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Musculoskeletal block Pathology practical . Normal anatomy and histology. The overall structure of a long bone. Gross pathology and histopathology. Case no. 1.
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A 22 years old male presented with localized pain above his right knee joint with recurrentمتكرر-معاود fever. Later, he had a discharging sinuses from the skin overlying the right knee. What is the most likely diagnosis ?
A 35 years old debilitated man presented to the orthopedic clinic with back pain, low grade fever, marked elevation of sedimentationترسب rate and recent kyphosisتحدب فقرات الظهر and scoliosisتقوس او اعوجاج لفقرات الظهر . • The patient has a history of coughing up blood, fever, chills, night sweats, weight loss, pallorشحوب الوجه, and often a tendency to fatigue very easily.
Fracture necrosis
rim of lymphocytes granuloma Including inside : epithelioid like cells langhans-type giant cells Section of bone shows granuloma formation with epithelioid like cells , langhans-type giant cells and rim of lymphocytes
A 40 years old woman complains of low grade fever , malaiseتوعك-فتور and stiffness in her joints each morning . • Key information : • Usually with women • Affecting wrist & hand region • There will be malaise (not feeling well )
Swollen and slightly deformed interphalangeal joints. Swelling in small joints
The normal head will be shiny in appearance which is it not here Rheumatoid arthritis affecting the head of femur. The synovium becomes edematous, thickened and hyperplastic and transforming its smooth contourشكل متعرج to one covered by delicate and bulbousمنتفخ fronds ورق leaf-like.
There are finger-like projections Section shows marked synovial hypertrophy with formation of villi (plural of villus : small vascular process-small projection)
Section of synovial tissue showing Hyperplastic synovium which is infiltrated by dense chronic inflammatory cells including many lymphocytes and plasma cells.
An obese 56 years old woman presented with bilateral ذو جانبينlocalized pain to her knees, hands and difficulty in walking .
Progressive erosionتآكل of articular cartilage, eburnated (hardening of the bone) articular surface , subchondral cyst and residualمتبقي-مرسب articular cartilage Predisposing factors الاسباب المهيئةfor osteoarthritis are marked obesity , previous injuries to a joint , diabetes and deformed joint .
Mushroom-shaped osteophytes (bony outgrowths ) and splittingشق-شطر of articular cartilage . There is absence of inflammation .
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.
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
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 . Wight loss -> malignant
Mass lesion involving the upper end of the tibial bone. The mass show pale(grayish white mass), yellowish cut surface with few hemorrhagic areas(red).
Malignant osteoid, Malignant pleomorphic cells showing abnormal mitoses
The etiology : Paget’sdisease , Radiation, fibrousdysplasia
