pathologi tulang

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    Structure of Normal Bone

    Functions :

    Supporting the body

    Providing attachment site formuscles & tendons

    provide motion

    Protects vital organs &

    houses of bone-marrows Mineral deposits, esp.

    calcium

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    Type of Bones

    The flat bones

    Skull, scapula, clavicle, vertebra, jaw & pelvis

    The tubular bones

    Femur, tibia, fibula, humerus, etc

    Cortical (or compact) bone

    Both types consists of

    Cancellous (or spongy) bone

    In a typical long bone (Such as femur) :

    Diaphysis is composed of cortical bone surrounding medullary

    cavity

    Epiphyses mostly are cancellous bone & a thin rim of cortical

    bone

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    Normal Bones

    is the basic structural unit of

    cortical bone

    It consists of

    a central Haversian canal- blood vessels

    - surrounding by lamelae of bone

    anastomosing system of canals

    Lamelae of Bone

    Have a large number of

    lacunae contain osteocytes

    The Haversian System = Osteon

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    Normal Bones

    Periosteum : a connective tissue layer

    (collagen), penetrate cortical bone

    a tight attachment

    together with large blood vessels & nerve

    Cortex Separated by endosteum Marrow space (a thin layer of connective tissue)

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    Methods of Biopsy

    Open Biopsy

    The most common method for diagnosing

    bone tumors

    Needle Biopsy

    Effective & safe technique

    A larger amount of tissue compare to FNAB

    Fine Needle Aspiration Biopsy (FNAB)

    The accuracy about 80% in bone tumors

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    Diagnosis of Bone Lesions

    Clinical datasor

    diagnosis

    Histopathological

    diagnosis

    Radiological

    diagnosis

    Frozen section :

    - To check the tumor margins

    - for metastatic tumor- to check the adequacy of

    biopsy

    - Name- Sex

    - Age

    - History

    - Examination

    - Lab. Findings- etc

    - Location- Type of lesion

    - Extension

    - Periosteal -

    reaction

    - Calcification

    - etc

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    Basic Principles of Cancer Cytogenetics

    In 1960 : The Philadelphia (Ph)chromosome in CML was discovered

    In 1970 : Chromosomal Banding

    techniques. Each chromosome could beidentified precisely

    Tissue must be fresh not frozen or fixed informalinin sterile culture media :

    Buffer sol (Hanks buffered salt solution)

    Cytogenetic Analysis

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    Bone Tumors

    Classification, based on :

    Cytologic features

    The matrix

    Benign tumors :

    Malignant tumors : rarely arise from

    benign ones

    Incidence : 0,2% of all cancers were Bone

    Sarcomas

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    Bone Sarcoma

    The most frequent : Osteosarcoma

    Followed by :

    Chondrosarcoma

    Myeloma

    Lymphoma

    Ewing Sarcoma

    Chordoma Fibrosarcoma

    etc

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    Surgical Margins

    Radical The entire compartment involved by tumor is removed

    Wide The tumor is removed with surrounding normal tissue

    & the reactive zones (composed of the fibrovascularpseudocapsule) is removed intact

    Marginal The tumor is removed entirely but the incision goes

    through the reactive zone

    Intra lesional The tumor is not removed intact & margins are

    involved

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    Entirely cartilage Malignant osteoid (-)

    Pelvic, shoulder girdles,upper ends of the femur& humerus

    More than 60% in thefourth-sixth decades

    Radiographic Usually large size

    75% calcification Mineralization shape, ring

    shaped, popcorn like, orcomma shaped

    Expansion of bone &thickening of cortex

    Bone produced by thetumor cells

    Malignant osteoid (+)

    The metaphyseal regionof long bones (region of

    the knee) The peak incidence is in

    the second decade of life

    Radiographic

    Lytic Sclerotic

    Codmans triangle

    Cloud like

    sunburst

    CHONDROSARCOMA OSTEOSARCOMA

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