Date post: | 29-Jun-2015 |
Category: |
Documents |
Upload: | genevieve-warner-learmonth |
View: | 176 times |
Download: | 1 times |
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