5. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Fig. 28 A synovial joint, on section.
6. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Rigid endoskeleton
- Supports the body
- Protects viceral organ
- Provides attachments for muscles
Metabolism of calcium and other minerals
Contains hematopoietic marrow
Function of Bone
7. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Fig. 2.1 Embryonic development of a long bone during the first six months
22. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Bone
marrow
hematopoieti
c lineage
Bone marrow
stromal cell
lineage
BONEBONE
23. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Bone marrow
hematopoietic lineage
CFM-GM ( colony forming unit
granulocyte-macrophage )
monobl
ast promonocy
te
mon
ocyte
Tissue
macropha
ge
osteoclast
24. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Bone marrow
stromal cell
lineage
( mesenchymalstem cell )CFU-F(Colony forming
unit fibroblast)
Stromal
osteoblast
precursor cell
Transitory osteoblast
Secretory osteoblast
Osteoblast
( bone lining cell )
25. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
( Receptor activator for
nuclear factor Kappa B)
( Rank ligands )
Osteobl
ast-
osteocla
st
interacti
on
38. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Histology of Synovium
•Intimal layer: A thin layer
of synovial cells or
synoviocytes
•Subintimal layer:
arterioles, fat and other
connective tissue cells
such as fibroblasts,
42. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Congenital
anomalies
Developmental
abnormalities:
complex,
variable, genetic
based and
manifest during
43. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Developmenta
l anomalies1) Defect in nuclear proteins and
transcription factor ( dysostosis)
2) Mutations in the hormone and
signal transduction ( dysplasia )
3) Defect in extracellular
structural proteins
49. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
OSTEOGENESIS IMPERFECTA
A group of distinct clinical syndromes with
various modes of inheritance and having in
common an increased propensity to fracture.
51. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Osteogenesis
ImperfectaAbnormal secretion type I
collagen
Decreased synthesis type I
collagen Decreased
Deletion 1(I) gene
Matrix
59. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Direct inoculations following
compound fracture
Osteomyelitis : caused by
Hematogenous spreading
(staphylococcus aureus, Salmonella)
61. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
OsteomyelitisOsteomyelitis
Involu
crum:
New bone
formation i
n periosteu
m
Seques
trum:
Dead bone
70. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Figure 231. Tuberculous osteomyelitis.Figure 231. Tuberculous osteomyelitis.
A sagittal section of a portion of the
vertebral column. Two vertebrae are involved an
d have collapsed, causing kyphotic angulation w
ith compression of the spinal cord.
71. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Spinal tuberculosis (Pott’s disease)
Psoas abscess
Disc destruction
Vertebral collapse
Paraplegia
75. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Commonly affects the spine
Spreads usually from pulmonary
disease via blood stream
Tuberculosis
77. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
A
B
Figure 244. Congenital syphilis. A, There are
radiolucent defects adjacent to the zones of
provisional calcification and periosteal new
bone around the diaphysis. The defect in the
proximal tibia is symmetrical (Wimberger’s
sign). B, Reexamination of the forearm three
weeks later reveals evidence of healing of the
metaphyseal lesions.
80. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Simple fracture
Impacted fracture
Comminuted fracture
Stress fracture
Greenstick fracture
Trauma to normal bone
81. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Osteoporosis
Osteomalacia
Hyperparathyroidism
Paget’s disease
Osteogennesis imperfecta
Tumors
Pathological fracture
90. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Avascular
necrosis
•Synonym:
Aseptic
necrosisosteonecr
osis
91. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Cause of osteonecrosis
• Idiopathic
• Post fracture
• Fat embolism
• Legg-Calves Perthes
disease
• Steroid induce
• Alcohol
96. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Rheumatoid arthritis
• Self-perpetuating , inflammatory joint
disease
• Initially characterized by swelling in
several joints and stiffness
• Roentgenographically show a chronic
inflammatory destruction of the joint
• Laboratory findings: Rheumatoid
factor, ESR
98. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Terminology in Rheumatoid
arthritis
•Pannus:
inflammed
synovium
attaching on
articular cartilage
100. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
PATHOLOGY OF SYNOVIUM in
rheumatoid arthritis
101. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Proposed mechanism for
rheumatoid diseases
Robbins and Cotran ( 7th
.
Ed) p. 137
106. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Histologic typing
of bone tumorBone-forming
tumorsCartilage forming
tumorsGiant cell
tumorsBone
marrow tum
ors
107. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Bone forming tumors
•Benign : OSTEOMA
• Malignant:
OSTEOSARCOMA
108. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Cartilage-forming tumors
• Benign : OSTEOCHONDROMA,
ENCHONDROMA, CHONDROBLASTOMA,
CHONDROMYXOID FIBROMA
• Malignant : CHONDROSARCOMA
109. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Bone marrow-
forming tumors
• Ewing’s
sarcoma
148. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Metabolic bone diseases
- Matrix
- Mineralization
- Deposition of waste product
formation
resorption
149. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Matrix formation defect
- Osteogenesis imperfecta
- Paget’s disease
- Mucopolysaccharidosis
150. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Matrix resorption defect
Hyperparath
yroidism
Osteopetrosi
s
165. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Table 1. Comparison of two types of involutional osteoporosis.
From Riggs and Melton(1986)with permission.
Type IType I Type IIType II
Age (years) 51-75 > 70
Sex ratio (female : male) 6:1 2:1
Type of bone loss Mainly cancellous Cancellous and compact
Rate of bone loss Accelerated Not accelerated
Fracture site Vertebrae (crush) and Vertebrae (wedge)
distal radius and hip
Parathyroid function Decreased Increased
Calcium absorption Decreased Decreased
Metabolism of 25-OH-D to Secondary decrease Primary decrease
1.25(OH)2D
Main causes Factors related to Factors related to
menopause ageing
25-OH-D = 25-hydroxyvitamin D ; 1.25(OH)2D = dihydroxyvitamin D.
166. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
PATHOGENESIS OF OSTEOPOROSISPATHOGENESIS OF OSTEOPOROSIS
ModelModel
Figure 4. Conceptual model of the pathogenesis of fractures relate to osteoporosis.
Modified from Riggs (1988).
167. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital…..
Deposition of waste product
- Pseudo - gout
- Gout
- Oxalosis
- Ochronosis
5 phases:Phase 1= osteoclastic resorption; phase 2=mononuclear resorption; phase 3=preosteoblastic and differentiation into osteoblasts; phase 4=osteoblastic matrix formation; phase 5= mineralization; phase 6= end product of remodeling in cancellous bone
