Difference between revisions of "Joints"
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*Classically on the wrist.<ref name=pmid17488856>{{Cite journal | last1 = Hasham | first1 = S. | last2 = Burke | first2 = FD. | title = Diagnosis and treatment of swellings in the hand. | journal = Postgrad Med J | volume = 83 | issue = 979 | pages = 296-300 | month = May | year = 2007 | doi = 10.1136/pgmj.2005.043992 | PMID = 17488856 }}</ref> | *Classically on the wrist.<ref name=pmid17488856>{{Cite journal | last1 = Hasham | first1 = S. | last2 = Burke | first2 = FD. | title = Diagnosis and treatment of swellings in the hand. | journal = Postgrad Med J | volume = 83 | issue = 979 | pages = 296-300 | month = May | year = 2007 | doi = 10.1136/pgmj.2005.043992 | PMID = 17488856 }}</ref> | ||
*May be painful.<ref name=Ref_Derm322>{{Ref Derm|322}}</ref> | *May be painful.<ref name=Ref_Derm322>{{Ref Derm|322}}</ref> | ||
===Gross=== | |||
*Mass at a joint - classically in the hand. | |||
DDx - clinical: | |||
*Metacarpal boss - degenerative [[arthritis]].<ref name=pmid432327>{{Cite journal | last1 = Cuono | first1 = CB. | last2 = Watson | first2 = HK. | title = The carpal boss: surgical treatment and etiological considerations. | journal = Plast Reconstr Surg | volume = 63 | issue = 1 | pages = 88-93 | month = Jan | year = 1979 | doi = | PMID = 432327 }}</ref> | |||
===Microscopic=== | ===Microscopic=== | ||
Features:<ref name=emed_gc>URL: [http://emedicine.medscape.com/article/1243454-overview http://emedicine.medscape.com/article/1243454-overview]. Accessed on: 8 February 2012.</ref><ref name=Ref_Derm322>{{Ref Derm|322}}</ref> | Features:<ref name=emed_gc>URL: [http://emedicine.medscape.com/article/1243454-overview http://emedicine.medscape.com/article/1243454-overview]. Accessed on: 8 February 2012.</ref><ref name=Ref_Derm322>{{Ref Derm|322}}</ref> | ||
Revision as of 12:22, 15 November 2012
Joints are important for locomotion. This article collects tidbits about their pathology.
Prosthetic joint infection
General
- Bits of tissue come for frozen section to r/o infection.
- The interface membrane (not the pseudocapsule) should be sampled to obtain a high sensitivity.[1]
Microscopic
Features:
- Neutrophils - key feature.
Notes:
- Various criteria for the number of neutrophils exist (see below).[2]
- The definitions suffer from HPFitis.
- Finding of plasma cells and lymphocytes is not contributory for the diagnosis of infection.[2]
- Granulomatous inflammation that isn't of a foreign-body type should get the usual work-up.[3]
Feldman criteria
Athanasou criterion
Juxta-articular myxoma
- Abbreviated JAM.
General
- Classically present as a mass or with pain.[4]
- May recur.
- Described as (microscopically) indistinguishable from intramuscular myxoma.[5]
Gross
Features:
- Close to large joints - classically around the knee.
- >85% of cases around the knee in one large series.[4]
Microscopic
Features:[4]
- Myxomatous stroma.
- +/-Cystic changes.
- Large nuclei with hyperchromasia and nuclear scalloping.[6]
DDx:
- Ganglion cyst.
- Intramuscular myxoma - surrounded by muscle.
Images:
Morton neuroma
Main article: Morton neuroma
Ganglion cyst
General
Gross
- Mass at a joint - classically in the hand.
DDx - clinical:
Microscopic
- Empty space(s); usually multiple.
- Fibrotic wall.
- No epithelial lining.†
- +/-Myxoid change - very common.
- May have some spindled fibroblasts.
† The entity is really a pseudocyst.[7]
DDx:
- Synovial cyst - true cyst(has an epithelial lining), villous projections into the cystic space.
- Juxta-articular myxoma.
- Myxoma.
- Digital mucous cyst - has many spindled fibroblasts, usu. superficial.[9]
Images:
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SOFT TISSUE ("GANGLION CYST"), LEFT WRIST, EXCISION:
- GANGLION CYST.
Micro
The sections show fibroadipose tissue with cyst-like spaces surrounded by fibrous tissue. There are no villous projections into the cyst-like spaces. Focal myxoid areas are present with rare bland spindle cells. There is no nuclear atypia and no mitotic activity is appreciated. Dense connective tissue consistent with tendon is present focally.
Rheumatoid arthritis
Main article: Rheumatoid arthritis
See also
References
- ↑ 1.0 1.1 Bori, G.; Muñoz-Mahamud, E.; Garcia, S.; Mallofre, C.; Gallart, X.; Bosch, J.; Garcia, E.; Riba, J. et al. (Apr 2011). "Interface membrane is the best sample for histological study to diagnose prosthetic joint infection.". Mod Pathol 24 (4): 579-84. doi:10.1038/modpathol.2010.219. PMID 21131917.
- ↑ 2.0 2.1 2.2 2.3 Bori, G.; Soriano, A.; García, S.; Mallofré, C.; Riba, J.; Mensa, J. (Jun 2007). "Usefulness of histological analysis for predicting the presence of microorganisms at the time of reimplantation after hip resection arthroplasty for the treatment of infection.". J Bone Joint Surg Am 89 (6): 1232-7. doi:10.2106/JBJS.F.00741. PMID 17545426.
- ↑ URL: http://path.upmc.edu/cases/case174.html. Accessed on: 8 January 2012.
- ↑ 4.0 4.1 4.2 Meis, JM.; Enzinger, FM. (Jun 1992). "Juxta-articular myxoma: a clinical and pathologic study of 65 cases.". Hum Pathol 23 (6): 639-46. PMID 1592386.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 624. ISBN 978-0781765275.
- ↑ URL: http://path.upmc.edu/cases/case38/micro.html. Accessed on: 2 January 2011.
- ↑ 7.0 7.1 7.2 URL: http://emedicine.medscape.com/article/1253223-overview]. Accessed on: 8 February 2012. Cite error: Invalid
<ref>tag; name "emed_gc" defined multiple times with different content - ↑ Hasham, S.; Burke, FD. (May 2007). "Diagnosis and treatment of swellings in the hand.". Postgrad Med J 83 (979): 296-300. doi:10.1136/pgmj.2005.043992. PMID 17488856.
- ↑ 9.0 9.1 9.2 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 322. ISBN 978-0443066542.
- ↑ Cuono, CB.; Watson, HK. (Jan 1979). "The carpal boss: surgical treatment and etiological considerations.". Plast Reconstr Surg 63 (1): 88-93. PMID 432327.