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CPS > Cytological examination > Flashcards

Cytological examination Flashcards

1
Q

Obtaining optimal information from a suitable sample requires…

A

Correct specimen collection or handling

Examination by an experienced Clinical Pathologist

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2
Q

What causes false negatives of a cytological sample?

A
  • Poor exfoliation of a neoplasm
  • Failure to sample tumour tissue
  • Extensive necrosis/inflammation present
  • (also, a neoplasm may not be well-differentiated enough to allow an accurate diagnosis)
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3
Q

What causes false positives of a cytological sample?

A

• Dysplasia (which can mimic neoplasia) may occur in inflammatory diseases

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4
Q

What is FNCS?

A

FNA no suction

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5
Q

What tubes do you put washes/lavages into?

A

Split samples into EDTA & sterile tubes & Process as soon as possible

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6
Q

What are the 4 basic tests you carry out on fluids?

A
  • Appearance of fluid
  • Total protein content
  • Nucleated Cell count (TNCC)
  • Cell type/s content (sediment smear under microscope)
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7
Q

How much fluid should you get from an Abdominocentesis/thoracocentesis? How can this show excess body cavity fluid?

A

A small amount of fluid is normal; too little for collection except in horses.
Marked hypoproteinemia is a common pathological cause of excess body cavity fluid

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8
Q

How do you prepare aspirates?

A

If the fluid is turbid, make direct smears
If clear, centrifuge and smear the deposit
• An ordinary centrifuge may be used at a slow speed for a short period
• Special centrifuges (cytocentrifuges) yield better smears when cell count is low (e.g., CSF)
Air-dry rapidly & stain

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9
Q

How do you prepare a core/tru-cut biopsy?

A

Roll Core along slide (gently) for cytology and then place in formalin pot for histology (Keep cytology preparations away from formalin fumes)

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10
Q

What must you do to slides before viewing or packaging them?

A

Dry them

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11
Q

What is a Transudate?

A

Excessive diffusion of plasma water from vasculature (transudation)

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12
Q

What causes increased transudation?

A

– Altered hydraulic pressure E.g. increased alveolar capillary pressure: Caused by Na and water retention or portal hypertension
– Decreased plasma oncotic pressure e.g., hypoalbuminaemia

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13
Q

What causes accumulation of transudate?

A

– impaired lymphatic drainage E.g, increased HP in posterior vena cava in venous congestion

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14
Q

What causes protein poor transudate?

A

Healthy vasculature impermeable to proteins therefore, Transudates low in protein
“Protein poor” transudates
– Reduced plasma oncotic pressure – e.g., hypoalbuminaemia
– Once lymphatic drainage can no longer compensate
– Portal hypertension (pre-sinusoidal) e.g certain cirrhosis

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15
Q

What causes protein rich transudate?

A

“Protein rich” transudates
– Proteins from interstitium (rather than vasculature)
– Varies by organ – 2g/dl in subcutis, 6g/dl in liver
– Portal hypertension (post-sinusoidal) e.g congestive cardiac failure
– May be referred to as “modified transudate”

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16
Q

What is modified transudate?

A
  • A transudate modified by the addition of protein or cells

* “Grey-zone” between transudate and exudate

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17
Q

What is an Exudate?

A
  • Exuding or oozing out of pores
  • Inflammation → increased vascular permeability
  • Plasma including protein leak from vasculature
  • Hydraulic pressure to push protein rich fluid into interstitium; protein in interstitium promotes oncotic fluid draw
  • Inflamed mesothelium more permeable
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18
Q

What cells accompany exudate?

A

• Accompanied by inflammatory cells
– Neutrophils and macrophages
– Neutrophils, macrophages and lymphocytes
– Occasionally eosinophils or lymphocytes predominate
– Cell counts lower in FIP because vasculitis rather than pleuritis

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19
Q

How do transudates look on cytology?

A

Appearance: Clear, watery
Protein poor: <20 g/l
Protein rich: 3-35 g/l
Nucleated cells <5 x109/l
Cell type/s: Few RBCs & Small mixed nucleated cell population
– neutrophils up to 60%
– lymphocytes, monocytes, macrophages, mesothelial cells

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20
Q

How do exudates look on cytology?

A

Appearance: Turbid or Bloody/purulent
Protein: > 20 g/l
Nucleated cells: >5 x109/l
Cell type/s: Many RBCs; nucleated cells are mostly neutrophils, they may be degenerate (karyolysis), and bacteria may be present
Occur in inflammation, infection & necrosis (including necrosis within tumours)

21
Q

How do neoplastic effusions look on cytology?

A

Appearance: May be bloody and/or turbid
Protein: often > 35 g/l
Nucleated cells often 5-25 x109/l
Cell type/s: RBCs; mixed nucleated cell population; Neoplastic cells may be seen
Tumour cells have an irritant or “foreign body” effect producing inflammation; there may also be tumour necrosis

22
Q

How do haemothorax/peritoneum fluids look on cytology?

A

Appearance: bloody (but does not clot )
PCV variable >0.03 l/l)
Protein:>20 g/l
Nucleated cells: variable (similar to blood >2-15x109/l)
Cell type/s: RBCs; no platelets, mixed nucleated and mesothelial cells; possibly haemosiderophages

23
Q

How does uroperitoneum look on cytology?

A

Appearance: serosanguinous (may be an odour of urine especially if heated)
Protein: 10-30 g/l
Nucleated cells: low at first progresses to 5-15 x109/l
Creatinine and Potassium > plasma if recent or ongoing
Cell type/s: Many RBCs; mixed nucleated cells (macrophages, neutrophils, mesothelial cells)

24
Q

How does chyle/chylous effusion look on cytology?

A

Protein:>20 g/l
Nucleated cells: 5-20 x109/l
Cell type/s: Cells vary with age of lesion (mostly mature lymphocytes at first)

25
Q

What can cause a chylous effusion?

A

Trauma/spontaneous rupture of the thoracic duct (idiopathic chylothorax)
But also can be caused by:
– Heart failure, cardiomyopathy, pericardial effusion
– Neoplasia,
– Lymphangectasia
Obstruction of minor lymphatics by chronic inflammation etc
Non-thoracic duct origin chylous thoracic fluid common in cats including cardiomyopathy, diaphragmatic hernia etc

26
Q

What is the protein and cellular composition of synovial fluid?

A 
Total protein (g/L): 
•	Dog: <25
•	Cat: <25
•	Horse: <20
•	Cow: <20
Total Nucleated Cells (x109/L) 
•	Dog: <3
•	Cat: <3
•	Horse: <0.5
•	Cow: <1
Cells form rows, >90% Mononuclear cells (predominantly monocytes/macrophages, and some lymphocytes)
27
Q

How does synovial fluid look in the case of Degenerative joint disease?

A
  • total protein, TNCC often normal

* cytology – normal (occasional dysplastic synoviocytes)

28
Q

How does synovial fluid look in the case of Inflammation - non-septic?

A

(commonly immune mediated in dogs & cats)
• total protein and TNCC increased
• neutrophils predominate

29
Q

How does synovial fluid look in the case of Inflammation - septic?

A

(common in horses & ruminants)

• as above; bacteria visible or on culture

30
Q

What are the normal cells in a bronchiolar lavage?

A

Ciliated columnar epithelial cells normally predominate; <10% leucocytes
(up to 20% eosinophils in cats)

31
Q

What does acute inflammation cell population look like?

A

• >70% of nucleated cells are neutrophils.

– The rest may be mononuclear cells (monocytes, macrophages, lymphocytes, plasma cells).

32
Q

What does non-septic or sterile acute inflammation cell population look like?

A

• Non-septic or sterile inflammation:

– neutrophils predominate but are well-preserved (non-degenerate).

33
Q

What does septic acute inflammation cell population look like?

A

• Septic inflammation:

– Neutrophils are degenerate (karyolysed) and bacteria are often present.

34
Q

What does ‘Eosinophilic’ acute inflammation cell population look like?

A

The cell content may be mixed, but 50% or more may be eosinophils.

35
Q

What is karyolysis?

A

Nuclear fading –> Anuclear necrotic cell

36
Q

What is pyknosis?

A

Nuclear shrinking –> Anuclear necrotic cell

37
Q

What is karyorrhexis?

A

Nuclear fragmentation –> Anuclear necrotic cell

38
Q

What does Epithelial neoplasia look like?

A

High yield, cells associated with one another, rafts, sheets, acini, cuboidal, columnar

39
Q

What does Spindle/Mesenchymal neoplasia look like?

A

Low yield, spindle shaped cells, usually single but may be in association/sheets, may be “matrix”

40
Q

What does Round cell neoplasia look like?

A

High yield, discrete round cells, not adherent

41
Q

What does a benign tumour look like?

A

A single population of uniform, large cells with pale, mildly granular cytoplasm and round to oval nuclei.

42
Q

What does a lipoma look like?

A

Soft, smooth, slow-growing, non- nodular painless masses occurring particularly in dogs
Aspirate smears are of low cellularity, with a few clumps of benign connective tissue cells & adipocyte

43
Q

What is Pleomorphism and what is it characteristic of?

A

Neoplasia

Pleomorphism within a cell type (not lymphoid) - Pleomorphism is wide variation in cell shape.

44
Q

What is the cell/ cytoplasmic ratio like in neoplastic cells?

A

High and/or variable nuclear to cytoplasmic ratio - In normal benign tissue, adjacent cells have a fairly constant, often low nucleus-to-cytoplasmic ratio. In malignant tissue it may be high, or it may vary hugely in adjacent cells, indicating unregulated, asynchronous growth

45
Q

Is Basophilia/ hyperchromasia associated with neoplasia?

A

Basophilia of the cytoplasm with Romanowsky stains is caused by high RNA content of immature cells
There may be vacuolation, granularity or phagocytosis of other cells.

46
Q

What do carcinomas look like?

A

Cellularity is often high; rounded or cells with distinct cell boundaries forming clusters, sheets or sometimes acini.

47
Q

What do sarcomas look like?

A

Cellularity is often low; often single, elongated/spindle-shaped cells with indistinct cell boundaries. It is often difficult to identify a specific cell of origin
Entwined nature of mesenchymal cells in tissues means they are difficult to persuade out of the mass with gentle aspiration

48
Q

What do round cell tumours look like?

A 
Cellularity is usually high; rounded or oval cells with distinct borders occur singly or small clusters 
Examples include 
•	Lymphoma
•	Plasmacytoma
•	Melanoma
•	Mast cell tumor
•	Histiocytoma
•	Transmissible venereal tumour (TVT)

CPS (16 decks)

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