Morphology of Bones and Joints

Pagets disease:
 Mono-ostotic\polyostotic
 Lytic phase: osteoclastic activity raised
 Mixed phase: both osteoclast and osteoblasts prevail
 Marrow is replaced by progenitor cells + blood vessels
 New bone= lamellar pattern \ cortex is thick and soft

Osteomyelitis
 Bone necrosis= sequestrum
 Sub-periosteal abscess > periosteal lifting > suppurative and ischemic damage > segmental bone necrosis >
rupture of abscess > draining sinus.
 Chronic inflammatory cells > cytokines > a) osteoclast resorption b) fibrous tissue ingrowth c) bone
formation > involucrum.

Osteosarcoma
 Gritty-grey mass= hemorrhage and cystic dilation
 Tumor can invade cortex, medullary cavity, metaphysis but not in epiphysis.
 Tumor: hyperchromatic nuclei, Giant cells, mitotic figures.
 Osteoid formation(diagnostic)
 Cells in broad sheets
 When cartilage is increased= chondroblastic osteosarcoma.

Ewing sarcoma
 Round cells larger than lymphocytes
 Few mitotic figures
 Scant glycogen cytoplasm
 Homer-wright rosettes
 Onion skin pattern of bone deposition

Giant cell tumor

 Red brown mass with cystic degeneration
 Uniform oval mono nuclear cells
 Scattered Giant cells
 Necrosis, hemorrhage, reactive bone formation.

Osteoarthritis
 Chondrocytes > clones > new matrix
 Horizontal and vertical fibrillations
 Gross appearance= granular named as chondromalacia
 Bone eburnations
 Joint mice
 Mushroom shaped osteophytes
 Pannus formation
Rheumatoid arthritis
 Involve small joints( proximal interphalangeal joint, metacarpo phalangeal joint)
 Chronic papillary synovitis: a) synovial hyperplasia b) perivascular inflammatory cell infiltrates c) increased
vascularity d) neutrophils+ fibrin deposition in synovium e) increased osteoclastic activity
 Pannus formation > fibrosis/ossification > ankylosis
 Synovial membrane is frond like
 Hall mark: joint effusions and juxtaarticular osteopenia
 Swan neck deformity
 Boutennier deformity
 Nodules on extensor surface of forearms
 Rheumatoid factor > vasculitis
 Pleuritis / pericarditis
 Interstitial fibrosis
 Uveitis / KCS

Gout
Acute arthritis:

 Neutrophils in synovium
 Mono sodium urate crystals in synovium
 Synovium= edematous / congested

Chronic tophacious arthritis:

 Repetitive precipitations > visible deposits

 Fibrosis and pannus formation
 Fibrous/bony ankylosis

Tophi

 Aggregate of urate crystals surrounded by leukocytes, macrophages, giant cells

 Appear in articular cartilage of joints / ear lobes/ nasal cartilage/ skin of fingertips

Gouty nephropathy:

 Urate deposition in medulla or free crystals

 Complicated into pyelonephritis.