Pathology

1. Pathology Locomotor system 1 - bone

2. Achondroplasia • See the short and disproportionately thick bones

3. OsteogenesisImperfecta- See the very large numbers of rib fractures (arrows). The infant died very shortly after birth.

4. This shows severe Paget’s disease ofbone from a 77 year old female.

5. Histology in a late stage of the disease.The trabeculae of the cancellous bone aremarkedly thickened. This picture is describedas a mosaic pattern, with haphazardly arrangedcement lines which link haphazardly arrangedunits of lamellar (cancellous) bone. Here, theosteoblastic and osteoclastic activity hassubsided. Arrows indicate the reversal lines.

6. An example of an acute fractureofthe femur in a child, with displacement,shortening and a large haematoma. Fracture ofa femur results in a great loss of blood andmay cause death if not treated quickly

7. This shows healing fractures oftibia and fibula. See the early resorption ofhaematomas and callus formation

8. This is an example of an osteoidesteoma of the finger. See the sclerotic centralnidus (arrow)

9. On histology, this is a low power viewfrom the centre of the osteoidosteoma. Thereare randomly interconnecting trabeculae ofwoven bone and these are predominantlyrimmed by osteoblasts (arrows). Thecytological features are entirely benign

10. This shows a cartilage—cappedexostosis (arrow), also called anosteochondroma, which is arising from theupper humerus from a man aged 21(AKA mushroomy thing)

11. This is an example ofenchondromatosis or Olliers disease in a boy,15 years old, with multiple enchondromas(arrows) present

12. This is a benign chondroblastoma(arrows) in the head of the humerus of a maleaged 16. He presented with pain in theshoulder and the tumour was curettedfollowing biopsy diagnosis. It recurred and thehead of the humerus was then excised

13. The giant cell tumour (arrows)occurred in the tibia in a man aged 29 years.He had noticed a slowly growing lump for 11months and there had been a dull ache in theregion made worse by walking. X-ray showeda large cystic radiolucent area in the uppertibia.

14. An osteosarcoma (arrows) of thefemur in a girl aged 11 years and this is anamputation specimen

15. Histology shows an osteosarcoma. Youcan see the haphazardly deposited pink osteoid(arrows) present surrounding and between themalignant tumour cells. The tumour cells varyconsiderably in size and shape and many havelarge hyperchromaticnuclei.

16. Osteosarcoma of the femur. Thehaemorrhagic hole is the site of a biopsy. Thelower part of the tumour is fibrous: the portion inthe shaft shows osteogenic activity. Male aged 31.

17. This was from a 69 year old withPaget’s disease of bone who had a history of 2months of a painful lump in the upper tibia

18. This is a chondrosarcoma of thescapula in a woman aged 35. She sufferedfrom multiple hereditary exostoses and a massarising from the shoulder blade had recentlyincreased in size and become painful. This isan operative surgical specimen. Note the whitetranslucent appearance of the tumour

19. Histology shows a chondrosarcoma.There is increased and uneven cellularity withmoderately pleomorphic cells present in achondroid matrix (blue arrows). A mitoticfigure is seen (red arrow).

20. This is another example of achondrosarcoma. Note the translucent whiteappearance, also seen in this tumour

21. Chordoma. This arose in the sacrumand is an operative surgical specimen

22. This is the spine and humerusshowing metastatic (black arrows) breastcarcinoma from a female aged 51 years. Thereis a pathological fracture (red arrows) of thehumeral neck and crush fractures of vertebrae

23. This shows multiple metastases tothe skull from a neuroblastoma of the adrenalgland from a one year old child

24. This is the spine from a womanaged 62 with multiple myeloma (arrows). Shehad presented with a 15 month history of bonepain. Radiological examination showedcollapse of several vertebrae and multipleradiolucent areas in the skull. Serum protein83g/l; Bence Jones protein found in her urine,Hb 8.5g/dl; 14% plasma cells in aspirated bonemarrow. Her blood urea rose to 51.3 mmol/l, 5days before her death

25. Bone tumours Benign • Osteogenic — osteoidosteoma.; • osteoblastoma • Chondrogenic: osteochondroma; chondroma, • chondroblastoma, chondromyxoidfibroma • Unknown origin — giant cell tumour • Fibrogenic — metaphyseal fibrous defect • Various mesenchymaltumours may also occur in bone such as haemangiomas, lipomasand neurilemmomas. Malignant (Note: haematopoieticmalignancies though present in bone marrow are not included in this grouping.) • Osteogenic — osteosarcoma • Chrondrogenic — chondrosarcoma • Unknown — malignant germ cell tumour, • Ewing’s tumour • Fibrogenic — fibrosarcoma • Notochord - chordoma. • Various malignant mesenchymaltumoursmay also be seen in bones

26. Can’t remember the exact mnemonic…. Pete wrote it down • Please Remember The Bony Lesions • Prostate • Renal • Thyroid • Breast • Lung