Role of Histopathology in the Diagnosis of Lytic Lesions of Bone: A Five Year Retrospective and Prospective Study

Background: The clinical and radiological features of many bone lesions overlap. Some benign processes such as osteomyelitis can mimic malignant tumors, a callus with an associated fracture can mimic osteosarcoma, whereas some malignant and metastatic lesions may mimic benign lesions. Even an orthopedic surgeon and radiologist together cannot come to a conclusion precisely. Therefore, the histopathological examination is the final guide to the orthopedic surgeon for the treatment of patients. The aim of this study to evaluate the histopathological examination of osteolytic lesions with assessment of their morphological pattern and their correlation with the clinicoradiological diagnosis. Materials & Methods: A retrospective and prospective analytical study done on all patients with the radiological diagnosis of lytic lesion of bone (as evaluated by a plain x-ray) attending the OPD of the orthopedics department, and admitted to Mahatma Gandhi Hospital and Mathura Das Mathur Hospital, Jodhpur during the period of July 2009- June 2014. Their biopsies were sent to the Department of Pathology, Dr. S.N.Medical College, Jodhpur. Data was entered and analyzed by using Microsoft Excel version 2007 and Statistical Package for social science ver.16(SPSS.16) and necessary and appropriate statistical tests were applied and p value less than 0.05 was considered statistically significant.Results: Our study shows that males were affected more commonly than females in most of the age groups except at the extremities of age where males and females were equally 1.Thebenign tumors when taken together were the most frequent lesions encountered (33.02%) followed by tumor like lesions (23.58%) and inflammatory lesions (22.65%). 16.98% cases were of malignant tumors and a small percentage (3.77%) were of metastasis from other sites.Pain was the most common presenting symptom singly as well as associated with other complaints like swelling, fever etc.The histopathological diagnosis was similar to the radiological diagnosis in 86 (81.1%) cases whereas it was not similar to the radiological diagnosis in 20 (18.9%) cases. Conclusion: We concluded that light microscopy or histopathology is the gold standard in the diagnosis of bone lesions and invariably accurate when correlated with clinicoradiological features