MENİSKEKTOMİ MATERYALLERİNDE HİSTOPATOLOJİK BULGULAR VE KALSİYUM DEPOLANMASI SIKLIĞI 142 ARTROSKOPİK MENİSKEKTOMİ

Öz

Dize ait meniskektomi materyallerinde yaş ve cinsiyet dağılımları yanısıra kalsiyum depolanması prevalansının belirlenmesi amaçlandı. Menisküs ve fibröz kartilaj dokusu eksize edilen 142 olgu erkek/kadın:76/66, ortalama yaş:43 kalsiyum depolanması ve diğer parametreleri belirlemek için incelendi. Menisküs doku örnekleri formalin fiksasyonu sonrası ışık mikroskobu ve polarize mikroskop ile histolojik olarak incelendi. Kalsiyum depolanması 8 %5.6 olguda izlendi. Kalsiyum depolanması için cinsiyet dağılımı açısından farklılık görülmedi. Kalsiyum depolanması olan olgular ileri yaş grubundaydı. Meniskektomi materyallerinde kalsiyum pirofosfat kristal depo hastalığı nadir değildir. Çalışma sonuçları inflamasyon ve kapiller proliferasyonun kalsiyum depolanması olanlarda olmayanlara oranla daha sık olduğunu göstermektedir. Yangısal değişikliklere ek olarak kalsiyum depolanmasının hiperparatiroidizm, hemokromatozis, hipotiroidizm ve Wilson hastalığı gibi sistemik olarak araştırılması gereken hastalıklarla arasıra birlikte olabilmesi nedeniyle, meniskektomi materyelleri disseke edilmeli ve olabilecek değişiklikleri belirlemek için mikroskobik olarak incelenmelidir

Anahtar Kelimeler

• Tibial menisküs,kondrokalsinozis,kalsiyum pirofosfat

HISTOPATHOLOGIC FINDINGS AND THE PREVALANCE OF CALCIUM DEPOSITION IN MENISCECTOMY MATERIALS. 142 ARTHROSCOPIC MENISCECTOMY

Abstract

We aimed to determine the prevalence of menisceal calcium deposition as well as its possible predilection for age and sex in meniscectomy materials of the knee. We reviewed tissue sections from 142 patients M/F: 76/66, mean age: 43 yrs to determine the frequency of meniscal and fibrous cartilage calcification and other parameters. Histological evaluation on meniscal samples after formalin fixation was carried out by light microscopy and polarized light microscopy. Calcium deposition was found in 8 5.6% patients. No sex difference was present for the calcium deposition. Increased prevalence of menisceal calcification with age was observed . CPPD Calcium pyrophosphate dihydrate crystal deposition disease of the knee is not infrequent in meniscectomy materials. The results of this study indicate that inflammation and capillary proliferation were seen more frequent in calcium deposition group than those without deposits. Meniscectomy materials should be dissected and reviewed microscopically for detection calcium deposition in addition to inflammatory changes, because of occasional association with diseases like hyperparathyroidism, hypothyroidism, hemochromatosis, Wilson disease that require systemic evaluation

Keywords

• Menisci-tibial,chondrocalcinosis,calcium pyrophosphate

References

1. Neame RL, Carr AJ, Muir K, Doherty M. UK community prevalence of knee chondrocalcinosis: evidence that correlation with osteoarthritis is through a shared association with osteophyte. Ann Rheum Dis 2003; 62(6):513-8.
2. Shidham V, Chivukula M, Basir Z, Shidham G. Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout and tumoral calcinosis. Mod Pathol 2001; 14(8):806-10.
3. Bullough PG. Joint diseases. In: Sternberg SS, Antonioli DA, Mills SE, Carter D, Oberman HA, editors. Diagnostic surgical pathology. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins; 1999. p. 223–61
4. Enzinger FM, Weiss SW, editors. Soft tissue tumors. 3rd ed. St. Louis, MO: Mosby; 1995.
5. Bullough PG. Non-neoplastic diseases of bones and joints. In: Silverberg SG, DeLellis RA, Frable WJ, editors. Principles and practice of surgical pathology and cytopathology. 3rd ed. New York: Churchill Livingstone; 1997. p. 846–7.
6. Rosai J. Bone and joints. In: Ackerman’s surgical pathology. 8th ed. St. Louis, MO: Mosby; 1996. p. 1996–7.
7. Yeldani AA, Kaufman DG, Reddy JK. Cell injury and cellular adaptations. In: Damjanov I, Linder J, editors. Anderson’s pathology. 10th ed. St. Louis, MO: Mosby; 1996. p. 368–9.
8. Williams CJ, Zhang Y, Timms A et.al. Autosomal dominant familial calcium pyrophosphate dihydrate deposition disease is caused by mutation in the transmembrane protein ANKH. Am J Hum Genet 2002; 71(4):985-91.

9. Blackburn WD. Calcium crystal disorders. In: Approach to a Patient with a Musculoskeletal Disorder. 1st ed. Professional Communication Inc., 1999, Chapter 3, 35-46.
10. Concoff AL, Kalunian KC. What is the relation between crystals and osteoarthritis? Curr Opin Rheumatol 1999; 11(5): 436-40.
11. Ishikawa K, Masuda I, Ohira T, Yokoyama M. A histological study of calcium pyrophosphate dihydrate crystal- deposition disease. J Bone Joint Surg Am 1989; 71(6): 875-86.
12. Schumacher HR. Crystal-induced arthritis: an overview. Am J Med 1996, 100(2A):46S-52S.
13. Derfus BA, Kurian JB, Butler JJ, Daft LJ, Carrera GF, Ryan LM, Rosenthal AK. The high prevalence of pathologic calcium crystals in pre-operative knees. J Rheumatol 2002; 29(3):570-4.
14. Malaviya AN, Al-Shari IM, Al-Shayeb AR, Shehab D, Hussain MA, Al-Mutairy M, Roberts OM, Al-Ghuriear S. Calcium pyrophosphatase dihydrate (CPPD) crystal deposition disease in a teaching hospital in Kuwait. Ann Rheum Dis 2001; 60(4):416-9.
15. Mitrovic DR, Stankovic A, Iriarte-Borda O, Uzan M, Quintero M, Miravet L, Kuntz D. The prevalence of chondrocalcinosis in the human knee joint. An autopsy survey. J Rheumatol 1988;15(4):633-41.
16. Fisseler-Eckhoff A, Muller KM. Arthroscopy and chondrocalcinosis. Arthroscopy.1992;8(1):98-104.