Pathology Quiz

1. Pathology Quiz 16 September 2011

3. Achondroplasia – dwarfism • Premature closure of growth plate, reduced chondrocyte proliferation • Appositional bone formation normal • Point mutation in FGFR3 gene

5. Rib fractures – neonatal thorax • Osteogenesisimperfecta • Type I collagen defect, usually AD

7. Skull of 77yo female • Bones are thicker but also softer, more porous - # • Paget’s disease of the bone • Pheases: 1. Osteolytic 2. osteoclastic-osteoblastic, 3. osteoslerotic • ?due to paramyxovirus • Histology shows late stage, thickened trabeculae with haphazard lamellae

9. Acute fracture of femur in child with shortening, haematoma

11. Healing fractures of tibia and fibula. Note early resorption of haematomas and callus formation

13. Osteoid osteoma of the finger. Note sclerotic central nidus. • benign, bone forming tumours – very painful • Commonly occur in the femur and tibia, usually in the cortex • Histology shows interconnecting trabeculae rimmed by osteoblasts

15. Osteochondroma, aka exostoses, in 21yo M humerus • May occur as solitary lesion or as part of multiple hereditary exotoses • Commonly arise at metaphyses of long bones

17. Enchondromatosis (Ollier’s disease) in 15yo boy • Developmental abnormality characterised by multiple cartilaginous nodules • Composed of benign cartilarge • Commonly found in metaphyses

19. Chondroblastoma – in head of humerus M 16yo • uncommon primary bone tumour, most often seen in knee epiphyses • Composed of sheets of compact chondroblasts and tumour cells

21. Giant cell tumour (arrows) in tibia M 29yo • Histologically benign, but conservative surgery has 40-60% recurrent rate • X-ray showed large cystic radiolucent area in the upper tibia

23. Osteosarcoma in femur of 11yo girl • Grossly appear as big, bulky tumours that are gritty / tan-white with areas of haemorrhage, cystic degeneration • Accounts for 20% of primary bone Ca, but 75% in Px <20yo • In young people, usually found in metaphyses of long bones (60% in knee) • If Px >25yo, can be any bone • Histology shows haphazardly deposited pink osteoid

25. Osteosarcoma in femur (M age 31). Haemorrhagic hole is from site of biopsy. • Shaft shows osteogenic activity

27. Osteosarcoma arising in upper tibia of 69yo F with Paget’s disease

29. Chondrosarcoma of the scapula (F age 35 with multiple hereditary exostoses) • Tumour has white translucent appearance • About 50% as frequent as osteosarcoma, Px are generally older (>30s) • Commonly arise in axial skeleton • Histology shows increased, uneven cellularity with pleomorphic cells in chondroid matrix

31. Chondrosarcoma

33. Chordoma arising in sacrum • Thought to arise from notochordal remnants, affects sacrum, base of skull and (rarely) vertebrae • Most Px are middle-aged or elderly • Lobulated, gelatinous tumours. Often appear bubbly and vacuolated • Slow growing but kill by local invasion

35. Breast Camets in spine and humerus (female age 51) • Red arrow = pathological fracture

37. Multiple mets to skull from neuroblastoma of adrenal gland from 1yo child

39. Spide from woman with multiple myeloma (woman age 62 with 15/12 history of bone pain)