Cytopathology of Osteolytic Lesions in Bone

Dr Genevieve Warner Learmonth

Cytopathologist / Histopathologist,Cytopathology Laboratory, Groote Schuur HospitalUniversity 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 shepherdess aged 60 years has 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:

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

Lytic lesion in Clavicle. Scolices and Rostellum of hooklets

Histology of lytic lesion in clavicle, cross section of scolex, and laminated membrane

Life cycle of Echinococcus granulosus in South Africa

A wolf in sheep’s clothing

TUBERCULOSIS in BONE

35 year old woman presents with pain in lumbar area for months, then sudden paraplegiaX-rays show lytic lesions in lumbar vertebraeJam Shedi needle aspirate yields necrotic material.Cytology: Papanicolaou stain

Collapse of spine with Kyphosis

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.

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.

TB and HIV ---the terrible twins

When screening a slide, note carefully what you observe, no matter how odd it may seem

Difficult to reach with health services