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PATH2005 > 6.1 - Diagostic Cytology > Flashcards

6.1 - Diagostic Cytology Flashcards

1
Q

Define diagnostic cytology

A

Interpretation of cellular changes related to benign, inflammatory and neoplastic conditions
Assessment of single cells or cell aggregates without typical landmarks seen in histopathology

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2
Q

Role in diagnosis in cytopathology

A

Screening investigation: populations at potential or real risk

Diagnostic investigation: symptomatic patients

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3
Q

: things to look for in diagnosis

A

Exfoliative cells in spaces (samples such as:)

  • fluids - csf, urine
  • secretions - sputum

Abrasive
- scraping - bronchus

Fine needle aspiration

  • superficial: thyroid, breast, skin
  • deep: lung, pancreas, liver
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4
Q

Changes in collection systems

A
  • before: collection via glass bottles

- now: collection via plastic bottles - able to comment on macroscopic appearance (clarity, viscosity)

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5
Q

Which smear type is most common?

A

Squash

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6
Q

Advantage of plasma thrombin - CB collection method

A

Cheap

Requires plasma and thrombin only

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7
Q

Describe clot and scrape method - CB collection methods

A

FNA material aspirated onto slide
Material allowed to clot
Inserted into cassette for paraffin embedding

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8
Q

BBC cell block fixative

A

Needle rinsed in sample
In 1ml of BBC cyto-cell block fixative
Drain excess on filter paper
Scrap components

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9
Q

Shandon cytoblock method

A

Manual preparation, concentrate cells on shandon cytocentrifuge, transfer into NBF

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10
Q

Collodion bag method: summarise the method

A
  1. Test tube filled with collodion
  2. Collodion sets for 1 hr
  3. Excess collodion into a container
  4. Test tube is dried, filled with water
  5. Stored with paraffin cover into a fridge
  6. Add concentration formalin-fixed specimen into collodion-coated tube
  7. Centrifuge and remove supernatant
  8. Bag is clamped, wrapped in lens paper & transferred to cassette to process
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11
Q

Advantages of CB

A
  1. Maintain architecture to closely resemble surgical specimen
  2. Small tissue fragments appear as mini biopsies useful for:
    - pattern recognition
    - sub classification
    - ID of features
    - diagnosis
  3. Stored indefinitely for future diagnosis + research purposes
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12
Q

Adv + Disad of: Clot and Scrape Method

A

Adv: inexpensive, no additional equipment required

Disadv: Does not work well with small samples, crush artifact is common

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13
Q

Adv + Disadv Formalin or alcohol vapour method

A

Adv: Cheap

Disadv: Time intensive, variable quality

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14
Q

Adv + Disadv: BBC fixative method

A

Adv: fast, low cost, good results

Disadv: none

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15
Q

Adv + Disadv: CB pellet alcohol fixation

A

Adv: inexpensive, rapid, good for FNAs of any types + fluids

Disadv: Cellular yield variable. limited data on IHC

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16
Q

Adv + Disadv: CB pellet formalin fixation

A

Adv: inexpensive, easy + rapid, optimal results for IHC and molecular studies

Disadv: Cellular yield variable

17
Q

Adv + Disadv: Collodion method

A

Adv: Good cellular yield, good for samples with scant cellularity

Disadv: time consuming, toxic ether fumes

18
Q

Disadvantage of plasma + thrombin method

A
  • unable to control clot formation
  • thrombo-plastin agents may interfere with surface antigens
  • makes target for IHC challenging
19
Q

Describe the process of plasma thrombin method

A
  1. cell suspension centrifuged
  2. supernatant aspirated and cell deposit mixed with plasma
  3. thrombin added and mixed
  4. Clot formed given time to retract
  5. Add NBF to clot
  6. Transfer clot to NBF for processing and sectioning
20
Q

Applications for fine needle aspirations

A
  • patients presented with a lesion
  • ovarian cyst fluids: dermoid cysts
  • collection of CSF: needle inserted at L3-L4
21
Q

Applications of endoscopic ultrasound

A
  • pancreatic lesions

- common bile duct lesions

22
Q

Outline the what is done during cytopreparation

A
  1. review methods and safe handling of hazardous samples
  2. prep cell samples for microscopy from gynae + non-gynae samples
  3. recognise unsatisfactory samples, artefacts
  4. Understand the application of special techniques (IHC, PCE, FCM)
23
Q

Fixative agents used

A
  1. alcohol
    - 95% ethanol
    - Acetic alc: 3% acetic acid + 95% ethanol
    - Spray fixatives: isopropanol + water soluble wax
  2. Post fix air dried smears in methanol
24
Q

Purpose of differential stains

A

allows for easy distinction between cells based on pH of cytoplasm

25
Q

Components stained in differential stains

A

Harris haemotoxylin - nucleus

Polychromatic combo of alcohol based OG6 and EA50 - cytoplasm

26
Q

What technique is used to stain wet fixed smears

A

papanicolaou technique

27
Q

Explain the process of air dried staining

A
  1. rehydrate smears - immerse in saline or 50:50 glyceral:DW
  2. post fix in 95% ethanol
28
Q

Which differential staining method is used for air dried smears?

A

Diff Quick

29
Q

Advantages of diagnostic cytopathology

A 
Rapid 
Non-invasive 
Low complication risk 
Accurate 
Inexpensive
30
Q

Disadvantages of diagnostic cytology

A

Less info than biopsy

Adequate sampling can be problematic

31
Q

What are the general criteria when identifying what is normal and abnormal in cytology

A
  1. Background smear
  2. Cellular arrangements
  3. Nuclear criteria: enlarged, hyper/hypochromatic, irregular nuclear membrane, prominent nucleoli
  4. Cytoplasmic features: presence of vacuoles + mucin and desne or delicate
32
Q

When evaluating the cell, what does the nucleus reflect?

A

the activity

33
Q

When evaluating the cell, what does the cytoplasm reflect?

A

the function

34
Q

What needs to be considered when evaluating smears?

A
  • clinical history
  • cells found singularly or in groups
  • evidence of microgranular structure, balls, papillae?
  • forming true tissue fragments?
  • background of smear: inflamed? necrosis?
35
Q

What features of the nucleus are considered when evaluating a cell?

A

size, shape, chromatin pattern, nucleoli

36
Q

What features of the cytoplasm are considered when evaluating a cell?

A

amount, shape, density, inclusions, vacuoles

37
Q

Describe fibroadenoma

A
  • common benign lesion
  • found in young women
  • present as rounded, well formed border, rubbery mass on FNA
  • variable combination of proliferated epithelial and stromal elements

PATH2005 (6 decks)

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