Bone Pathology

Types of Bone
• Cortical bone(compact bone) : is the dense outer surface
of bone that forms a protective layer around the internal
cavity
• Trabecular bone (also called cancellous or spongy bone)
consists of delicate bars and sheets of bone trabeculae.
• Epiphysis
– from subarticular plate to epiphyseal cartilage
• Metaphysis
– Area between epiphyseal plate to the area where bone
develops its funnel shape
• Diaphysis
– Body of bone, between metaphyses
 Cells
• Osteoblasts
– Produce the protein
– Osteoid
• Osteocyte
– Osteoblast within bone in a lacuna
• Osteoclast
– Multinucleated
– Resorbs bone
– Howship’s lacunae
 Bone Lesions
• Fracture:
-discontinuity of bone
– pathologic; stress fracture
• Three phases
– Inflammatory
– Reparative
– Remodeling
 Inflammatory Phase
• First week
• Rupture of blood vessels in the periosteum and soft tissues
• Bone necrosis at the site
• Neovascularization peripheral to blood clot
• Neutrophils , macrophages and other mononuclear cells
• Clot organization and early fibrosis
• Callus formation
– Woven bone, some cartilage
 Reparative Phase

• Months
• Proliferating fibroblasts and osteoblasts
• Blood clot resorption
• Callus bridge
 Remodeling Phase

• Several weeks - years

• Callus has sealed the bone ends
• Remodeling
 Osteonecrosis
• Ischemic death of bone and marrow in absence of
infection
– Trauma
– Emboli: bone infarction
– Radiation
 Myositis Ossificans

• Formation of reactive bone in muscle as a result

of injury
• Mimics neoplasm radiographically and
histologically
• Lower limbs
 Osteomyelitis
• Inflammation of bone caused by an infectious organism
• Staphylococcus, streptococcus

• Direct penetration
– Wounds, fractures, surgery
• Hematogenous
– Bloodstream

• Sequestrum: fragment of necrotic bone in the pus

• Involucrum: Periosteal new bone covering the
sequestrum
 Osteoporosis
Reduction of bone mass per unit of bone volume
• Primary Osteoporosis
• Most common
• Uncertain etiology
• Postmenopausal women
• Elderly persons (senile) (Genetic ,Estrogens decline ,Increased
osteoclastic activity ,Decreased synthetic activity of osteoblasts)
• Reduction in the number and size of trabeculae ,Fractures can
be the first sign.
• Secondary Osteoporosis
• Corticosteroids (Inhibition of osteoblasts)
• Hematologic malignancies
 Bone tumors

Osteochondroma
is the most frequent benign bone tumor, it may lead to deformity or
interfere with the function of adjacent structures such as tendons
and blood vessels. The most common locations are the
metaphyses of the lower femur, upper tibia & upper humerus.
The average age of the patient at onset is approximately 10 years
Osteochondroma is Cap composed of mature cartilage overlying
mature bone.
 Chondroma

• Benign cartilaginous tumor

• Small bones of hands and feet.
 Osteoma
• Benign bone forming tumor composed of
compact or mature trabecular bone limited
almost exclusively to craniofacial bones,
especially paranasal sinuses .
 Osteosarcoma

It is malignant tumor of bone

usually occurs in patients between 10 and 25
years of age.

Location Most osteosarcomas arising de novo

are located in the metaphyseal area of the long
bones, particularly the lower end of the femur,
the upper end of the tibia, and the upper end of
the humerus
Gross appearance
The gross appearance of the cut surface
of an osteosarcoma varies a great deal,
depending on the relative amounts of bone,
cartilage, cellular stroma, and vessels .The
range extends from bony hard to cystic,
friable, and hemorrhagic.
Gross appearances of osteosarcoma of femur.
Microscopic features
Microscopically,
osteosarcoma may destroy the pre-existing bone trabeculae or
grow around them in an appositional fashion. The key feature for
the diagnosis is the detection, somewhere in the tumor, of
osteoid and/or bone (calcified osteoid) produced directly by the
tumor cells
Osteoid is recognized by its eosinophilic-staining quality, its glassy
appearance, irregular contours, and the fact that it is surrounded
by a rim of osteoblasts.
Osteosarcoma
 Chondrosarcoma
a malignant tumor of cartilage-forming tissues, is
divided into two major categories on the basis of
microscopic criteria: conventional chondrosarcoma and
chondrosarcoma variants.
Conventional chondrosarcoma. The majority of the
patients with conventional chondrosarcoma are
between 30 and 60 years of age.
Chondrosarcoma
Microscopically, conventional chondrosarcomas show a
remarkably wide range of differentiation, the common
denominator being the production of a cartilaginous
matrix and the lack of direct bone formation by the
tumor cells. This range in differentiation is the basis for
the grading of these tumors into well, moderately, and
poorly differentiated.
The nuclei are plump and hyperchromatic; there may be
two or more nuclei per cell and two or more cells per
lacuna
Chondrosarcoma