Cytopathology of lytic lesions in bone can be helpful to diagnose infectious processes as well as neoplastic lesions. Tuberculosis, hydatid disease of bone are illustrated. Haemosiderosis of bone is also discussed,

1. Cytopathology of
Osteolytic Lesions in Bone
 Dr Genevieve Warner Learmonth
Cytopathologist / Histopathologist,
Cytopathology Laboratory, Groote Schuur Hospital
University of Cape Town

3. 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

4. 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.

5. Clear Fluid with scanty translucent
hooklets and laminated membrane

6. 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

7. Lytic lesion in Clavicle. Scolices and Rostellum of hooklets

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

9. Life cycle of Echinococcus
granulosus in South Africa

10. A wolf in sheep’s clothing

11. TUBERCULOSIS in BONE
35 year old woman presents with
pain in lumbar area for months, then
sudden paraplegia
X-rays show lytic lesions in lumbar vertebrae
Jam Shedi needle aspirate yields necrotic
material.
Cytology: Papanicolaou stain

12. Collapse of spine with Kyphosis

13. Necrotising Inflammation, no
evidence of granulomata

14. Rare Langhan’s cell

15. Ragged fragments of bone

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

17. Histology ---Necrotising inflammation.
No granulomata.

18.  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.

19. TB and HIV ---the terrible twins

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

21.  Difficult to reach with health services