Scenario 2 - Part 1:
A 54-year-old male, ESKD on maintenance hemodialysis for three years, who underwent parathyroidectomy 12 months ago, was asked to participate in a bone biopsy pilot study, investigating the spectrum of bone histopathological changes in patients who underwent parathyroidectomy through the past twelve months. The patient’s labs are shown in table 1
Test |
Value |
S. Creatinine |
4.1 mg/dL |
S. Corrected Calcium |
7.9 mg/dL |
S. Phosphorus |
3.9 mg/dL |
iPTH |
97 pg/mL |
 The histopathological examination is revealed in figure 1
A- Interpret the above bone specimen.
B- What is the most likely cause behind the development of this pathology?
30 Comments
Leave a Reply
You must be logged in to post a comment.
A – Adynamic Bone Disease
B – parathyroidectomy
A- Interpret the above bone specimen.
Keeping with ABD: decreased bone formation and resorption and no marrow fibrosis. fluorescent labels showed decreased mineralization
B- What is the most likely cause behind the development of this pathology?
Parathyroidectomy results in low bone turnover (hypocellularity and activity)
A-hypo cellularity, ow bone volume indicate ABD
B-total parathyroidectomy lead to low PTH
A- Interpret the above bone specimen.Hypocellularity, low osteoclasts and osteoblasts activity, no osteoid bone leading to low bone volume. This is indicating that the patient is having low bone turnover- Adynamic bone disorder.
B- What is the most likely cause behind the development of this pathology?
Most likely the history of parathyroidectomy leading to low PTH activity leading to hypocalcemia and hypophosphatemia and adynamic bone disorder.
A- Interpret the above bone specimen.LOSS OF OSTEOCLAST OSTEOBLAST
DEFECTIVE MINERALIZATION
B- What is the most likely cause behind the development of this pathology?COULD BE CAUSED BY PARATHYROIDECTOMY
Model answer by the board:
A. Interpret the above bone specimen.
Low bone volume with paucity of the bone cells are present. Moreover, there is no tetracycline labelling. These findings represent a case with adynamic bone disease.
B. What is the most likely cause behind the development of this pathology?
The patient had a parathyroidectomy 12 months ago and now his PTH level is very low, which contributes to hypoactive bone and low cellularity.
A. Acellular speciment. Disruptive trabecular network.
B. Adynamic bone disease induced through parathyroidectomy
A- Interpret the above bone specimen.Reduced numbers of osteoblast and osteoclast, minimal osteoid , decreased mineralization & presence of aluminum rim due to Adynamic bone disease
B- What is the most likely cause behind the development of this pathology?
A- Interpret the above bone specimen
Reduced numbers of osteoblast and osteoclast, decreased mineralization this is due to Adynamic bone disease
B- What is the most likely cause behind the development of this pathology?
it is secondary to parathyroidectomy
The 1st image from the right shows high osteoid, and the 1stphto from the left shows a severe low bone mass (osteoporosis!?). most likely due to parathyroidectomy
A- Interpret the above bone specimen.
There is disrupted trabecular network , minimal osteoid
no osteoblasts or osteoclasts , defective mineralizations and presence of aluminum rim
What is the most likely cause behind the development of this pathology?
adynamic bone disease due to parathyroidectomy and concomitant aluminum toxicity.
…
A- Interpret the above bone specimen.
B- What is the most likely cause behind the development of this pathology?
A- Interpret the above bone specimen.
Show discontinus trabeculae with no osteoid, no osteoblast and osteoclast minimal tetracycline labeling suggest Adynamic bone disease
B- What is the most likely cause behind the development of this pathology?
Hypoparathyroidism post surgery
the pathology shows no osteoblasts, or osteofibrosis, no bone marrow fibrosis, minimal osteoid, there is no tetracycline labelling along the bone surface
all these changes point to adynamic bone disease
What is the most likely cause behind the development of this pathology hypoparathyroidism
Interpret the above bone specimen. scant cells with no osteoblasts or osteoclast activity mostly adynamic bone disease type of ROD
B- What is the most likely cause behind the development of this pathology?
Post surgical of near total hypoparathyroidism
Interpret the above bone specimen.
What is the most likely cause behind the development of this pathology?
A- Interpret the above bone specimen.absence of cells (Osteoblasts and Osteoclasts): ABD
B- What is the most likely cause behind the development of this pathology?Post-Parathyroidectomy (PTH is <2x normal) -> hypoparathyroidism
A- Interpret the above bone specimen.
No osteoblasts or osteoclast mostly adynamic bone disease.
B- What is the most likely cause behind the development of this pathology? Post surgical hypoparathyroidism
A- adynmic bone dis
b- parathyroidatomy
No osteoclast , no osteoblast
no osteoid formation
low bone volume
a picture of adynamic bone disease
Secondary to parathyroidectomy
Interpret the above bone specimen.this pictuer showed no bone activity at all with no osteoclast and osteoblast
no bone cells
What is the most likely cause behind the development of this pathology?Adynamic bone disease due to hypoparathyroid following parathyroidectomy
– Interpret the above bone specimen.
no osteoid cell ,no oestoblast ,no osteoclast
==================
B- What is the most likely cause behind the development of this pathology?adynamic bone disease
A- Interpret the above bone specimen.
B- What is the most likely cause behind the development of this pathology?
A- Interpret the above bone specimen.
B- What is the most likely cause behind the development of this pathology?
A- Interpret the above bone specimen?.
B- What is the most likely cause behind the development of this pathology?
Adynamic bone disease
A- Interpret the above bone specimen.Low activity of the osteoblast and osteoclast with very low osteoid tissue and low mineralization.
Adynamic bone disease
B- What is the most likely cause behind the development of this pathology?Adynamic bone disease post parathyroidectomy
the lab. revealed
hypocalcemia
hypophosphatemia
hypoPTH
THE BIOPSY
SHOW ADYNAMIC BONE DISEASE
trabecular thin interrupted
osteoid mass decreased
failure of mineralization
A – decreased number of osteoblasts and osteoclasts with no osteoid tissue and loss of trabecular network pattern…..consistant with ABD with osteoporosis
B- mostly secondary to parathyroidectomy
A- Interpret the above bone specimen.In my opinion this low bone turnover osteomalcia
B- What is the most likely cause behind the development of this pathology?Mostlikly post parathyroiedectomy