Histopathologische Klassifikationsprinzipien rheumatischer Gelenkerkrankungen

Krenn, Veit; Waldstein, Wenzel; Najm, Aurélie; Perino, Giorgio; Gaulke, Ralph

doi:10.1007/s00132-018-3649-x

Cited by 15 publications

(12 citation statements)

References 25 publications

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“…Most tissue samples in this study were harvested from hip joints (44 samples, 88%), whereas 6 samples (12%) were taken from knee joints. Heterotopic ossification around the knee joint has already been observed before and presents a known long-term complication in orthopaedic knee surgery 26,33 . In the current study, the knee tissue samples were Grade I HO, even in the two septic revision cases.…”

Section: Discussionmentioning

confidence: 87%

“…Only in cases of large tissue samples (more than 10 mm in diameter) osseous tissue had been separated in principle from adhering soft tissue and embedded separately, so that a soft tissue fraction (1.1) and an osseous tissue fraction (1.2) were generated which guaranties a complete histopathologic evaluation of osseous tissue as well as soft tissue. Tissues samples with a size up to 20 × 20 × 10 mm where completely embedded, large tissue samples where representatively embedded, including at least 50% of the tissue mass 26 . All these methods follow the published recommendations which are part of the DGORh, DGOOC and IAP (German section) recommendations for bone tissue processing in non-neoplastic orthopedic pathology 26 .…”

Section: Methodsmentioning

confidence: 99%

“…Tissues samples with a size up to 20 × 20 × 10 mm where completely embedded, large tissue samples where representatively embedded, including at least 50% of the tissue mass 26 . All these methods follow the published recommendations which are part of the DGORh, DGOOC and IAP (German section) recommendations for bone tissue processing in non-neoplastic orthopedic pathology 26 .…”

Section: Methodsmentioning

confidence: 99%

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Heterotopic Ossification in Orthopaedic and Trauma surgery: A Histopathological Ossification Score

Ohlmeier

Krenn

Thiesen

et al. 2019

Sci Rep

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Heterotopic Ossification (HO) is a potential long-term complication in orthopaedic surgery. It is commonly classified according to the Brooker classification, which is based on radiological findings. To our knowledge the correlation of histological features to the Brooker grade is unknown as is the association between HO and the indication for revision. The aim of this paper is to analyze the ossification grade of HO tissue in patients undergoing revision hip and knee arthroplasty and to propose a histologically based classification system for HO. We also assess the relationship between the grade of HO and the indication for revision (septic and aseptic revision). From January to May 2019 we collected 50 human HO samples from hip and knee revision arthroplasty cases. These tissue samples were doubleblinded and sent for histopathological diagnostic. Based on these results, we developed a classification system for the progression of HO. The grade of ossification was based on three characteristics: Grade of heterotopic ossification (Grade 1-3), presence of necrosis (N0 or N1) and the presence of osteomyelitis (HOES-Score Type 1 to 5). Demographic data as well as surgical details and indication for surgery was prospectively collected from clinical records. Fifty tissue samples were harvested from 44 hips and 6 knee joints. Of these 33 exhibited Grade I ossifications (66%), followed by 11 Grade II (22%) and one Grade III (2%). Necrosis was noted in two tissue samples (4%) and 2 more had osteomyelitis findings according to HOES-Score. Six samples (12%) with radiologically suggestive of HO turned out to be wear-induced synovitis, SLIM Type 1. Of these cases 16 were septic (32%) and 34 aseptic (68%) revisions. Most of the HO tissue samples were classified as a low-grade. High-grade ossification-Score is rare. Higher grades of ossification seem to be associated with septic revision cases. Wear-induced synovitis potentially influences HO development. A histological scoring system for ossification grading can be derived from the data presented in this study. Heterotopic Ossification (HO) or Myositis ossificans (MO) is a recognized complication of total hip and total knee arthroplasty surgery. It is more commonly noted in revision arthroplasty cases and its etiology is poorly understood and thought to be multifactorial 1-3 (Fig. 1). The incidence of HO has been reported to be as high as 26-41% 4-6 and can lead to painful restriction of joint motion 7,8. Effective therapy strategies have been found with the use of nonsteroidal antiinflammatory drugs (NSAID) and focused radiotherapy 9-11. It has been proposed that mesenchymal progenitor cells are responsible for the development of HO 2,12. These progenitor cells transform into osteoblasts under the influence of morphogenes 2. The concentrations of morphogene can be elevated in muscle and soft tissue after any kind of trauma, so that an enchondromal ossification leads to formation and maturation of lamellar bone 2. This is the proposed mechanism by which HO occurs following maj...

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Section: Discussionmentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Heterotopic Ossification in Orthopaedic and Trauma surgery: A Histopathological Ossification Score

Ohlmeier

Krenn

Thiesen

et al. 2019

Sci Rep

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“…Lipoma arborescens (LA) refers to a benign, villous, non-destructive proliferation of intra-articular adipose tissue, which has its own layer of synovial surface cells andonce it has reached a certain sizecan result in a subcutaneous soft-tissue swelling [5 -7] Histopathology reveals enlarged, densely packed adipocytes associated with rarefaction of the synovial surface-cell layer, but with no signs of spindle cell proliferation and no evidence for atypical stromal cells or lipoblasts. Fibrosis and blood residuals associated with macrophage infiltration can develop as a result of mechanical impingement of the synovial lipoma [1]. This disorder belongs to the lipoma group and is caused by mesenchymal proliferation which can, in rare cases, also involve internal organs such as the gastrointestinal tract [3].…”

Section: Histopathologymentioning

confidence: 99%

“…In the present publication and in our case, we shall confine ourselves to the field of non-traumatic origins. The differential diagnosisdepending on patient age, the affected joint and the specific case historyprimarily includes degenerative changes of the joints (osteoarthritis), auto-immune disorders such as rheumatoid arthritis, metabolic disorders such as, for example, gout and pseudogout, infectious forms of arthritis, reactive arthritis such as, for example, Lyme borreliosis and para-infectious causes, specific infections such as, for example, tuberculosis, gonorrhoea and syphilis, and articular manifestations of gastrointestinal disorders (Crohnʼs disease, ulcerative colitis) as well as mesenchymal tumours [1,2]. In turn, these mesenchymal tumours are classified into benign and malignant entities.…”

Section: Introductionmentioning

confidence: 99%

Lipoma arborescens – Uncommon Diagnosis for Joint Swelling: Case Report and Review of the Literature

et al. 2019

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Introduction Soft tissue swelling of the knee joint can be caused by many diseases. Lipomas are one of the most reasonable differential diagnoses we have to consider. Therefore, we now present the uncommon case of a Lipoma arborescens (LA) and differentiate it from a quite similar manifesting spindle cell lipoma as follows. Case Report A 49-years old patient reports about progressive knee pain for four years and observes an increasing joint swelling. This swelling is a soft tissue, shiftable tumour, not painful. The magnetic resonance imaging (MRI) with contrast agent brings the diagnosis of an advanced osteoarthritis of the knee joint and classifies the tumour as LA. Subsequently, we treat the osteoarthritis by implanting a total knee arthroplasty with simultaneous intraoperative tumour resection performed as total synovectomy. The histopathological processing confirms the clinically and radiologically made diagnosis of LA. Summary Lipoma arborescens presents an uncommon subgroup of Lipomas, which is characterized by a slowly progressive increasing soft tissue swelling, especially around bigger human joints. Due to its intraarticular location, the LA might become clinically relevant when it reaches a certain tumour size. Looking at the diagnostics, sonography, MRI and especially the histopathological processing give the crucial results. Final proof can only be made by histopathological examination. Additionally, we have some differential diagnoses to exclude. Under these we predominantly find the spindle cell lipoma, synovial haemagioma, vascular synovial malformations and tenosynovial giant-cell tumour. Furthermore, an atypical lipomatous tumour should be excluded by FISH-analysis via determining the MDM2-Genamplification.

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Advances in ameliorating inflammatory diseases and cancers by andrographolide: Pharmacokinetics, pharmacodynamics, and perspective

Liu

You

et al. 2021

Medicinal Research Reviews

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Andrographolide, a well-known natural lactone having a range of pharmacological actions in traditional Chinese medicine. It has long been used to cure a variety of ailments. In this review, we cover the pharmacokinetics and pharmacological activity of andrographolide which supports its further clinical application in cancers and inflammatory diseases. Growing evidence shows a good therapeutic effect in inflammatory diseases, including liver diseases, joint diseases, respiratory system diseases, nervous system diseases, heart diseases, inflammatory bowel diseases, and inflammatory skin diseases. As a result, the effects of andrographolide on immune cells and the processes that underpin them are discussed. The preclinical use of andrographolide to different organs in response to malignancies such as colorectal, liver, gastric,

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Histopathologische Klassifikationsprinzipien rheumatischer Gelenkerkrankungen

Cited by 15 publications

References 25 publications

Heterotopic Ossification in Orthopaedic and Trauma surgery: A Histopathological Ossification Score

Heterotopic Ossification in Orthopaedic and Trauma surgery: A Histopathological Ossification Score

Lipoma arborescens – Uncommon Diagnosis for Joint Swelling: Case Report and Review of the Literature

Advances in ameliorating inflammatory diseases and cancers by andrographolide: Pharmacokinetics, pharmacodynamics, and perspective

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