1. Locomotor system 1 - bone Pathology

2. Achondroplasia See the short and disproportionately thick bones

3. Osteogenesis Imperfecta - See the very large numbers of rib fractures (arrows). The infant died very shortly after birth.

4. This shows severe Paget’s disease of bone from a 77 year old female.

5. Histology in a late stage of the disease. The trabeculae of the cancellous bone are markedly thickened. This picture is described as a mosaic pattern, with haphazardly arranged cement lines which link haphazardly arranged units of lamellar (cancellous) bone. Here, the osteoblastic and osteoclastic activity has subsided. Arrows indicate the reversal lines.

6. An example of an acute fractureof the femur in a child, with displacement, shortening and a large haematoma. Fracture of a femur results in a great loss of blood and may cause death if not treated quickly

7. This shows healing fractures of tibia and fibula. See the early resorption of haematomas and callus formation

8. This is an example of an osteoid esteoma of the finger. See the sclerotic central nidus (arrow)

9. On histology, this is a low power view from the centre of the osteoid osteoma. There are randomly interconnecting trabeculae of woven bone and these are predominantly rimmed by osteoblasts (arrows). The cytological features are entirely benign

10. This shows a cartilage—capped exostosis (arrow), also called an osteochondroma, which is arising from the upper humerus from a man aged 21 (AKA mushroomy thing)

11. This is an example of enchondromatosis or Olliers disease in a boy, 15 years old, with multiple enchondromas (arrows) present

12. This is a benign chondroblastoma (arrows) in the head of the humerus of a male aged 16. He presented with pain in the shoulder and the tumour was curetted following biopsy diagnosis. It recurred and the head of the humerus was then excised

13. The giant cell tumour (arrows) occurred in the tibia in a man aged 29 years. He had noticed a slowly growing lump for 11 months and there had been a dull ache in the region made worse by walking. X-ray showed a large cystic radiolucent area in the upper tibia.

14. An osteosarcoma (arrows) of the femur in a girl aged 11 years and this is an amputation specimen

15. Histology shows an osteosarcoma. You can see the haphazardly deposited pink osteoid (arrows) present surrounding and between the malignant tumour cells. The tumour cells vary considerably in size and shape and many have large hyperchromatic nuclei.

16. Osteosarcoma of the femur. The haemorrhagic hole is the site of a biopsy. The lower part of the tumour is fibrous: the portion in the shaft shows osteogenic activity. Male aged 31.

17. This was from a 69 year old with Paget’s disease of bone who had a history of 2 months of a painful lump in the upper tibia

18. This is a chondrosarcoma of the scapula in a woman aged 35. She suffered from multiple hereditary exostoses and a mass arising from the shoulder blade had recently increased in size and become painful. This is an operative surgical specimen. Note the white translucent appearance of the tumour

19. Histology shows a chondrosarcoma. There is increased and uneven cellularity with moderately pleomorphic cells present in a chondroid matrix (blue arrows). A mitotic figure is seen (red arrow).

20. This is another example of a chondrosarcoma. Note the translucent white appearance, also seen in this tumour

21. Chordoma. This arose in the sacrum and is an operative surgical specimen

22. This is the spine and humerus showing metastatic (black arrows) breast carcinoma from a female aged 51 years. There is a pathological fracture (red arrows) of the humeral neck and crush fractures of vertebrae

23. This shows multiple metastases to the skull from a neuroblastoma of the adrenal gland from a one year old child

24. This is the spine from a woman aged 62 with multiple myeloma (arrows). She had presented with a 15 month history of bone pain. Radiological examination showed collapse of several vertebrae and multiple radiolucent areas in the skull. Serum protein 83g/l; Bence Jones protein found in her urine, Hb 8.5g/dl; 14% plasma cells in aspirated bone marrow. Her blood urea rose to 51.3 mmol/l, 5 days before her death

25. Bone tumours Benign Osteogenic — osteoid osteoma.; osteoblastoma Chondrogenic: osteochondroma; chondroma, chondroblastoma, chondromyxoid fibroma Unknown origin — giant cell tumour Fibrogenic — metaphyseal fibrous defect Various mesenchymal tumours may also occur in bone such as haemangiomas, lipomas and neurilemmomas. Malignant (Note: haematopoietic malignancies though present in bone marrow are not included in this grouping.) Osteogenic — osteosarcoma Chrondrogenic — chondrosarcoma Unknown — malignant germ cell tumour, Ewing’s tumour Fibrogenic — fibrosarcoma Notochord - chordoma. Various malignant mesenchymal tumours may also be seen in bones

26. Can’t remember the exact mnemonic…. Pete wrote it down Please Remember The Bony Lesions Prostate Renal Thyroid Breast Lung