Cytopathology of bone lesions seminar iap2012
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Transcript of Cytopathology of bone lesions seminar iap2012
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Cytopathology of Osteolytic Lesions in Bone
Dr Genevieve Warner Learmonth
Cytopathologist/Histopathologist,
Cytopathology Laboratory, Groote Schuur Hospital
University of Cape Town
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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
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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.
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Clear Fluid with scanty translucent hooklets and laminated membrane
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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
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Histology of lytic lesion in clavicle,cross section of scolex
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Life cycle of Echinococcus granulosus in South Africa
JACKAL SHEEP
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A wolf in sheep’s clothing
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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
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Jam Shedi needle aspirate of vertebra for Cytology of fluid portion and Histology of bony fragments
Numerous siderotic granules
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Haemosiderin laden macrophages
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Perls stain for Iron
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Histology of Siderosis in Lytic destroyed Bone
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Masses of haemosiderin laden macrophages
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Attempt at bone repair, creeping substitution and endosteal fibrosis, osteoclastic activity
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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
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Clinical Outcome
The Fine Strong Mine Worker
becomes
“A Man of Steel with Bones of Clay”
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TUBERCULOSIS IN BONE
Tuberculosais in bone
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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
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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.
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Necrotising Inflammation, no evidence of granulomata
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Rare Langhan’s cell
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Ragged fragments of bone
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TB bacilli, ZN stain and autofluorescence with Papanicolaou stain using LED
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Histology ---Necrotising inflammation. No granulomata.
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TB and HIV ---the terrible twins
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Difficult to reach with health services
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