Please enable JavaScript.
Coggle requires JavaScript to display documents.
CNSLF Bone Path 3 - Joint disease/Arthritis (iv) (Gout arthritis…
CNSLF Bone Path 3 - Joint disease/Arthritis (iv)
Gout arthritis
M>F
peak incidence in 5th decade
25% of cases familial
deposition of monosodium uric acid crystals due to hyper uricaemia (serum urate > 7 mg/dl - primary or secondary)
primary
90%
risk factors
age (rare before 30)
family hx
alcohol
obesity
lots of meat
secondary
10%
overproduction of uric acid usually a/w excessive breakdown of nucleic acids
leukaemia, MM, massive cell lysis due to cytotoxic drugs e.g. chemo
renal under secretion (e.g. renal failure, diuretics, salicylate + ethanol)
enzyme deficiency e.g.hypoxanthine guanin phosphorylbosyl transferase (HGPRT - aka Lesch-Nyhan syndrome - esp in young males)
pathogenesis
deposition of urate crystals on surface of articular cart
interaction with leukocytes - degenerative changes
monoarticular: metatarsophalangeal joint of big toe = most commonly affected
deposition of uric acid in tissue results in tophus formation
stages
acute inflamm arthritis
asymp periods between attacks
chronic deposition of urate in + around joints (tophi)
comps
interstitial nephritis
renal calculi
renal failure
pathological dx
examine aspirated synovial fluid - narrow needle shaped crystals + neutrophils
alcohol fixation (crystals are water soluble, dissolve during formalin processing)
synovial bx
pseudogout
deposition of ca pyrophosphate on articular cart
M=F
usually > 50 y/o
classified into
hereditary
primary (idiopathic)
secondary (hyperparathyroidism, hypothyroidism, HFE, DM)
asymp until crystals are shed into joint space (spontaneous or due to trauma)
synovial fluid contains neutrophils + rhomboid crystals (rectangular, larger)
knees, wrists, shoulders
Tumours of soft tissue
tumours of mesenchymal origin that are classified according to their histologic differentiation
benign forms
malignant form = sarcoma
rare
M>F
occurs in organs or soft tissues
poorly understood pathogenesis
risk factors
radiation
chemical agents (e.g. vinyl chloride + angiosarc)
viruses (e.g. HHV8 + Kaposi's sarc)
genetic syndromes (Li fraumeni/germline p53 deletion + osteosarc)
prognosis
grade
degree of differentiation
cellularity
pleomorphism
presence + number of mitoses
presence of necrosis
stage
location (superficial has better prognosis than deep0
histologic type
dx
histologic exam
IHC
nearly all vimentin +ve (tumour marker)
leiomyosarc = desmin + actin +ve
rhabdomyosarc = myoglobin +ve
molecular dx
some have specific genetic abnormality
Ewing's = t(11;22)
Synovial = t(t;18)
classification
tumours of adipose tissue
lipoma
liposarcoma
tumours of smooth muscle
leiomyoma (e.g. uterine fibroids)
leimyosarcoma
tumours of skeletal muscle
rhabdomyoma
rhabdomyosarcoma
fibrohistiocytic tumours
fibrous histiocytoma
malignant fibrous histiocytoma
vasc tumours
haemangioma
angiosarcoma
peripheral N tumours
neurofibroma
malignant peripheral N sheath tumours
tumours of uncertain histogenesis (cell of unknown origin) - e.g. synovial sarcoma (doesn't arise from synovium)
majority of GISTs of c-kit mutations or PDGFR A
STI-571 (imatinib/gleevec) = selective tyrosine kinase R i