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71 Cards in this Set

  • Front
  • Back
What is Osteoarthritis and what is it’s paradox?
=a degenerative joint disease

osteoarthritis is NON-inflammatory (or minimal inflamm)
What is the primary pathology of osteoarthritis?
=destruction of cartilage
What specific changes are seen w/ OA?
fibrillation, eburation, narrowing of joint space (on X-ray), subchondral cysts, osteophytes (bony outgrowth)
What signs indicate OA clinically?
Increasing/old age
Morning stiffness
Limitation of motion
What joints are most affected by OA?
Spine, hip, knee, distal interpharyngeal joints
Define: chondromalacia
=softening of cartilage
Define: ankylosis
=fixation of a joint
Define: synovitis
=inflamm of synovium
***Rheumatoid Arthritis***
***Rheumatoid Arthritis***
What kind of disorder is Rheumatoid Arthritis?
=chronic SYSTEMIC inflamm disorder w/ AUTOIMMUNITY!
What is seen histologically w/ RA?
Hypertrophy and chronic inflamm ⇒ pannus (“a cloth” that covers the articular cartilage); dense lymphoid aggregates*, no PMNs
What stxs are destroyed in RA?
Destruction of articular cartilage: synovium grows into joint space
Destruction of subchondral bone
Bone ankylosis: stiffening of the bone
Where is the most severe pathology of RA?
What body stxs other than joints are affected in RA?
• Skin – rheumatoid nodules in 25% (usually on extensor surfaces)
• Blood vessels – vasculitis
• Lungs
• Heart – pericardium, myocardium, valves
• Aorta
• Muscles
What can occur secondary to chronic inflammation?
Amyloidosis (assoc with chronic inflammation)
Etiology of RA:
Genetic predisposition to uncontrolled immune reaction
What autoantibody is found in most cases of RA?
Rheumatoid factor (RF) found in 80% of RA pts*
What is Rheumatoid factor?
Autoantibody to Fc portion of autologous IgG
What are the seronegative spondyloarthropathies?
=arthritis and some other problem, assoc with HLA B-27
1. ankylosing spondylitis
2. Reiter’s syndrome
3. enteropathic arthritis
4. psoriatic arthritis
Most common characteristics of pts w/ RA:
20-40 y/o
Symmetrical pain, stiffness, dec motion, and distortion of joints
What HLA is RA related to?
HLA B-27
What is ankylosing spondylitis associated with?
Axial joints, uveitis, aortitis, amyloidosis
What is Reiter’s syndrome?
Arthritis, nongonococcal urethritis (cervicitis), conjunctivitis
***Infectitious Arthritis***
***Infectitious Arthritis***
Signs of infectious arthritis:
Hematogenous or direct (trauma) causes
“hot joint”
lots of PMNs in synovial fluid
Etiologies of infectitious arthritis:
• Suppurative: Gonococcus, Staph*, Strep*, H. influenza*
• Gram-negative: E. coli, Salmonella, Pseudomonas
• Tuberculous arthritis
• Lyme disease
• Viral arthritis
***Lyme Disease***
***Lyme Disease***
What bug causes lyme disease?
Borrelia burgdorferi
What tick causes Lyme disease?
Ixodes scapularis
What is the difference b/w making an early and late diagnosis of Lyme disease?
Early diagnosis: cure
Late diagnosis: chronic disease
What are the possible CNS manifestations of Lyme disease?
Cranial neuritis
What are some possible cardiac manifestations of Lyme disease?
Heart block
Other late manifestations of Lyme disease if it goes untreated:
Erythema chronicum migrans* - frequently missed finding
Destructive chronic arthritis
Acrodermatitis atrophicans
What are some tick transmitted disease?
STAR: southern tick associated rash
Lyme disease
***Crystal Arthropathies: Gout and Pseudogout***
***Crystal Arthropathies: Gout and Pseudogout***
Primary cause of gout?

Secondary cause of gout?
Primary (90%): high uric acid

Secondary (10%): high uric acid, high nucleic acid turnover, low excretion
Other causes of gout:
1. chronic renal disease
2. inborn errors
What types of crystals are found in gout?
Monosodium urate crystals (MSU crystals)
What is a tophus?
=urate crystals w/in inflamm tissue
Other names for pseudogout?
1. Chrondrocalcinosis
2. Calcium pyrophosphate deposition disease (CPPD)
Causes of intraarticular crystal formation in pseudogout:
1. idiopathic (sporadic)
2. hereditary
3. secondary
What is the treatment for pseudogout?
No known treatment (but gout can be treated)*
***Tumors and Tumor-like Lesions***
***Tumors and Tumor-like Lesions***
What is a Baker’s cyst?
=popliteal cyst
Outpouching of the synovium
What is a bursa?
=a sac lined by synovium
What is a ganglion?
=a synovial cyst
What is a bursa?
A synovial filled sac that lubricates a joint for movement
What is pigmented villonodular synovitis?
Benign tumor of the synovium showing proliferative and nodular changes in synovial lined joints, bursae, and tendon sheaths
How are Soft Tissue Tumors (STTs) classified?
According to how they recapitulate: adipose tissue, fibrous tissue/fibrohistiocytic, muscle (smooth, skeletal), vascular tumors, peripheral nerve tumors, uncertain histiogenesis
Are STTs usually benign or malignant?
What percent of CA deaths?
benign > malignant, 100:1
2% cancer deaths; 0.8% of all malignancies
3 etiologies of STTs:
1. Radiation
2. Immunosuppression (AIDS)
3. Genetics
4 syndromes where you see STTS:
1. neurofibromatosis type I (von Recklinghausen’s dz): neurofibroma, malignant Schwannoma
2. Gardner syndrome: fibromatosis
3. Li-Fraumeni syndrome: p53
4. Osler-Weber-Rendu syndrome: telangiectasia
Most common site for STTs:
Lower extremity (40%)
Trunk and retroperitoneum (30%)
And other areas where you have lots of soft tissue
How do you grade STTs?**
What are lipomas? How do they appear clinically?
Benign fatty tumors
Appearance: soft, mobile, painless, well encapsulated, mature fat cell, no pleomorphism
What is the most common sarcoma in adults?

What age group gets them?

How do they appear histologically?
40-60 yo
histo: well-differentiated (indolent), myxoid (intermediate), round cell and pleomorphic variant (aggressive)
What do lipoblasts look like? What do they mimic?
Liposarcomas have lipoblasts: nuclear scalloping (mimic fetal fat cells)
***Fibrous STTs***
***Fibrous STTs***
Reactive pseudosarcomatous due to…
What is myostitis ossificans and what is it’s relevance?
Central zoning on X-ray

Can look microscopically like a sarcoma, but the zoning on X-ray tells you that it’s benign
Some examples of fibromatoses (superficial):

Who gets them more often?
1. palmar – Dupuytren contracture; flexion contracture of 4th-5th digits
2. plantar
3. penile – Peyronie disease; dorsal aspect of penis

What is a desmoid tumor? How are they managed?
Deep-seated fibromatoses

Need to make sure they are resected completely, b/c the recur
Where are they found?
What do they look like histologically?
Rare, aggressive
Location: retroperitoneal, thigh, knee, distal extremities

Histo: malignant spindle cells, “herringbone pattern”
2 types of fibrohistiocytic tumors:
1. dermatofibromas
2. malignant fibrous histiocytoma (MFH)
Histiologic appearance?
Location and size?
Pleomorphic, storiform (cartwheel) architecture, histiologic overlap

Location: muscles in proximal extremities; retroperitoneal
Size: large and aggressive
Common tumor of skeletal muscle in kids:
Histo appearance?
Rhabdomyosarcoma: childhood/adolescence

Location: head/neck, GU (urinary bladder, vagina)
Histo: small round cells (rhabdomyoblast), aka “tadpole” or “strap” cell, or
Alveolar type of architecture with small cells
What is embryonal rhabdomysarcoma?

…Sarcoma botryoides…
What is the most common neoplasm in women?
Examples? Histo?
Leiomyoma (benign)

Example: uterine “fibroids”
Histo: fascicles intersecting at right angles

Leiomyosarcomas look “terrible”
Synovial sarcomas?
Usually in younger adults
Has biphasic architecture: spindles and ...
to know:
15% of STTs are sarcomas
kids → rhabdo
young adult → synovial sarcomas