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Category Archives: Bone
Langerhans Cell Histiocytosis
Langerhans Cell Histiocytosis
Eosinophilic Granuloma
Clinical presentation:
- boys in flat or long bones in meta or diaphysis
Types of Langerhans Cell Histiocytosis:
- solitary or multiple bone lesion and other organs (skin, bone, liver, spleen)
Gross appearance:
- sharply circumscribed
Histology:
- Langerhans cells (polygonal cells with eosinophilic cytoplasm, oval nuclei with longitudinal grooves resembling coffee beans), eosinophils, giant cells, neutrophils, foam cells, lymphocytes, fibrosis, necrosis, mitoses
Posted in Bone
Tagged , Eosinophilic granuloma, Histiocytosis, Langerhan cells, Langerhans, Langerhans cell histiocytosis
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Solitary Bone Cyst
Solitary Bone Cyst
Also known as Unicameral bone cyst.
Clinical presentation:
- boys in upper humerus or femur
Gross appearance:
- straw, blood tinged fluid
Histology:
- fibroblasts, blood vessels, hemosiderin
Treatment:
- curretage and replacement with bone chips
Posted in Bone
Tagged , Bone cyst, cyst, Solitary bone cyst, Unicameral, Unicameral bone cyst
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Aneurysmal Bone Cyst
Aneurysmal Bone Cyst
Clinical presentation
- kids, metaphysis and epiphysis
Gross appearance
- lytic lesion with periosteal reaction
- cysts filled with blood, septae (contain fibroblasts, giant cells, blood vessels)
Differential diagnosis
- telangiectatic osteosarcoma, giant cell tumour of bone, giant cell reparative granuloma (if in jaw)
Chondromyxoid Fibroma
Chondromyxoid Fibroma
Clinical presentation
- young adult at metaphysis, long bones and small bones of the feet
Gross appearance
- small, cartilaginous
Histology
- low power → lobulated appearance due to hypocellular chondroid lacunae, myxoid (stellate shape with atypia) foci and adjacent cellular foci and giant cells at periphery, much atypia
Prognosis
- benign, but may have local recurrence
Osteochondroma
Osteochondroma
Clinical presentation
- exostoses, young males at metaphyses
Gross appearance
- sessile or pedunculated
Histology
- fibrous cap (continuous with perichondrium),
- cartilage (endochondral ossification at interface),
- bone
Can get secondary chondrosarcoma
Differential diagnosis
- secondary chondrosarcoma, parosteal osteosarcoma (spindle cells between trabeculae)
Chordoma
Chordoma
Location:
- sacral, coccygeal
- sphenooccipital
- cervical (chondroid chordoma)
Gross appearance
- myxoid-blue and hemorrhagic
Histology
- myxoid matrix with cords of small round cells with vacuolated cytoplasm, fibrous strands separating into tumour cells into lobules or cords
- physalipherous (bubbly) cells
Chordoma variants:
Chondroid chordoma → chondroid differentiation, better prognosis (cervical)
Dedifferentiated chordoma → differentiation into high grade spindle lesion
Posted in Bone
Tagged Chondroid chordoma, Chordoma, Chordoma variants, Dedifferentiated chordoma, Physalipherous, Sphenooccipital
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Multiple Myeloma
Multiple Myeloma
Plasmacytoma
Clinical presentation
- older patients, bone pain and fracture
▪ widespread skeletal lytic lesions
▪ hepatosplenomegaly
▪ hypercalcemia
▪ primary amyloidosis (AL type) and renal insufficiency due to toxicity of light chains Bence Jones proteins
Gross appearance
- lytic lesions in diaphysis of the skull and long bones
Histology
- plasma cell infiltrate withprominent nucleoli, perinuclear hof (Golgi)
- Russell bodies (cytoplasmic rods), Dutcher bodies (intranuclear rods)
Special studies:
serum: monoclonal IgG in serum (monoclonal spike in serum electrophoresis)
blood: peripheral smear→rouleaux formation
Immunohistochemistry
- CD138+, light chain restriction
Differential diagnosis
-chronic osteomyelitis (will see other inflammatory cells and vascularity)
“osteosclerotic myeloma” –> poeMs:
poeMs
polyneuropathy, organomegaly, endocrinopathy, monoclonal IgM gammopathy and skin lesions
Posted in Bone
Tagged , Bence jones, Bence-Jones protein, CD138, endocrinopathy, monoclonal IgM gammopathy, Multiple myeloma, organomegaly, Plasmacytoma, poeMs, polyneuropathy, skin lesions
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Giant Cell Reparative Granuloma
Giant Cell Reparative Granuloma
Clinical presentation
- Giant cell lesion primarily of jaw
Microscopy
- giant cells and small oval and spindly mononuclear cells, capillaries, hemorrhage, hemosiderin, reactive bone with osteoblastic rimming
Posted in Bone
Tagged , Giant cell granuloma, Giant cell reparative granuloma, granuloma, Reparative granuloma
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Brown Tumor of Hyperparathyroidism
Brown Tumor of Hyperparathyroidism
Clinical presentation
- forms in the setting of secondary hyperparathyroidism
1. parathyroid tumor causing hyperparathyroidism
2. chronic renal faiulre resulting in high levels of PO4 and low levels of Ca++
Location
- phalanges, spine, clavicle, skull
Gross appearance
- large lytic, brown (due to hemorrhage)
Microscopy
- giant cells with hemorrhage, hemosiderin, microfractures, ingrowth of vascularized fibrous tissue with fibroblastic stromal cells
Differential diagnosis
- giant cell tumor (more uniformly distributed giant cells, no interstitial hemorrhage, no fibroblastic stromal cells), giant cell reparative granuloma
Posted in Bone
Tagged , Brown tumor of hyperparathyroidism, Giant cell tumor, Hyperparathyroidism, Hyperparathyroidism Brown Tumor, Parathyroid tumor
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Malignant Giant Cell Tumors
Malignant Giant Cell Tumors
Clinical presentation
- benign giant cell tumor juxtaposed
Microscopy
- looks like MFH, osteosarcoma or chondrosarcoma
Posted in Bone
Tagged , Giant cell tumor, giant cells, Malignant giant cell tumors, Malignant giant cells
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