Musculoskeletal System

Pathology

By
Dr .Yasir Suliman
 MSK system
Bone
Joints
Muscles
Soft tissues
 Bone Pathology -1
Metabolic-1
Infections -2
Tumors -3
Congenital -4
 The Normal

© Dr.yasir 2oo7
 Normal bone
Canaleculae

Trabeculae
 Types of bones
Compact

Lamellar
Bones
Cancellous

Woven
Bone turn over (physiology)
 1-Metabolic Bone Diseases
Due to imbalance in bone turn over:-
Defect Disease
Formation + Resoption Osteoporosis
 Investigations in Bone Disorders
Radiological : X-ray, bone scan,….
Biochemical
Calcium
Phosphates
PTH
Vit D3
Alkaline phosphatase.
Biopsy.
Others
 1- Osteoporosis
Definition :
Skeletal disorder chr by ↓↓bone mass with ↑
fragility and ↑ tendency to fracture
 Pathogenesis and Causes
Bone atrophy due to↓ formation and ↑ resoption
Secondary:
Hormonal : DM, Cushing,
Primary: estrogen,..
Postmenopausal Immobilization.
Senile
Nutritional.
Other bone pathology.
Genetic factors: Vit D
receptors,..
 Pathogenesis ( 1 ry)
Estrogen
Cytokines

RANK, RANKL
 Pathology Normal bone

◙↓ bone mass ( osteopenia)

 Normal mineralization.
◙ Thin trabiculae and wide canaliculae.
 Collapse of vertebrae ( code fish #) Osteoporosis

◙ Pathological fractures.
 Clinical Features
in elderly females.
Early : asymptomatic.
Bone pain.
Pathological factures.

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Pr TT
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 Diagnosis
Radiological : osteopenia and pathological #
Biochemical :
All bone profile normal.
Routine and hormonal studies .
Bone biopsy:
 Osteomalacia and Rickets
Defective mineralization of bone matrix
resulting in excessive osteoid formation and bone
softening.
 Causes
Vit D3 deficiency.
  Diet
 Malabsorption.
 ↓ sun exposure
Vit D3 abnormal metabolism.
Liver , renal ( Vit D dependent rickets type I)
Normal level Vit D3.
  PO4.
End organ resistance (type II)
Toxins
Hypophosphatesia.
 Pathology
↓ bone mineralization.
 ↑Osteoid formation.
↑ Cartilage formation.
 Clinical Features
Adults

Children
Bone pain
 ↓ Growth Proximal
Long bone deformity muscles weakness
Pathological
Pigeon breast
fractures.
Rickets rosary
 Diagnosis
Clinical
Treatment
Radiological. ??
Biochemical

Ca PO4 Vit D3 PTH ALP

 Radiological findings

Deformity Green stick Wide

epiphysial
fracture plate
 1ry Hyperparathyroidism
↑↑ PTH due to primary PT gland disorder.
Causes : adenoma , adenocarinoma.
Effects ↑bone resorption , ↑Ca ,↓ PO4.
Clinically:
Of hypercalcaemia: bone, GIT, CNS, Kidney.
Bone :pain and pathological fractures.
Bone pathology:
Bone inflammation, fibrosis and cysts
formation ( Osteitis fibrosa cystica)
Brown tumor: deposition of hemosedren.
Osteoporosis.
Diagnosis: Bone profile:-

Ca PO4 Vit D3 PTH ALP

N N
 Renal Osteodystrophy
In CRF: low Vit D3 and low Ca.
Lead to 2ry ↑PTH.
Lead to bone ↑resoption : pathological #
 Paget's disease
↑↑ bone turnover → disorganized bone structure ,
fibrosis and thickening.
Both osteoclast and osteoblasts are active.
Causes : unknown( viral infections?)
Pathology:
Fibrosis ( bone mosaic)
 Bone vasculature.
Thickening and deformity.
Clinically:
Bone deformity (local or general)
Common site : skull & pelvic
Complications:
 Pathological fracture.
 Nerves compression.
 Congestive heart failure.
 Late : malignancy.
Diagnosis:
Clinical
Radiological
biochemical
Ca PO4 Vit D3 PTH ALP

N N N N
 Bone Infections
Acute osteomyelitis
Pyogenic
Brodie’s abscess
Chronic osteomyelitis
Bone TB
 Acute Osteomyelitis
Acute inflammation of bone and marrow cavity
Causes
Pyogenic bacteria: Staph Aureus , Stripto,
Neisseria Salmonella (In SSA)
Route of infection
 Blood stream
 Compound fracture
 2ry from soft tissue or skin
 Pathology
Site : metaphysis of long bone/ vertebrae
Hyperemia
Abscess → elevated periosteum
Thrombosis and ischemic necrosis)
(sequestrum)
Reactive new bone ( involucrum)
External sinus draining ( cloaca)
 Draining sinus
Sequestrum
sequestrum

: Involucrum

Resorption
Bone formation
 Clinical Effects
Of inflammation : cardinal & systemic.
Complications
Osteonecrosis
Septicemia and metastatic abscesses
Septic arthritis
Change in growth
chronic osteomyelitis
Diagnosis an Treatment : Straight
!!!forward
 Chronic OM
From acute
Clinically : sinus draining and deformity
Complications
Bacterial spread
Fracture
Squamous carcinoma
Amyloidosis
 Bone Tuberculosis
2ry ( by blood)
Long bones and vertebrae
Clinically:
Fever, pain, sinus
In vertebrae: collapse #: Kyphosis and
scoliosis
Pott's disease: compression of s. cord (lower
thoracic + lumbar)
Diagnosis and Treatment : Give
Pathology
!!option
Normal Vert
Extrusion of
disc

Collapsed
Vert Cord
Spread compression
Question ?
 Congenital Bone Diseases

A chondroplasia
Ostegenesis imperfecta
Osteopetrosis
Others
 1-Osteopetrosis
Called marble bone disease (AR)
Due to congenital ↓ in osteoclastic activity
↓resoption  large fragile bone
Complications
 Pathological #
 BM compression  Anemia, LEP
 Nerve compression
Osteopetrosis
 2- Ostognesis imperfcta
Rare inherited disease (1/8000)
AD
Mutations of gene for type I collagen
– COL 1A1 gene on chromosome 17
– COL 1A2 gene on chromosome 7
Abnormal osteoid production – osteopenia
Clinically :pathological #, blue sclera, ....
 3- A chondroplasia
Congenital defect in cartilage formation
Premature closure of epiphysis
Short stature ( what ∆ ∆ ?)