Pathologi tulang

8/10/2019 Pathologi tulang

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Structure of Normal Bone

Functions :

Supporting the body

Providing attachment site formuscles & tendons

provide motion

Protects vital organs &

houses of bone-marrows Mineral deposits, esp.

calcium


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Type of Bones

The flat bones

Skull, scapula, clavicle, vertebra, jaw & pelvis

The tubular bones

Femur, tibia, fibula, humerus, etc

Cortical (or compact) bone

Both types consists of

Cancellous (or spongy) bone

In a typical long bone (Such as femur) :

Diaphysis is composed of cortical bone surrounding medullary

cavity

Epiphyses mostly are cancellous bone & a thin rim of cortical

bone


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Normal Bones

is the basic structural unit of

cortical bone

It consists of

a central Haversian canal- blood vessels

- surrounding by lamelae of bone

anastomosing system of canals

Lamelae of Bone

Have a large number of

lacunae contain osteocytes

The Haversian System = Osteon


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Normal Bones

Periosteum : a connective tissue layer

(collagen), penetrate cortical bone

a tight attachment

together with large blood vessels & nerve

Cortex Separated by endosteum Marrow space (a thin layer of connective tissue)


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Methods of Biopsy

Open Biopsy

The most common method for diagnosing

bone tumors

Needle Biopsy

Effective & safe technique

A larger amount of tissue compare to FNAB

Fine Needle Aspiration Biopsy (FNAB)

The accuracy about 80% in bone tumors


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Diagnosis of Bone Lesions

Clinical datasor

diagnosis

Histopathological

diagnosis

Radiological

diagnosis

Frozen section :

- To check the tumor margins

- for metastatic tumor- to check the adequacy of

biopsy

- Name- Sex

- Age

- History

- Examination

- Lab. Findings- etc

- Location- Type of lesion

- Extension

- Periosteal -

reaction

- Calcification

- etc


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Basic Principles of Cancer Cytogenetics

In 1960 : The Philadelphia (Ph)chromosome in CML was discovered

In 1970 : Chromosomal Banding

techniques. Each chromosome could beidentified precisely

Tissue must be fresh not frozen or fixed informalinin sterile culture media :

Buffer sol (Hanks buffered salt solution)

Cytogenetic Analysis


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Bone Tumors

Classification, based on :

Cytologic features

The matrix

Benign tumors :

Malignant tumors : rarely arise from

benign ones

Incidence : 0,2% of all cancers were Bone

Sarcomas


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Bone Sarcoma

The most frequent : Osteosarcoma

Followed by :

Chondrosarcoma

Myeloma

Lymphoma

Ewing Sarcoma

Chordoma Fibrosarcoma

etc


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Surgical Margins

Radical The entire compartment involved by tumor is removed

Wide The tumor is removed with surrounding normal tissue

& the reactive zones (composed of the fibrovascularpseudocapsule) is removed intact

Marginal The tumor is removed entirely but the incision goes

through the reactive zone

Intra lesional The tumor is not removed intact & margins are

involved


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Entirely cartilage Malignant osteoid (-)

Pelvic, shoulder girdles,upper ends of the femur& humerus

More than 60% in thefourth-sixth decades

Radiographic Usually large size

75% calcification Mineralization shape, ring

shaped, popcorn like, orcomma shaped

Expansion of bone &thickening of cortex

Bone produced by thetumor cells

Malignant osteoid (+)

The metaphyseal regionof long bones (region of

the knee) The peak incidence is in

the second decade of life

Radiographic

Lytic Sclerotic

Codmans triangle

Cloud like

sunburst

CHONDROSARCOMA OSTEOSARCOMA


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