there is fiber loss and adipose tissue infiltration
NORMAL
DMD
7-Duchenne muscular dystrophy
Case no.8
A 52-year-old woman presents with 6-month history of
progressive muscle weakness and a skin rash.
Physical examination is remarkable for a diffuse
purple/red discoloration of the skin over her cheeks,
nose, and eyelids. Examination confirms proximal
muscle weakness.
Laboratory findings show an increase in creatine
kinase (10 times the normal).
• The histologic
appearance of
muscle shows
perifascicular
atrophy of muscle
fibers and
inflammation .
• Patient usually have
positive antinuclear
antibody (ANA) and
increased creatine
kinase .
8-Dermatomyositis