Musculoskeletal block Pathology practical

1. Musculoskeletal block Pathology practical

2. Normal anatomy and histology

4. The overall structure of a long bone

8. Gross pathology and histopathology

9. Case no. 1

10. A 22 years old male presented with localized pain above his right knee joint with recurrent fever. Later, he had a discharging sinuses from the skin overlying the right knee. What is the most likely diagnosis ?

14. Osteomyelitis

16. Case no. 2

17. A 35 years old debilitated man presented to the orthopedic clinic with back pain, low grade fever, marked elevation of sedimentation rate and recent kyphosis and scoliosis . • The patient has a history of coughing up blood, fever, chills, night sweats, weight loss, pallor, and often a tendency to fatigue very easily.

20. Section of bone shows granuloma formation with epithelioid like cells , langhans-type giant cells and rim of lymphocytes

21. 2- Spinal TB - Potts Disease (Tuberculousosteomyelitis)

23. Case no. 3

24. A 40 years old woman complains of low grade fever , malaise and stiffness in her joints each morning .

25. Swollen and slightly deformed interphalangeal joints.

26. Rheumatoid arthritis affecting the head of femur. The synovium becomes edematous, thickened and hyperplastic and transforming its smooth contour to one covered by delicate and bulbous fronds .

27. Section shows marked synovial hypertrophy with formation of villi

28. Section of synovial tissue showing Hyperplastic synovium which is infiltrated by dense chronic inflammatory cells including many lymphocytes and plasma cells.

29. 3- Rheumatoid arthritis

31. Case no. 4

32. An obese 56 years old woman presented with bilateral localized pain to her knees, hands and difficulty in walking .

33. Progressive erosion of articular cartilage, eburnatedarticular surface , subchondral cyst and residual articular cartilage Predisposing factors for osteoarthritis are marked obesity , previous injuries to a joint , diabetes and deformed joint .

34. Mushroom-shaped osteophytes (bony outgrowths ) and splitting of articular cartilage . There is absence of inflammation .

35. 4- Osteoarthritis

37. Case no. 5

38. A 16 years old male was found to have a small swelling protruding from upper part of his leg with local pain .

39. 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.

40. These are probably not true neoplasms, but they are a mass lesion that extends outward from the metaphyseal region of a long bone.

41. 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

43. 5- Osteochondroma(osteochondromaexostosis)

45. Case no. 6

46. 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 .

48. Mass lesion involving the upper end of the tibial bone. The mass show pale, yellowish cut surface with few hemorrhagicareas.

49. Malignant osteoid, Malignant pleomorphic cells showing abnormal mitoses