Musculoskeletal System Flashcards

Pathoma MS Chp 18

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1
Q

Achondroplasia

Pathology:

Symptoms/Signs:

Causes:

A

Path:
Impaired cartilage proliferation in the growth plates of lone bones (Dwarfism)

Signs:
1) Short extremities & normal head/chest (poor endochondral growth)

Causes:
FGFR3 mutation (overexpression)

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2
Q

Path:
Impaired cartilage proliferation in the growth plates of lone bones (Dwarfism)

Signs:
1) Short extremities & normal head/chest (poor endochondral growth)

Causes:
FGFR3 mutation (overexpression)

A

Achondroplasia

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3
Q

Osteogenesis imperfecta

Pathology/cause:

Symptoms/Signs:

A

Path:
Defective bone resorption due to deficient type 1 collage synthesis

Signs:
1) Multiple fractures
2) Blue sclera
3) Hearing loss

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4
Q

Path:
Defective bone resorption due to deficient type 1 collage synthesis

Signs:
1) Multiple fractures
2) Blue sclera
3) Hearing loss

A

Osteogenesis imperfecta

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5
Q

Osteopetrosis

Pathology:

Symptoms/Signs:

Causes:

Treatments:

A

Path:
Defective bone resorption causing abnormally thick bones

Signs:
1) Fractures
2) Anemia/Thrombocytopenia/Leukopenia with extramedullary hematopoiesis
3) Vision/Hearing loss
4) Hydrocephalus
5) Renal tubular acidosis

Causes:
Carbonic anhydrase mutation (osteoclast dysfunction)

Treatment:
Bone transplant

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6
Q

Path:
Defective bone resorption causing abnormally thick bones

Signs:
1) Fractures
2) Anemia/Thrombocytopenia/Leukopenia with extramedullary hematopoiesis
3) Vision/Hearing loss
4) Hydrocephalus
5) Renal tubular acidosis

Causes:
Carbonic anhydrase mutation (osteoclast dysfunction)

Treatment:
Bone transplant

A

Osteopetrosis

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7
Q

Rickets

Pathology:

Symptoms/Signs:

Cause:

A

Path:
Abnormal bone mineralization in children (<1yrs)

Signs:
1) Pigeon chest
2) Frontal bossing (enlarged forehead)
3) Rachitic rosary
4) Bowed legs

Cause:
Vit D deficiency in kids

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8
Q

Path:
Abnormal bone mineralization in children (<1yrs)

Signs:
1) Pigeon chest
2) Frontal bossing (enlarged forehead)
3) Rachitic rosary
4) Bowed legs

Cause:
Vit D deficiency in kids

A

Rickets

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9
Q

Osteomalacia

Pathology:

Symptoms/Signs:

Cause:

Labs:

A

Path:
Inadequate bone mineralization in adults

Signs:
1) Fractures

Cause:
Vit D deficiency in adults

Labs:
Low serum Ca2+ & PO4-
High PTH & Alkaline phosphatase

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10
Q

Path:
Inadequate bone mineralization in adults

Signs:
1) Fractures

Cause:
Vit D deficiency in adults

Labs:
Low serum Ca2+ & PO4-
High PTH & Alkaline phosphatase

A

Osteomalacia

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11
Q

OsteoPOROSIS

Pathology:

Symptoms/Signs:

Cause:

Labs:

Treatment:

Avoid ________

A

Path:
Trabecular bone loss (porous bones)

Signs:
1) Bone pain & fractures in weight bearing areas (spine/hips etc)
2) Shortened height & Kyphosis

Causes:
1) Genetics (vit D receptor variants)
2) Diet (vit D deficiency)
3) Sedentary

Labs:
Low bone density (DEXA scan)
Normal serum Ca2+, PO4-, & Alkaline phosphatase

Treatment:
Exercise
Vit D & Ca2+ sup
Bisphosphates
Estrogen replacement

AVOID Glucocorticoids

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12
Q

Path:
Trabecular bone loss (porous bones)

Signs:
1) Bone pain & fractures in weight bearing areas (spine/hips etc)
2) Shortened height & Kyphosis

Causes:
1) Genetics (vit D receptor variants)
2) Diet (vit D deficiency)
3) Sedentary

Labs:
Low bone density (DEXA scan)
Normal serum Ca2+, PO4-, & Alkaline phosphatase

Treatment:
Exercise
Vit D & Ca2+ sup
Bisphosphates
Estrogen replacement

AVOID Glucocorticoids

A

Osteoporosis

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13
Q

Paget’s disease of the bone

Pathology:

Symptoms/Signs:

Treatments:

Complications:

A

Path:
Osteoclast & osteoblast imbalance localized to one or more bones occurring in stages:
1) Osteoclastic
2) Mixed
3) Osteoblastic
Results in thick/sclerotic bones that fracture easily

Signs:
1) Bone pain
2) Bigger hat size
3) Hearing loss
4) Lion-facies

Treatments:
1) Calcitonin (inhibit osteoclasts)
2) Bisphosphates (osteoclast apoptosis)

Complication:
1) High-out out cardiac failure (AV shunts in bone)
2) Osteosarcoma

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14
Q

Path:
Osteoclast & osteoblast imbalance localized to one or more bones occurring in stages:
1) Osteoclastic
2) Mixed
3) Osteoblastic
Results in thick/sclerotic bones that fracture easily

Signs:
1) Bone pain
2) Bigger hat size
3) Hearing loss
4) Lion-facies

Treatments:
1) Calcitonin (inhibit osteoclasts)
2) Bisphosphates (osteoclast apoptosis)

Complication:
1) High-out out cardiac failure (AV shunts in bone)
2) Osteosarcoma

A

Paget’s disease of the bone

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15
Q

Osteomyelitis

Pathology:

Symptoms/Signs:

Cause:

Diagnostic tests:

A

Path:
Systemic bone marrow infection with hematogenous spread

Signs:
1) Bone pain & Fever/Leukocytosis
2) Sequestration/Lytic focus (abscess)
3) Involucrum/Sclerosis

Causes:
1) S. aureus (main)
2) N. gonorrhea (sexually +ve adults)
3) Salmonella (sickle-cell)
4) Pseudomonas (diabetes/IV drug abuse)
5) Pasteurella (cat/dog scratches)
6) M. tuberculosis (Pott disease)

Tests:
Blood cultures

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16
Q

Path:
Systemic bone marrow infection with hematogenous spread

Signs:
1) Bone pain & Fever/Leukocytosis
2) Sequestration/Lytic focus (abscess)
3) Involucrum/Sclerosis

Causes:
1) S. aureus (main)
2) N. gonorrhea (sexually +ve adults)
3) Salmonella (sickle-cell)
4) Pseudomonas (diabetes/IV drug abuse)
5) Pasteurella (cat/dog scratches)
6) M. tuberculosis (Pott disease)

Tests:
Blood cultures

A

Osteomyelitis

“SMelly Socks Need ProPer washing”

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17
Q

Avascular/Aseptic necrosis

Pathology:

Cause:

Complications:

A

Path:
Ischemic necrosis of bone & marrow

Causes:
1) Trauma/Fracture (main)
2) Steroids
3) Sickle cell
4) Caissons disease

Complications
Osteoarthritis & fractures

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18
Q

Path:
Ischemic necrosis of bone & marrow

Causes:
1) Trauma/Fracture (main)
2) Steroids
3) Sickle cell
4) Caissons disease

Complications
Osteoarthritis & fractures

A

Avascular/Aseptic necrosis

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19
Q

Osteoma

Pathology:

Associated condition:

A

Path:
Benign facial bone tumor

Ass:
Gardeners syndrome

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20
Q

Path:
Benign facial bone tumor

Ass:
Gardeners syndrome

A

Osteoma

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21
Q

Osteoid Osteoma

Pathology:

Symptoms/Signs:

Diagnostic tests:

A

Path:
Benign osteoblast tumor of the cortex of long bones in young adults (men)

Signs:
1) Bone pain (relieved by aspirin)

Tests:
Boney mass <2cm with a radiolucent core (osteoid)

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22
Q

Path:
Benign osteoblast tumor of the cortex of long bones in young adults (men)

Signs:
1) Bone pain (relieved by aspirin)

Tests:
Boney mass <2cm with a radiolucent core (osteoid)

A

Osteoid Osteoma

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23
Q

Osteochondroma

Pathology:

Histological findings:

Complications:

A

Path:
Bone tumor with a cartilage cap that arises in the metaphysis

Histo:
Bone is continuous with marrow space

Complication:
Cartilage cap rarely transforms into a chondrosarcoma

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24
Q

Path:
Bone tumor with a cartilage cap that arises in the metaphysis

Histo:
Bone is continuous with marrow space

Complication:
Cartilage cap rarely transforms into a chondrosarcoma

A

Osteochondroma

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25
Q

Osteosarcoma

Pathology:

Symptoms/Signs:

Cause/Risk:

Tests/Histology:

A

Path:
Malignant Osteoblastic tumor in teens that arises in long bone metaphysis (distal femur or proximal tibia)

Signs:
1) Fractures
2) Bone pain & swelling

Cause/risk:
Familial retinoblastoma or Paget’s disease

Histo/tests:
1) Destructive mass with a sunburst app & lifted periosteum
2) Pleomorphic cells (make osteoid)

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26
Q

Path:
Malignant Osteoblastic tumor in teens that arises in long bone metaphysis (distal femur or proximal tibia)

Signs:
1) Fractures
2) Bone pain & swelling

Cause/risk:
Familial retinoblastoma or Paget’s disease

Histo/tests:
1) Destructive mass with a sunburst app & lifted periosteum
2) Pleomorphic cells (make osteoid)

A

Osteosarcoma

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27
Q

Giant cell tumor

Pathology:

Diagnostic tests/Histology:

Complication:

A

Path:
A locally aggressive multinucleated GC & Stromal tumor in the epiphyses of long bones (dist. femur & prox. tibia) in young adults

Test/Histo:
Soap bubble X-ray

Complication:
Reoccurrence

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28
Q

Path:
A locally aggressive multinucleated GC & Stromal tumor in the epiphyses of long bones (dist. femur & prox. tibia) in young adults

Test/Histo:
Soap bubble X-ray

Complication:
Reoccurrence

A

Giant cell tumor

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29
Q

Ewing sarcoma

Pathology:

Diagnostic tests:

Complication:

A

Path:
Malignant poorly differentiated neuroectoderm tumor in the diaphysis of long bones in male children under 15yrs

Tests:
1) Onion skin X-ray
2) Round blue cells
3) 11;22 Translocation

Complication:
Metastasis

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30
Q

Path:
Malignant poorly differentiated neuroectoderm tumor in the diaphysis of long bones in male children under 15yrs

Tests:
1) Onion skin X-ray
2) Round blue cells
3) 11;22 Translocation

Complication:
Metastasis

A

Ewing sarcoma

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31
Q

Chondroma

Pathology:

A

Path:
Benign cartilage tumor in medulla of small bones of the hands/feet

32
Q

Path:
Benign cartilage tumor in medulla of small bones of the hands/feet

A

Chondroma

33
Q

Chondrosarcoma

Pathology:

A

Path:
Malignant cartilage tumor in the medulla of the pelvis & central skeleton

34
Q

Path:
Malignant cartilage tumor in the medulla of the pelvis & central skeleton

A

Chondrosarcoma

35
Q

Metastatic bone tumor

Pathology:

A

Path:
Osteolytic (punched-out) lesions usually from colon cancer metastasis

36
Q

Path:
Osteolytic (punched-out) lesions usually from colon cancer metastasis

A

Metastatic bone tumor

37
Q

Osteoarthritis

Pathology:

Causes:

Symptoms/Signs:

A

Path:
Progressive degeneration of articular cartilage in a limited number of joints (oligoarticular)

Cause:
1) Wear & Tear (age, obesity, & trauma)

Signs:
1) Joint stiffness that worsens throughout the day

2) Disrupted cartilage lining the articular surface & joint mice (floating cartilage)

3) Eburnation of subchondral bone

4) Osteophytes (reactive bony growths in the DIP (Heberden nodes) & PIP (Bouchard nodes)

38
Q

Path:
Progressive degeneration of articular cartilage in a limited number of joints (oligoarticular)

Cause:
1) Wear & Tear (age, obesity, & trauma)

Signs:
1) Joint stiffness that worsens throughout the day

2) Disrupted cartilage lining the articular surface & joint mice (floating cartilage)

3) Eburnation of subchondral bone

4) Osteophytes (reactive bony growths in the DIP (Heberden nodes) & PIP (Bouchard nodes)

A

Osteoarthritis

39
Q

Rheumatoid arthritis

Pathology:

Symptoms/Signs:

Cause:

Labs/Histological findings:

Complications:

A

Path:
Autoimmune destruction of cartilage (entire skeleton EXCEPT DIP)

Cause:
HLA-DR4 gene (middle-aged women)

Labs/Histo:
1) IgM vs Fc part of IgG
2) Neutrophils & high protein in synovial fluid
3) Pannus (synovitis causing inflamed granulation tissue)
4) Narrowed joint spaces & fusion
5) Osteopenia

Complications:
Anemia of chronic disease & secondary amyloidosis

40
Q

Path:
Autoimmune destruction of cartilage (entire skeleton EXCEPT DIP)

Cause:
HLA-DR4 gene (middle-aged women)

Labs/Histo:
1) IgM vs Fc part of IgG
2) Neutrophils & high protein in synovial fluid
3) Pannus (synovitis causing inflamed granulation tissue)
4) Narrowed joint spaces & fusion
5) Osteopenia

Complications:
Anemia of chronic disease & secondary amyloidosis

A

Rheumatoid arthritis

41
Q

Ankylosing spondylarthritis

Pathology:

Symptoms/Signs:

Causes:

Complication:

A

Path:
Arthritis-like involvement of the sacroiliac joints & spine in young men

Signs:
1) Lower back pain
2) Bamboo spine (vertebra fusion)
3) Uveitis
3) Aortitis

Causes:
Lacking a rheumatoid factor
HLA-B27 association

Complication:
Aortic regurgitation

42
Q

Path:
Arthritis-like involvement of the sacroiliac joints & spine in young men

Signs:
1) Lower back pain
2) Bamboo spine (vertebra fusion)
3) Uveitis
3) Aortitis

Causes:
Lacking a rheumatoid factor
HLA-B27 association

Complication:
Aortic regurgitation

A

Ankylosing spondylarthritis

43
Q

Reiter syndrome

Pathology:

Symptoms/Signs:

Cause:

A

Path:
Arthritic-like signs weeks following a Gi or Chlamydia trachomatis infection in young men

Sigs:
1) Arthritis
2) Urethritis
3) Conjunctivitis

Causes:
Lacking a rheumatoid factor
HLA-B27 association

44
Q

Path:
Arthritic-like signs weeks following a Gi or Chlamydia trachomatis infection in young men

Sigs:
1) Arthritis
2) Urethritis
3) Conjunctivitis

Causes:
Lacking a rheumatoid factor
HLA-B27 association

A

Reiter syndrome

45
Q

Psoriatic arthritis

Pathology:

Symptoms/Signs:

Cause:

A

Path:
Arthritic-signs in 10% of psoriasis cases

Signs:
1) Sausage-like fingers/toes

Causes:
Lacking a rheumatoid factor
HLA-B27 association

46
Q

Path:
Arthritic-signs in 10% of psoriasis cases

Signs:
1) Sausage-like fingers/toes

Causes:
Lacking a rheumatoid factor
HLA-B27 association

A

Psoriatic arthritis

47
Q

Infectious arthritis

Pathology:

Symptoms/Signs:

Causes:

A

Path:
Infection of a joint (knee)

Signs:
1) Warmth/redness
2) Limited ROM
3) Fever/High WBC & ESR

Causes:
1) N. gonorrhea (young adults #1)
2) S. aureus (older children & adults #2)

48
Q

Path:
Infection of a joint (knee)

Signs:
1) Warmth/redness
2) Limited ROM
3) Fever/High WBC & ESR

Causes:
1) N. gonorrhea (young adults #1)
2) S. aureus (older children & adults #2)

A

Infectious arthritis

49
Q

Pseudogout

Pathology:

Symptoms/Signs:

Labs/Histological findings:

A

Path:
Deposition of CPPD (Ca2+ pyrophosphate dihydrate) into joints/tissues

Signs:
1) Gout

Labs/Histo:
Rhomboid-crystals with weakly +ve birefringent under polarized light

50
Q

Path:
Deposition of CPPD (Ca2+ pyrophosphate dihydrate) into joints/tissues

Signs:
1) Gout

Labs/Histo:
Rhomboid-crystals with weakly +ve birefringent under polarized light

A

Pseudogout

51
Q

Chronic gout

Pathology:

Symptoms/Signs:

Labs/Histological findings:

A

Path:
Long-term deposition of monosodium urate crystals in joints/tissues

Signs:
1) Renal failure (urate nephropathy)
2) signs of gout

Labs/Histo:
1) Hyperuricemia
2) Needle-crystal with -ve birefringent under polarized light
3) Tophi (chalky-white uric acid crystals)

52
Q

Path:
Long-term deposition of monosodium urate crystals in joints/tissues

Signs:
1) Renal failure (urate nephropathy)
2) signs of gout

Labs/Histo:
1) Hyperuricemia
2) Needle-crystal with -ve birefringent under polarized light
3) Tophi (chalky-white uric acid crystals)

A

Chronic gout

53
Q

Primary gout

Pathology:

Labs:

A

Path:
Deposition of monophosphate urate crystals in joints/tissues due to ideological hyperuricemia

Labs:
Hyperuricemia & needle-crystals with -ve birefringent under polarized light

54
Q

Path:
Deposition of monophosphate urate crystals in joints/tissues due to ideological hyperuricemia

Labs:
Hyperuricemia & needle-crystals with -ve birefringent under polarized light

A

Primary gout

55
Q

Secondary Gout

Pathology:

Symptoms/Signs:

Causes:

Labs/Histological findings:

A

Path:
Deposition of monosodium urate crystals in the joints/tissues due to another condition

Signs:
1) SUPER painful big toe (podagra)
(avoid alcohol & meat!)

Causes:
1) Leukemia & myeloproliferative disorder (increase cell turnover)

2) Lesch-Nyhan syndrome (def HGPRT resulting hyperuricemia, self-mutilation, & retardation

3) Renal insufficiency

Labs/Histo:
1) Needle-shaped crystals with -ve birefringent under polarized light
2) Hyperuricemia

56
Q

Path:
Deposition of monosodium urate crystals in the joints/tissues due to another condition

Signs:
1) SUPER painful big toe (podagra)
(avoid alcohol & meat!)

Causes:
1) Leukemia & myeloproliferative disorder (increase cell turnover)

2) Lesch-Nyhan syndrome (def HGPRT resulting hyperuricemia, self-mutilation, & retardation

3) Renal insufficiency

Labs/Histo:
1) Needle-shaped crystals with -ve birefringent under polarized light
2) Hyperuricemia

A

Secondary Gout

57
Q

Dermatomyositis

Pathology:

Symptoms/Signs:

Cause:

Lab/Histological findings:

Treatment:

A

Path:
Inflammation of the skin & muscles

Signs:
1) Bilateral proximal muscle weakness
2) Heliotrope rash (upper lids)
3) Grotton lesions (red papules on elbows/knuckles/knees)

Cause:
Ass with gastric carcinoma

Labs/Histo:
1) High CK
2) +ve ANA cells
3) +ve Anti-Jo-1 Antibodies
4) Perimysial inflammation (CD4+T)
5) Perivascular trophy (CD8+T)

Corticosteroids

58
Q

Path:
Inflammation of the skin & muscles

Signs:
1) Bilateral proximal muscle weakness
2) Heliotrope rash (upper lids)
3) Grotton lesions (red papules on elbows/knuckles/knees)

Cause:
Ass with gastric carcinoma

Labs/Histo:
1) High CK
2) +ve ANA cells
3) +ve Anti-Jo-1 Antibodies
4) Perimysial inflammation (CD4+T)
5) Perivascular trophy (CD8+T)

Corticosteroids

A

Dermatomyositis

59
Q

Polymyositis

Pathology:

Lab/Histological findings:

A

Path:
Inflammation of skeletal muscles (ONLY)

Labs/Histo:
1) Endomysial inflammation (CD8+T) with necrotic muscle fibers

60
Q

Path:
Inflammation of skeletal muscles (ONLY)

Labs/Histo:
1) Endomysial inflammation (CD8+T) with necrotic muscle fibers

A

Polymyositis

61
Q

X-linked muscular dystrophy

Pathology:

Cause:

A

Path:
Muscle wasting & replacement with fat

Cause:
Mutated dystrophin

62
Q

Path:
Muscle wasting & replacement with fat

Cause:
Mutated dystrophin

A

X-linked muscular dystrophy

63
Q

Duchenne muscular dystrophy

Pathology:

Symptoms/Signs:

Cause:

A

Path:
Proximal muscle weakness in 1 yr olds

Signs:
1) Calf pseudohypertrophy
2) Cardiorespiratory failure (Death)

Cause:
Deleted dystrophin

64
Q

Path:
Proximal muscle weakness in 1 yr olds

Signs:
1) Calf pseudohypertrophy
2) Cardiorespiratory failure (Death)

Cause:
Deleted dystrophin

A

Duchenne muscular dystrophy

65
Q

Becker muscular dystrophy

Pathology/Cause:

A

Path/Cause:
A milder condition due to mutated dystrophin

66
Q

Path/Cause:
A milder condition due to mutated dystrophin

A

Becker muscular dystrophy

67
Q

Myasthenia gravis

Pathology:

Symptoms/Signs:

Associated condition:

Treatments:

A

Path:
Autoantibodies vs post synaptic Ach receptors in the NMJ

Signs:
1) Muscle weakness (worse with use)
2) Ptosis & Diplopia

Ass:
Thymic hyperplasia or thymoma

Treatments:
AchE agents or Thymectomy

68
Q

Path:
Autoantibodies vs post synaptic Ach receptors in the NMJ

Signs:
1) Muscle weakness (worse with use)
2) Ptosis & Diplopia

Ass:
Thymic hyperplasia or thymoma

Treatments:
AchE agents or Thymectomy

A

Myasthenia gravis

69
Q

Lambert-Eaton syndrome

Pathology:

Symptoms/Signs:

Cause:

Treatment

A

Path:
Autoantibodies vs presynaptic Ca2+ channels in the NMJ (inhibiting Ach release)

Signs:
1) Proximal muscle weakness (better with use)

Cause:
SCLC

Treatment:
Resecting the cancer (AchE doesn’t help)

70
Q

Path:
Autoantibodies vs presynaptic Ca2+ channels in the NMJ (inhibiting Ach release)

Signs:
1) Proximal muscle weakness (better with use)

Cause:
SCLC

Treatment:
Resecting the cancer (AchE doesn’t help)

A

Lambert-Eaton syndrome

71
Q

Lipoma

Pathology:

A

Path:
Benign fat tumor in adults

72
Q

Liposarcoma

Pathology/Histology:

A

Path/Histo:
Malignant fat tumor inn adults with lipoblast cells

73
Q

Path/Histo:
Malignant fat tumor inn adults with lipoblast cells

A

Liposarcoma

74
Q

Rhabdomyoma

Pathology:

Labs/Histological findings:

A

Path:
Malignant skeletal muscle tumor in children

Labs/Histo:
1) Tumor in the head, neck, or vagina
2) Rhabdomyoblast cells that are desmin +ve

75
Q

Path:
Malignant skeletal muscle tumor in children

Labs/Histo:
1) Tumor in the head, neck, or vagina
2) Rhabdomyoblast cells that are desmin +ve

A

Rhabdomyoma