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Bones and Joints

Diseases
Bagian Patologi Anatomi
Dr. Juliana Lina, Sp.PA
Infections
Osteomyelitis bacterial infection
Staphylococcus species, E. coli,
N. gonorrhoeae, H. influenza, Salmonella
species hematogen or direct into the bone.
Tuberculous Spondylitis (Pott Disease)
originates from lungs or lymph nodes
hematogen and resulting in tuberculous
spondylitis, arthritis, and osteomyelitis.
In adults
Caused by Staphylococcus aureus, E. coli
and other organisms originate from the
urinary tract.
Predisposing factors IV drug abuse, upper
urinary tract infections, urological procedures,
and hematogenous spread of organisms from
other sites.
Vertebral osteomyelitis may lead to
compression fractures of the vertebral body
and to neurologic deficits.
Metabolic Bone Diseases
Disorders of metabolism decreased
synthesis or increased destruction,
reduced bone mineralization, or both.
Osteoporosis.
Osteomalacia.
Primary hyperparathyroidism.
Renal osteodystrophy.
Diffuse skeletal lesions, mass of normally mineralized bone
is decreased and no longer provides adequate mechanical
support fracture
Primary osteoporosis uncertain origin and occurs
principally in postmenopausal women (type 1) and elderly
persons of both genders (type 2)
Secondary osteoporosis associated with a defined cause,
including endocrine and genetic abnormalities
The etiology genetic factors, calcium intake,
malabsorption, smoking, vitamin D deficiency, low body
mass index, hypogonadism, alcoholism, exercise, a lifestyle,
and glucocorticoid therapy.
Osteomalacia (soft bones) is a disorder of
adults characterized by inadequate
mineralization of newly formed bone matrix.
Rickets refers to a similar disorder in
children, in whom the growth plates
(physes) are open.
Conditions associated with osteomalacia
and rickets abnormalities in vitamin D
metabolism, phosphate-deficiency states,
and defects in the mineralization process
itself.
Figure 26-14. Metabolism of vitamin D and the regulation of blood calcium. Ca
2+, calcium; PTH, parathyroid hormone.
Joints
Arthritis is joint inflammation; with pain,
swelling, and changes in structure.
(1)Inflammatory arthritis, usually involving the
synovium and mediated by inflammatory cells
(e.g., rheumatoid arthritis)
(2)Noninflammatory arthritis, as exemplified by
primary osteoarthritis.
Primary osteoarthritis,
The destruction of joints results from intrinsic
defects in the joint cartilage. The prevalence and
severity of primary osteoarthritis increases with
age. After age 55, osteoarthritis is more common
in women. Many cases of primary osteoarthritis
exhibit a familial clustering, suggesting a
hereditary predisposition.
Secondary osteoarthritis
Underlying cause, including congenital or acquired
defects of joints, trauma, crystal deposits,
infection, metabolic diseases, endocrinopathies,
inflammatory diseases, osteonecrosis, and
hemarthrosis.
Rheumatoid Arthritis (RA)
Is a systemic, chronic inflammatory
disease in which chronic polyarthritis
involves diarthrodial (synovial, moveable)
joints.
RA may occur at any age but usually
begins in the third or fourth decade, and
the prevalence increases until age 70.
An increased serum uric acid level and urate crystal
deposition in joints and kidneys.
All patients with gout have hyperuricemia, but fewer
than 15% of people with hyperuricemia have gout.
Gout is characterized by acute and chronic arthritis
and is classified as primary or secondary, depending
on the etiology of the hyperuricemia.
In primary gout, hyperuricemia is present without any
other disease
Secondary gout occurs in association with leukemias,
lymphomas, after chemotherapy and ethanol intake
Neoplasms of Bone and
soft tissue
Benign Tumors of Bone
Osteoma benign, slow-growing tumor composed of
cortical type bone.
Nonossifying fibroma fibrous cortical defect, occurs in
the metaphysis of a long bone (tibia or femur) very
common and present as many as 25% of all children
between ages 4 and 10 years regresses mostly
asymptomatic, although pain or fracture may present.
Osteoid Osteoma thin, irregular, trabeculae within a
cellular granulation tissue containing osteoblasts and
osteoclasts.
Solitary chondroma (enchondroma) is a benign,
intraosseous tumor composed of well-differentiated
hyaline cartilage. The diagnosis is made at any age, and
many cases are entirely asymptomatic.
Osteochondroma

Is a developmental defect of the skeleton, which


arises from a defect of the growth plate.
Solitary osteochondroma is the most common form
of the lesion.
Histopathology a cartilage-capped, bony mass
is surrounded by a surface fibrous membrane,
which is the perichondrium.
Enchondromatosis (Ollier disease)
Development of numerous cartilaginous
masses bony deformities shows
multiple, tumor-like masses of abnormally
arranged hyaline cartilage (enchondromas)
Metaphyses and diaphysis
Tend to be chondrosarcomas.
Paget Disease of Bone
Resorpsi tulang yang berlebihan
Pria dan perempuan > 60 tahun,1 % elderly
di AS
Patologi soliter atau multipel, tulang aksial
spine, skull, dan pelvis.
Gambaran klinisbiasanya asimptomatik;
adanya nyeri, mikrofraktur
Pemeriksaan radiologi
Malignant Tumors of Bone
Osteosarcoma (osteogenic sarcoma) primary
malignant bone tumor characterized by the
formation of bone tissue by tumor cells. It
represents 20 %, in adolescents between 10-20
years old, common in boys
Pathogenesis associated with mutations in
tumor suppressor genes, retinoblastoma gene
and p53 gene; can develop in previously to
external, therapeutic radiation; pre-existing
benign bone lesions such as fibrous dysplasia,
osteomyelitis, and bone marrow infarcts
Histologic malignant cells with osteoblastic
differentiation producing woven bone. 98%
patients die have lung metastases, bones
(35%), the pleura (33%), and the heart (20%).
Chondrosarcoma
Malignant tumor of cartilage
Arises from pre-existing of enchondromas,
solitary osteochondroma, or hereditary
multiple osteochondromas.
The second, commonly in men, mostly in 4-5
decades (45 years).
Pain
5-year survival rate for low-grade
chondrosarcomas is 80%, for moderate-grade
tumors 50%, and for high-grade tumors, it is
only 20%.
Wide excision
Osteosarcoma

Chondrosaroma
Giant Cell Tumor (GCT) of Bone
Locally aggressive, potentially malignant
neoplasm characterized by the presence of
osteoclastic, multinucleated, giant cells.
Pathology: In most cases (90%), GCT of bone
originates at the junction between the
metaphysis and the epiphysis of a long bone
Manifest with pain, microfractures and
pathologic fractures are frequent.
Ewing Sarcoma (EWS)
Uncommon malignant bone tumor (5%)
Composed of small, uniform, round cells
In children and adolescents, 2/3 of cases < 20
years; common in boys
Pathology: primarily in childhood, especially the
humerus, tibia, and femur
EWS metastasizes to lungs,brain, and skull
ARIGATO