Pathology of Bone

When 1 first developed an interest in the pathology of bone 1 found that there were relatively few books on the subject available. Much of my information had either to be obtained from searching the journals or from senior colleagues in the field, who, 1 should add, were always more than willing to teach me. With this memory in mind, 1 have endeavoured to produce a book which 1 hope is of a convenient size and yet will hold sufficient information to be of use mainly to the pathologist faced with a bone problem. This is not intended to be an all-embracing source of knowledge on the subject; indeed, such a task could not be undertaken by a single author in these days of the rapid increase in information even in small subspecialist areas within bone pathology. Although this book is written mainly for the pathologist, it is hoped that it may also be of interest and value to orthopaedic surgeons, rheumatolog­ ists and radiologists. Most of the illustrations are original and many of the drawings are my own. There has been a long tradition of interest in bone pathology at The London Hospital, which has resulted in a wealth of material being available to me from the archives of the Department of Morbid Anatomy. A few of the photo­ graphs are those of Prof. H. Turnbull; the observant reader will detect these, since the scales used are not metric.

1. Normal Bone.- Structure of bones.- Histological types of bone.- Cortical bone.- Cancellous bone.- Normal development of the skeleton.- Growth plate.- Reserve zone.- Proliferation zone.- Hypertrophic zone.- Metaphysis.- Ossification groove and perichondrial ring.- Mineralisation of bone.- Matrix vesicles.- Bone collagen and its mineralisation.- Origin of bone cells.- Osteoblast.- Osteoclast.- Cells in bone.- Osteoblasts.- Osteocytes.- Osteoclasts.- Bone resorption.- Control of bone cell function.- References.- 2. Abnormal Development of the Skeletal System.- The chondrodysplasias.- General considerations.- Achondroplasia.- Achondrogenesis.- Thanatophoric dysplasia.- Short-rib-polydactyly syndromes.- Chondroectodermal dysplasia (Ellis-van Creveld syndrome).- Asphyxiating thoracic dysplasia (Jeune syndrome).- Stippled epiphyses and chondrodysplasia punctata.- Other types of chondrodysplasia identifiable at birth.- Hypochondroplasia.- Metaphyseal dysplasias.- Multiple epiphyseal dysplasias.- Other types of chondrodysplasia not identifiable at birth.- Ultrastructural studies.- Osteogenesis imperfecta.- Classification.- Biochemical abnormalities.- Histological appearances.- Osteopetrosis.- Osteopetrosis of autosomal dominant type.- Osteopetrosis of autosomal recessive type.- Macroscopic and histological appearances.- Osteopetrosis in animals.- Pycnodysostosis.- Some other forms of abnormal skeletal development.- Cleidocranial dysplasia (cleidocranial dysostosis).- Congenital dislocation of the hip.- Slipped femoral capital epiphysis.- References.- 3. Inborn Biochemical Disorders of Metabolism.- The mucopolysaccharidoses.- Hurler’s syndrome.- Hunter’s syndrome.- Maroteaux-Lamy syndrome.- Morquio’s syndrome.- Histological appearances.- The mucolipidoses.- Mucolipidosis I.- Mucolipidosis II.- Mucolipidosis III.- Generalised gangliosidosis I.- The sphingolipidoses.- Gaucher’s disease.- Niemann-Pick disease.- Hypophosphatasia.- Oxalosis.- References.- 4. Quantitative Methods in Bone Biopsy Examination.- Bone biopsy.- Laboratory processing of the biopsy.- Staining methods.- Basic principles of measurement.- Point counting with an eyepiece graticule.- Linear intercept method.- Tetracycline labelling.- Measurements made and terms used in bone morphometry.- Normal values.- Variation and reproducibility.- Semi-automatic and automatic methods in bone quantitation.- Comparison of methods used in bone quantitation.- References.- 5. Metabolic Bone Disease.- Vitamin D metabolism.- Parathyroid hormone.- Primary hyperparathyroidism.- Secondary and tertiary hyperparathyroidism.- Hypoparathyroidism.- Psuedohypoparathyroidism.- Osteomalacia and rickets.- Vitamin D deficiency.- Malabsorption of vitamin D.- Vitamin D deficiency, bone disease and gastrointestinal disorders.- Impaired vitamin D metabolism in the liver and kidney.- Vitamin D-dependent rickets.- Phosphate depletion and hypophosphataemia.- Familial hypophosphataemia.- Other forms ofhypophosphataemic bone disease.- Inhibitors of mineralisation.- Osteomalacia in metabolic acidosis.- Hypophosphatasia.- Renal osteodystrophy.- Calcitonin.- The bones and other hormones.- Growth hormone and acromegaly.- Thyroid hormone, hyperthyroidism and hypothyroidism.- Adrenal cortical steroids and Cushing’s syndrome.- Diabetes mellitus.- References.- 6. Paget’s Disease of Bone.- Clinical features.- Fractures.- Tumours.- Cardiovascular effects.- Biochemical changes.- Radiological appearances.- Morbid anatomy and histopathology.- Aetiology.- Ultrastructural studies.- References.- 7. Hyperostosis.- Ankylosing hyperostosis of the spine (diffuse idiopathic skeletal hyperostosis).- Hyperostosis frontalis interna.- Melorheostosis.- Osteopoikilosis.- Other sclerosing disorders of bone.- Osteopathia striata.- Endosteal hyperostosis.- Sclerosteosis.- Infantile cortical hyperostosis.- Fluorosis.- Hypertrophic osteoarthropathy.- References.- 8. Osteoporosis and Bone Atrophy.- Clinical features.- Involutional osteoporosis.- Principal aetiological factors.- Histomorphometry.- Osteoporosis in the young.- Immobilisation osteoporosis.- Corticosteroid-induced osteopenia.- Localised bone loss.- Disappearing bone disease.- References.- 9. Necrosis and Healing in Bone.- Fractures and fracture healing.- Factors affecting the healing of fractures.- Failure of union.- Pathological fractures.- Stress or fatigue fractures.- Bone grafts.- Reactions of bone adjacent to joint prostheses and other implants.- Pathological examination of bone related to implants.- Reaction of osseous tissue adjacent to bone cement.- Direct contact of bone with implant material.- Wear debris and the implant bed.- Necrosis of bone.- Perthes disease (Legg-Calve-Perthes disease).- Effects of electrical stimulation on healing in bone.- Endogenous electrical signals in bone.- Bone response to exogenous electrical stimuli.- References.- 10. Infection of Bone.- Osteomyelitis in children.- Adult osteomyelitis.- Osteomyelitis in drug addicts.- Osteomyelitis and haemoglobinopathy: salmonella infection.- Osteomyelitis caused by direct spread of organisms.- Radiological appearances of osteomyelitis.- Pathology of osteomyelitis.- Complications of osteomyelitis.- Chronic bone abscess.- Tuberculosis.- Other organisms.- Brucellosis.- Leprosy.- Treponemal infections.- Syphilis.- Yaws.- Fungi and actinomycosis.- Actinomycosis.- Blastomycosis.- Coccidioidomycosis.- Cryptococcosis.- Maduromycosis.- Parasitic disease.- Viral infections.- References.- 11. Bone Tumours and Tumour-like Conditions.- Classification of bone tumours.- General approach to bone tumour pathology.- Clinical features.- Radiological features.- Histopathological diagnosis.- Particular types of bone tumour.- Cartilaginous tumours.- Osteochondroma (cartilage-capped exostosis).- Chondroma.- Chondroblastoma.- Chondromyxoid fibroma.- Chondrosarcoma.- Bone-forming tumours.- Osteoid osteoma.- Osteoblastoma.- Osteosarcoma (general considerations).- Telangiectatic osteosarcoma.- Osteosarcoma on the outside of the bone.- Osteosarcoma in abnormal bone.- Giant cell tumour.- Malignant fibrous tumours.- Round cell tumours.- Ewing’s sarcoma.- Primary malignant lymphoma.- References.