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Cytopathology of bone lesions seminar iap2012


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Cytopathology of bone lesions seminar iap2012

  1. 1. Cytopathology ofOsteolytic Lesions in Bone Dr Genevieve Warner Learmonth Cytopathologist/Histopathologist, Cytopathology Laboratory, Groote Schuur Hospital University of Cape Town
  2. 2. 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
  3. 3. Bony lesion: A sheperdess aged 60 yearsfrom The Karoo, difficulty inwalking.X Ray: knee joint destroyed.Clinical Diagnosis:?AneurysmalBone Cyst.Jam Shedi needle aspirated clear
  4. 4. Clear Fluid with scanty translucenthooklets and laminated membrane
  5. 5. Clinical Impression: Aneurysmal BoneCyst  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
  6. 6. Histology of lytic lesion inclavicle,cross section of scolex
  7. 7. Life cycle of Echinococcusgranulosus in South Africa
  8. 8. A wolf in sheep’s clothing
  9. 9. 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
  10. 10. Jam Shedi needle aspirate ofvertebra for Cytology of fluid portionand Histology of bony fragments
  11. 11. Haemosiderin ladenmacrophages
  12. 12. Perls stain for Iron
  13. 13. Histology of Siderosis in Lyticdestroyed Bone
  14. 14. Masses of haemosiderin ladenmacrophages
  15. 15. Attempt at bone repair,creeping substitution andendosteal fibrosis, osteoclasticactivity
  16. 16. Clinical features ofSiderosis 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
  17. 17. Clinical Outcome The Fine Strong Mine Worker becomes“A Man of Steel with Bones of Clay”
  18. 18. Tuberculosais in bone
  19. 19. 35 year old woman presentswith pain in lumbar area formonths, then suddenparaplegia Xrays show lytic lesions in lumbar vertebrae Jam Shedi needle aspirate yields necrotic material. Cytology: Papanicolaou stain
  20. 20.  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.
  21. 21. Necrotising Inflammation, noevidence of granulomata
  22. 22. Rare Langhan’s cell
  23. 23. Ragged fragments of bone
  24. 24. TB bacilli, ZN stain andautofluorescence withPapanicolaou stain using LED
  25. 25. Histology ---Necrotisinginflammation. No granulomata.
  26. 26. TB and HIV ---the terrible twins
  27. 27.  Difficult to reach with health services