Bone Joint, Soft Tissue - Pathology - Lecture Slides, Slides of Pathology

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BONE

JOINT

SOFT TISSUE

CELLS of BONE

• OSTEOPROGENITOR (“STEM”)  (TGFβ)
• OSTEOBLASTS (surface of spicule ), under control of calcitonin to take blood calcium and put it into bone.
• OSTEOCYTES (are osteoblasts which are now completely surrounded by bone)
• OSTEOCLASTS (macrophage lineage), under control of PTH to chew up the calcium of bone and put it into blood

ADJECTIVES of BONE

• Compact
  • Dense
  • Cortical
• Spongy
  • Cancellous
  • Membranous
  • Endosteal
  • Spicular

BONE DISEASES

• 1) MALFORMATIONS AND DISEASES CAUSED BY DEFECTS INTRANSCRIPTION FACTORS, polydactyly, syndactyly, absence of a bone NUCLEAR PROTEINS AND
• 2) DISEASES CAUSED BY DEFECTS INachondroplasia, thanatophoria HORMONES AND SIGNAL TRANSDUCTION MECHANISMS,
• 3) DISEASES ASSOCIATED WITH DEFECTS IN EXTRACELLULAR STRUCTURAL PROTEINS
  • Type 1 Collagen Diseases (Osteogenesis Imperfecta)
  • Types 2, 10, and 11 Collagen Diseases
• 4) DISEASES ASSOCIATED WITH DEFECTS INMACROMOLECULES FOLDING AND DEGRADATION OF
  • Mucopolysaccharidoses
• 5) DISEASES ASSOCIATED WITH DEFECTS INAND TRANSPORTERS) METABOLIC PATHWAYS (ENZYMES, ION CHANNELS,
  • Osteopetrosis
• 6) DISEASES ASSOCIATED WITH DECREASED BONE MASS
  • Osteoporosis
• 7) DISEASES CAUSED BY OSTEOCLAST DYSFUNCTION
  • Paget Disease (Osteitis Deformans)
• 8) DISEASES ASSOCIATED WITH ABNORMAL MINERAL (Ca++) HOMEOSTASIS
  • Ricketts and Osteomalacia
  • Hyperparathyroidism
  • Renal Osteodystrophy

2) DISEASES CAUSED BY DEFECTS IN

HORMONES AND SIGNAL TRANSDUCTION MECHANISMS

• Achondroplasia, dwarf (non-lethal)
• Thanatophoria, dwarf (lethal, FGF- mutations)
• a point mutation (usually Arg for Gly375) in the gene that codes for FGF receptor 3 (FGFR3), which is located on the short arm of chromosome 4. In the normal growth plate, activation of FGFR3 inhibits cartilage proliferation, hence the term “achondroplastic”;
• A MUTATION causes FGFR3 to be constantly activated.

3) DISEASES ASSOCIATED WITH DEFECTS IN

EXTRACELLULAR STRUCTURAL

PROTEINS

• OSTEOGENESIS IMPERFECTA TYPES

• (“Brittle” bone disease, too LITTLE bone), BLUE sclerae
• Mutations in genes which code for the alpha-1 and alpha-2 chains of COLLAGEN 1
• Mutations of COLLAGEN 2,10, 11 manifest themselves as CARTILAGE diseases, ranging from joint cartilage destruction to fatal sequelae

Categories of Generalized Osteoporosis Primary Postmenopausal (^) Idiopathic Senile Secondary Endocrine disorders (^) Rheumatologic disease Hyperparathyroidism (^) Drugs Hypo-hyperthyroidism (^) Anticoagulants Hypogonadism (^) Chemotherapy Pituitary tumors (^) Corticosteroids Diabetes, type 1 (^) Anticonvulsants Addison disease (^) Alcohol Neoplasia (^) Miscellaneous Multiple myeloma (^) Osteogenesis imperfecta Carcinomatosis (^) Immobilization Gastrointestinal (^) Pulmonary disease Malnutrition, Malbs., Hepatic Insuf., Vit C,D (^) Homocystinuria Anemia Docsity.com

7) DISEASES CAUSED BY OSTEOCLAST

DYSFUNCTION

Paget Disease (Osteitis Deformans)

• Matrix madness, Osteoblasts/-cytes gone wild
• THREE PHASES:
  • 1) Increased osteoclast resorption
  • 2) Increased “hectic” bone formation (osteoblasts)
  • 3) Osteosclerosis
• ELEVATED ALKALINE-PHOSPHATASE
• ELEVATED urine HYDROXYPROLINE

RENAL OSTEODYSTROPHY

• PHOSPHATE RETENTION

• HYPOPHOSPHATEMIA

• HYPOCALCEMIA

• INCREASED PTH

• INCREASED OSTEOCLASTS

• METABOLIC ACIDOSIS  release of HYDROXYAPATITES from matrix

FRACTURES, adjectives

• Complete, incomplete
• Closed, open (communicating)
• Communited (splintered, “greenstick”)
• Displaced (NON-aligned)
• PATHOGENIC, (non-traumatic, 2º to other disease, often metastases)
• “STRESS” fracture

OSTEONECROSIS

• Also called AVASCULAR necrosis
• Also called ASEPTIC necrosis
• CAUSE: ISCHEMIA
  • Trauma
  • Steroids
  • Thrombus/Embolism
  • Vessel injury, e.g., radiation
  • INCREASED intra-osseous pressure  vascular compression
  • Venous hypertension too

OSTEONECROSIS

Disorders Associated with Osteonecrosis

Idiopathic Pregnancy

Trauma Gaucher disease

Corticosteroid administration

Sickle cell and other anemias

Infection (^) Alcohol abuse

Dysbarism Chronic pancreatitis

Radiation therapy Tumors

Connective tissue disorders

Epiphyseal disorders Docsity.com

OSTEOMYELITIS

• COMPLICATIONS
  • Subperiosteal abscess
  • Draining sinus
  • Joint involvement
• SEQUESTRUM (dead bone)

vs.

• INVOLUCRUM (new bone)

OSTEOMYELITIS

• Tuberculous
  • Usually blood borne
  • TB of spine is known as POTTS disease
• Syphilis
  • CONGENITAL
  • TERTIARY, “SABRE” shins