By Andrew E. Horvai (ed.), Thomas Link (ed.)
Shop time picking and diagnosing pathology specimens with excessive Yield Bone and delicate Tissue Pathology, edited by means of Drs. Andrew Horvai and Thomas hyperlink. a part of the High-Yield Pathology sequence, this name is designed that can assist you overview the foremost pathologic gains of bone and soft-tissue malformations, realize the vintage glance of every ailment, and quick make certain your analysis. Its templated layout, very good colour images, concise bulleted textual content, and authoritative content material may help you appropriately establish greater than a hundred and sixty discrete ailment entities.
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Additional info for Bone and Soft Tissue Pathology
A, Marked reduction in both the marrow space and haversian system. B, Note the absence of osteoclasts and cortical-appearing bone. B Fig 5. Anteroposterior radiograph of the pelvis (A) and frog-leg lateral view of the right hip (B) in a patient with osteopetrosis showing diffuse sclerosis of the proximal femur and the pelvis with femoral bowing. The bone-in-bone appearance of the pelvic bones is well visualized. Deformity of the right femoral head suggests remote fracture. Fig 4. Osteopetrotic bone from an adult with calcifying cartilaginous tissue not remodeling into mature bone.
A B C D Fig 2. Microscopic changes of osteonecrosis. A, Low magnification showing the periphery of the lesion with ingrowth of granulation tissue (center) and necrosis (right). B, Intermediate magnification showing bone marrow fat necrosis and necrotic bone with empty lacunae. C, High magnification of granulation tissue adjacent to necrotic bone with empty lacunae. D, Irregular calcifications and granulation tissue at the edge of a well-established lesion. , neoplasm, osteomyelitis, osteoporosis) help establish the etiology 45 46 Bone Fracture and Fracture Callus A C B Fig 1.
B, Later changes of articular cartilage destruction and necrosis. Bacterial colonies are rarely evident in routine histologic evaluation. B Fig 3. In the intraoperative evaluation of septic loosening, the quantity of neutrophils in synovium, implant capsule (A), or granulation tissue should be scored. Neutrophils associated with fibrin (B) do not correlate with septic loosening. , thiazides) Presentation • Episodic acute attacks of inflammatory arthritis, usually monoarticular • Predilection for the first metatarsophalangeal joint (most common initial presentation), but also affects ankles, heels, knees, wrists, fingers, elbows • Development of sodium urate deposits (tophi) around affected joints • Uric acid nephrolithiasis, chronic nephropathy, or both Prognosis and treatment • Chronic relapsing condition with variable rate of progression and frequency of acute flares • Treatment: uric acid–lowering agents, discontinuation of diuretics, fluid administration, and alkalinization of urine during chemotherapy Radiology • Swelling of periarticular soft tissues, typically at the first metatarsophalangeal joint • Subsequent erosion of periarticular bone leading to classic punched-out appearance with overhanging edges • Tophi are radiolucent but may also calcify • Little reactive sclerosis • Usually no regional osteopenia (in contrast to rheumatoid arthritis) • Occasionally soft tissue deposits, which mimic soft tissue tumors Pathology Gross • Tophaceous deposits in the joints and periarticular soft tissue have chalky-white appearance • Destruction of articular cartilage and adjacent bone Histology • Synovial fluid cytology in acute gouty synovitis • Inflammatory exudate (neutrophils and lymphocytes) can be mistaken for septic arthritis • Sodium urate crystals: needle shaped, with strong negative birefringence (appear bright yellow under polarized light) • Sections of tophi show variably sized deposits of fluffy eosinophilic material rimmed by macrophages, giant cells, and fibrous tissue • Crystals are usually dissolved by conventional aqueous processing; for better preservation, ethanol fixation with or without examination of fresh tissue is recommended Ancillary tests • Demonstration of sodium urate crystals in synovial fluid • Blood uric acid level may be elevated but is neither diagnostic nor specific Main differential diagnosis • Septic arthritis • Other crystal-induced synovitis • R heumatoid arthritis • Osteoarthritis 33 34 Gout A Fig 1.