Scenario 2 - Part 2:

The above-mentioned bone biopsy study recruited another patient with ESKD who underwent parathyroidectomy 12 months ago with a similar preoperative clinical profile. However, he developed progressive cognitive dysfunction a few months post-parathyroidectomy. The bone histopathological pictures are presented in figure 2 &3.

figure 2

figure 3

figure 3 is stained for Aluminum using Solochrome azurine.

 

C- Interpret the above bone slides.

D- What might explain the histopathological discord between the two pictures?

28 Comments

  • Muhammad Soobadar


    lack of cells with positive aluminium staining represents aluminium induced osteomalacia

    b Alumiun enters bone and causes mineralisation disruption as well stopping cell activity

  • Amna Kununa


    C- Interpret the above bone slides.
     Increase in osteoid volume, an increase in the fraction of wide osteoid seams, with defect mineralization of bone protein. aluminium deposition at mineralization front

    D- What might explain the histopathological discord between the two pictures?
    Aluminum overload causes defective mineralization, increased matrix synthesis by osteoblasts, inhibition of osteoblast differentiation, and the inhibition of osteoclast function

  • Hagar Ali


    C-aluminum deposition with hypocellularity lead to ABD
    D-aluminum deposition lead to demineralization

  • Asma Aljaberi


    C- Interpret the above bone slides.
    Hypercellularity with low osteoclasts and osteoblasts, high osteoid bone, and minerzliation defect. It also showing aluminum deposition in the second slide.

    D- What might explain the histopathological discord between the two pictures?
    Aluminum deposition causes mineraliztion defect.

  • Mohamed Abdulahi Hassan


    C- Interpret the above bone slides.ELEVATED OSTEOID VOLUME WITH POSSITIVE ALUMINUM STAINING
    D- What might explain the histopathological discord between the two pictures?DEFICIENT MINERALIZATION AND ALUMINUM DEPOSITION IN THE BONE

  • Mahmoud Sobh


    Model answer by the board:
    C.    Interpret the above bone slides.
    High osteoid volume with paucity of bone cells together with positive Aluminum staining  is suggestive for Aluminum induced osteomalacia.
    D.    What might explain the histopathological discord between the two pictures?
    The patient with Aluminum staining has defective mineralization that results from Aluminum accumulation in the bone. Aluminum is transported into the bone, where it disrupts mineralization and bone cell growth and activity. 

  • Nour Al Natout


    C. Increased osteoid thickness, decreased mineralization, no osteoblasts and osteoclasts . Positive aluminium deposit.
    D. Osteomalacia due to aluminium intoxication

  • Rania Mahmoud


    C- Interpret the above bone slides.No osteoblasts
    No osteoclasts
    No mineralization
    Positive aluminum deposition
    D- What might explain the histopathological discord between the two pictures?Aluminum toxicity causing osteomalacia

  • Mahmud ISLAM


    The osteoid is thick but the mineralization is defective. in figure 3 there is aluminum deposition (red lining) which inhibits mineralization

  • Asmaa Salih KHUDHUR


    C- Interpret the above bone slides.
    figure 2
    there is areas of thick and thin osteoid
    no osteoblasts
    no osteoclasts
    normal bone volume
    no mineralization

    figure 3

    aluminum rim cover more than 15% of the bone as shown by solo chrome azurine stain for aluminum..

    What might explain the histopathological discord between the two pictures?
    osteomalacia due to aluminum toxicity

  • Mahmoud Elsheikh


    C- Interpret the above bone slides.

    • low mineralization, low osteoclast and osteoblast activity .

    D- What might explain the histopathological discord between the two pictures?

    •  Aluminum intoxication, ABD
  • Riaan Flooks


    C- Interpret the above bone slides.

    • Aluminium deposition

    D- What might explain the histopathological discord between the two pictures?

    • Presence of osteomalacia
  • Israa Hammoodi


    C- Interpret the above bone slides.
    No osteoblast or osteoclast, increase osteoid surface

    Positive aluminum deposition
    D- What might explain the histopathological discord between the two pictures?

    Aluminum toxicity causing osteomalacia

  • Ahmed Wagih


    Interpret the above bone slides decreased no of osteoblasts and osteoclasts. increased ostoid surfaces,
    solochrome stain shows aluminium deposits along bone surface
    What might explain the histopathological discord between the two pictures the patient has osteomalacia 2ry to aluminium toxicity

  • KAMAL ELGORASHI


    Interpret the above bone slides.

    • The minimum activity of osteoclast/osteoblast.
    • Low stoeid bone formation.

    What might explain the histopathological discord between the two pictures?Aluminium toxicity, ABD

  • HASSAN ALYAMMAHI


    C- Interpret the above bone slides.
    No bone cells, undermineralization

    D- What might explain the histopathological discord between the two pictures?
    
    Aluminium Toxicity

  • Rabab ALaa Eldin keshk Rabab


    D- A case of aluminium intoxication inducing osteomalacia

  • Rabab ALaa Eldin keshk Rabab


    C- Interpret the above bone slides.
    Figure 2 high oesteoid volume with low bone turn over
    Figure 3 show aluminum deposition in oesteoid surfaces with mineralization defect acase of oesteomalicia
    D- What might explain the
    histopathological discord between the two pictures?

  • Khaldon Rashed Ahmed Moqbil


    Ostoid formation no bone cell
    due aluminium intoxication

  • Alaa Abdel Nasser


    figure 2 : increased osteoid volume, defective mineralization, no visualised osteoblast or osteoclast (picture of mineralization defect osteomalacia)
    figure 3 is stained for Aluminum using Solochrome azurine: positive staining foe aluminium
    What might explain the histopathological discord between the two pictures?A case of aluminium intoxication inducing osteomalacia and low turn over bone disease

  • Rihab Elidrisi


    Interpret the above bone slides.this slid showed increased ostoid with no bone cells
    there is Aluminum positive line

    What might explain the histopathological discord between the two pictures?

    • Solochrome azurine stain for aluminum covers > 25% of the bone surface confirming the diagnosis aluminum bone deposition and intoxication.

    This histomophometric showed features of ABD

  • Ashraf Ahmed Mahmoud


    C- Interpret the above bone slides.

    • low of mineralization .
    • less osteoclast and osteoblast activity .

    D- What might explain the histopathological discord between the two pictures?

    •  Aluminum intoxication.
    • ABD
  • Emad mohamed mokbel Salem


    positive aluminum staining with picture of aluminum intoxication

  • Ibrahim Omar


    C- Interpret the above bone slides.

    • neither osteoblast nor osteoclast activities.
    • normal osteoid volume but with lack of adequate mineralization
    • +ve aluminum stating

    D- What might explain the histopathological discord between the two pictures?

    • Aluminum toxicity with osteomalacia and adynamic bone disease
  • Ben Lomatayo


    C- Interpret the above bone slides?
    1.Figure 2

    • Thick osteoid rimming the trabecular bone i.e., increased osteoid volume.
    • Absence of mineralization
    • Absence of remodellening unit activities i.e., osteoclasts, & osteoblast
    • Normal bone volume
    • All these point toward mineralization defect

    2.Figure 3

    • Solochrome azurine stain for aluminum covers > 25% of the bone surface confirming the diagnosis aluminum bone deposition and intoxication.

    D. What might explain the histopathological discord between the two pictures?

    • Osteomalacia caused by aluminum intoxication as revealed by the special aluminum stain i.e., solochrome azurine stain.
  • Weam El Nazer


    C- Interpret the above bone slides.Excess osteoid (unmineralized bone matrix) accumulation
    Widened osteoid seams
    Increased osteoid volume, low osteoclast, and osteoblast activity
    Osteomalacia picture.
    figure 3 is stained for Aluminum using Solochrome azurine: positive aluminum stainingD- What might explain the histopathological discord between the two pictures?positive aluminum staining. osteomalacia secondary to aluminum intoxication

  • Elsayed Ghorab


    i think ????
    slide figer 2 >>show post parathyroidectomy over activity of implanted part
    slide figer 3 >>>aluminum intoxication low bone turn over picture

    ??? need opinion and explanation of our prof

  • Mark Nagy Zaki Amin Mark


    C- positive staining with Aluminum specific stains in more than 25% of bone structures consistant with AL intoxication

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