ࡱ> >@=  bjbj .8eeF<<        8X4D ",......,[Z Z5  o555F  ,5,55<Pˉ+k"T0\,55 ZZ5< :   Bone and Muscle Pathology Review 1. Hereditary Disorders of Bone Osteogenesis imperfecta Many types Mutations of collagen type 1 Multiple fractures Dentinogenesis imperfecta Achondroplasia 20% autosomal dominant; 80% random mutations Most common form of inherited dwarfism Epiphyseal plates close prematurely Cor pulmonale Osteopetrosis Autosomal dominant or recessive Osteoclast hypofunction causes very dense bone AR: severe, with anemia, nerve entrapment, hydrocephalus, infections, fractures AD: milder 2. Non-Neoplastic Bone Lesions Fracture Inflammatory phase (first week; clot and callus formation) Reparative phase (months; callus bridge) Remodeling phase (weeks-years; remodeling of callus) Osteonecrosis Ischemic death of bone without infection Physical event: trauma, embolism, radiation Systemic disease: sickle cell, lupus, gout Toxic effect: corticosteroids, alcoholism Myositis Ossificans Reactive bone formation within muscle Caused by trauma Looks like a neoplasm Lower limbs Osteomyelitis Bone inflammation caused by infection Staph, Strep, E. coli, N. gonorrhea, H. influenzae, Salmonella Results from direct penetration or hematogenous spread Sequestrum (necrotic bone fragment) may be surrounded by Brodie abscess (pus and reactive bone) and may have a cloaca (a draining sinus). Involucrum (new periosteal bone) eventually seals off the sequestrum. Osteoporosis Decreased bone mass per unit volume Normal ratio of mineral to matrix Primary occurs in elderly women (decreased estrogen, less exercise) Secondary occurs with corticosteroid use, alcoholism Osteomalacia and Rickets Osteomalacia: inadequate mineralization of bone Called rickets when it occurs in children Usually caused by vitamin D deficiency Can also be caused by phosphate deficiency Hyperparathyroidism Usually caused by parathyroid adenoma Excess parathyroid hormone causes hypercalcemia Stone (kidney stones), bone (areas of bone resorption called brown tumors), moan (psychiatric manifestations), and groan (GI symptoms) disease Can also be caused by renal failure Paget Disease Disorder of bone remodeling Three phases (hot, mixed, cold) Bones of skull: cotton wool appearance, hypercementosis of jaws Tests: alkaline phosphatase, urine hydroxyproline Fibrous Dysplasia Monostotic Ground glass appearance on xray McCune Albright syndrome Jaffe syndrome Osteoarthritis Most common joint disease Primary (cartilage defect), secondary (to trauma, crystal deposits, infection) Weight-bearing joints (knees, hips, spine) and hands Eburnated (very dense, ivory-like) bone, Heberden nodes Rheumatoid Arthritis Chronic, systemic, autoimmune, inflammatory disease Symmetrical small-joint involvement Starts as synovial disease (hyperplastic synovium, pannus) Rice bodies, rheumatoid nodules Spondyloarthropathy Group of diseases including: Ankylosing spondylitis (spine in young men) Reactive arthritis (patients also may have conjunctivitis, non-gonococcal urethritis, and oral lesions Arthritis occurring in patients with psoriasis or inflammatory bowel disease Gout Increased serum urate leads to urate crystals in joints, kidneys Primary or secondary (malignancy, alcoholism) Acute gout (podagra), tophaceous gout (tophi in ear, Achilles tendon) Histology: granulomas with needle-shaped crystals Joint tumors and tumor-like things Ganglion cyst: wrist Synovial cyst: herniation of synovium through joint capsule (Baker cyst when its behind the knee) Pigmented villonodular tenosynovitis (ouch) Giant cell tumor of tendon sheath (most common tumor of hand; benign) 3. Bone Neoplasms Benign neoplasms Osteoma: occurs in skull in older adults Osteoid osteoma: occurs in legs in teenagers Chondroma: occurs in hands and feet in young adults Osteochondroma: occurs in long bones in teenagers Giant cell tumor: occurs around knee in young adults Malignant neoplasms Osteosarcoma: most are primary (occur in femur in teenagers); some are secondary (occur in patients with Pagets disease of bone) Chondrosarcoma: occurs in arm, leg, pelvis of older adults Ewing sarcoma: rare malignancy that occurs in teenagers; has t(11;22) Metastatic tumors of the jaw: breast and prostate most common; poor prognosis 4. Muscle Disorders Duchenne Muscular Dystrophy X-linked Deletion of dystrophin gene Degeneration of muscles Wheelchair-bound by age 10-15; death from respiratory insufficiency or arrhythmia Myotonic Dystrophy Autosomal dominant Atrophy of type I fibers, hypertrophy of type II fibers Muscle weakness and sustained muscular contractions Gets worse from one generation to next Myasthenia Gravis Autoimmune disease Antibodies to acetylcholine receptor cause muscle fatigue Extraocular muscles and muscles of extremities particularly affected Removal of thymus can be curative     PAGE  Musculoskeletal Pathology - PAGE 4 of 4 !"%9ABCQ[G U     ) ĵĦě}}}rrcěTITh&ohIXOJQJh&ohIXB*OJQJphh&ohIXCJ OJQJaJ h&ohe{OJQJh&oh+B*OJQJphh&ohe{B*OJQJphh&oh+OJQJh&oha CJ OJQJaJ h&ohCJ OJQJaJ h&oh+CJ OJQJaJ h&ohAZCJ(OJQJaJ(h&oh+CJ(OJQJaJ(h&ohTCJ(OJQJaJ(!"BC[f 8 F G U u  ) gdIXgd+ & F 8^gd+) d & Q { |  ^ f g t  & F 8^gdqgdqgdIX & F 8^gdIX  % Q z { | ^ l ~ ? e f g s t 4LM|}45yyyynyh&oh&`OJQJh&`h&`OJQJh&`OJQJh&`h&`B*OJQJphh&`B*OJQJphh&ohYB*OJQJphh&oh|XOJQJh&ohYOJQJh&ohAZB*OJQJphh&ohqB*OJQJphh&ohqOJQJh&ohIXOJQJ+ 34M}5e*Ff & F 8^gd6gd6 & F 8^gd&`gd&`gdY & F 8^gdq5de*>?N#$%:nȽȲsh]]hh&oh\<&OJQJh&oh#2)OJQJh&oh~tB*OJQJphh&ohPOJQJh&oh~tOJQJh&ohHxOJQJh&oh&B*OJQJphh&oh&OJQJh&ohYOJQJh&oh6OJQJh&oh6B*OJQJphh&oh&`OJQJh&`h&`OJQJh&`OJQJ/>?Nh$%:ngda  & F 8^gd\<& & F 8^gd~tgd~t & F 8^gd&gd& & F 8^gd6gd6JK$% !ƷƊ{pdUh&`h&`B*OJQJphhAB*OJQJphh&`h&`OJQJh&`h&`CJ OJQJaJ hCJ OJQJaJ h&oh&`OJQJh&oh\<&OJQJh&oh~tOJQJh&oh~tB*OJQJphh&oha OJQJha ha OJQJha OJQJha ha B*OJQJphha B*OJQJph KFt%!Jw & F 8^gd&`gd&`gda gd~t & F 8^gd~t & F 8^gda !*CIJmvw&'*+xyz{~;<Ʒݙ{papVh&oh&OJQJh&oh\<&B*OJQJphh&oh\<&OJQJh&oh\<&CJ OJQJaJ h&ohCJ OJQJaJ h&oh~tOJQJh&`ha OJQJha OJQJh&`h&`B*OJQJphh B*OJQJphh&`h OJQJh&`h&`OJQJh OJQJh&`OJQJhAOJQJ!w'+yz{;<Obgd& & F 8^gd\<&gd\<&gd~tgd&` & F 8^gd&`<O   ûuu_u+h&ohP0JCJOJQJaJmHnHu)jh&oha 0JCJOJQJUaJ h&oha 0JCJOJQJaJha ha 0Jjha 0JUh&ojh&oUh&OJQJh\<&OJQJh&oh|XOJQJh&oh|XB*OJQJphh&oh\<&OJQJh&oh\<&B*OJQJphVgd& & F 8^gd|Xgd|Xgd\<& & F 8^gd\<&   gd&h]hgdAZ &`#$gd l,1h/ =!"#$% 6666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA`D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 4 @4 AZFooter  !.)@. 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