Cytopathology of Osteolytic Lesions in Bone

Dr Genevieve Warner Learmonth

Cytopathologist/Histopathologist,

Cytopathology Laboratory, Groote Schuur Hospital

University of Cape Town

Lytic lesions in Bone Lytic lesions are easily aspirated using a

Jam Shedi needle. Most lytic lesions in bone are metastatic

tumours. However infectious lesions of bone due to

Tuberculosis and opportunistic infections due to HIV/AIDS are becoming more common in South Africa.

Metabolic diseases can also present as lytic lesions in bone

Bony lesion: A sheperdess aged 60 years from The Karoo, difficulty in walking.

X Ray: knee joint destroyed.

Clinical Diagnosis:?Aneurysmal Bone Cyst.Jam Shedi needle aspirated clear fluid for Cytology.

Clear Fluid with scanty translucent hooklets and laminated membrane

Clinical Impression: Aneurysmal Bone Cyst

Note extensive involvement of tibia, fibula, knee joint space, patella and soft tissues.

No clinical signs of inflammation

No sinus formation No pain No clinical evidence of

parathyroid dysfunction. No renal disease

Histology of lytic lesion in clavicle,cross section of scolex

Life cycle of Echinococcus granulosus in South Africa

JACKAL SHEEP

A wolf in sheep’s clothing

SIDEROSIS

Mine Worker presented with massive brawny oedema of lower limbs

Clinically suspected of circulatory prroblems, cardiac failure, thrombophlebitis etc etc.

After three weeks in hospital bed he complained of backache.

Xray of spine showed several collapsed vertebrae, ? Osteoporosis, ?TB, ? myeloma

Jam Shedi needle aspirate of vertebra for Cytology of fluid portion and Histology of bony fragments

Numerous siderotic granules

Haemosiderin laden macrophages

Perls stain for Iron

Histology of Siderosis in Lytic destroyed Bone

Masses of haemosiderin laden macrophages

Attempt at bone repair, creeping substitution and endosteal fibrosis, osteoclastic activity

Clinical features of Siderosis Collapse of vertebral bodies “coin on

edge” lesion Adult scurvy –gingival hypertrophy Clinical stigma of Vitamin C deficiency Bleeding, anaemia, capillary fragility,

oedema of periphery – legs and arms Destruction of weight bearing bones Iron deposition in liver, dysfunction of

liver

Clinical Outcome

The Fine Strong Mine Worker

becomes

“A Man of Steel with Bones of Clay”

TUBERCULOSIS IN BONE

Tuberculosais in bone

35 year old woman presents with pain in lumbar area for months, then sudden paraplegia

Xrays show lytic lesions in lumbar vertebrae

Jam Shedi needle aspirate yields necrotic material.

Cytology: Papanicolaou stain

Drug-susceptible TB and MDR-TB are spread the same way. TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These germs can float in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB germs can become infected.

Necrotising Inflammation, no evidence of granulomata

Rare Langhan’s cell

Ragged fragments of bone

TB bacilli, ZN stain and autofluorescence with Papanicolaou stain using LED

Histology ---Necrotising inflammation. No granulomata.

TB and HIV ---the terrible twins

Difficult to reach with health services