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POD > Cytology > Flashcards

Cytology Flashcards

1
Q

indications for aspiration of lymph nodes?

A

enlargement,
pain, metastasis check

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2
Q

reasons for enlargement of lymph nodes, broadly

A

hyperplasia,
inflammation or
neoplasia

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3
Q

what is the cytology of a normal lymph node?

A

70-90% small lymphocytes, remainder medium to large lymphocytes, plasma cells, macrophages, few neutrophils, eosinophils, mast cells

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4
Q

what causes reactive hyperplasia of a lymph node? how does the cytology change?

A

• due to antigenic stimulation in area of drainage
• small lymphocytes still predominate
• increase in large lymphocytes and plasma cells
• may see Russell bodies inside plasma cells (called Mott cell)
in chronic stimulation

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5
Q

what is lymphadenitis? what can we see cytologically? What will we see in the case of a mycobacterial infection?

A

-enlargement in one or more lymph nodes, usually due to infection
• an increase in neutrophils, eosinophils, or macrophages
• the organism may be present in the lymph node
• mycobacterial infection typically causes granulomatous inflammation

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6
Q

what is lymphoma? What will we see cytologically? What are some differences between species?

A

-a cancer of the lymphatic system
• homogenous population of lymphocytes
• mitotic figures frequent
• in the dog most lymphomas are large cell type
• in cats and horses a mixed cell size is more common
• most lymphomas are treatable in small animals

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7
Q

common types of metastatic neoplasia

A

• mast cell tumors,
melanoma, malignant
histiocytic tumours
• carcinomas, and
potentially any malignant tumor

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8
Q

best chance of distinguishing cancer via cytology

A

• best applied to neoplasms that will exfoliate readily
• clinical information very important!
• caution to distinguish hyperplasia from neoplasia
• often best combined with histopathology
• can at least guide initial case management and/or direct further diagnostics

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9
Q

cytological classifications of cancer

A
  1. epithelial
  2. mesenchymal cell (spindle cell, stromal cell)
  3. round cell tumors
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10
Q

characteristics of an epithelial cell cancer, and examples of types

A

• should see cell borders, tend to adhere to each other, form tubules, acini, sheets
• Adenoma, carcinoma,
adenocarcinoma,
transitional cell carcinoma, squamous cell carcinoma, etc.

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11
Q

characteristics of a mesechymal cell cancer, and examples of types

A

• indistinct cytoplasmic boundaries
• often long cytoplasmic tails (spindles)
• soft tissue sarcoma, fibroma, hemangiosarcoma,
osteosarcoma, chondrosarcoma, etc.

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12
Q

characteristics of round cells tumors

A

• discrete round shape and nucleus
• do not adhere to each other, single, discrete cells
• can often recognize the specific neoplasm

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13
Q

cytological features of cancer

A
  1. Size: neoplastic cells may be larger than their benign counterpart
  2. Nuclear enlargement: increased nuclear to cytoplasmic ratio (N/C ratio)
  3. Nucleoli: increased number and size compared to benign
    counterpart
  4. Hyperchromasia: nuclear and cytoplasmic hyperchromasia is a common feature
    of neoplastic cells
  5. Increased and abnormal
    mitotic figures
    • neoplastic cells often
    have an increased
    number of cells in
    mitosis
    • gross structural gene
    changes may manifest
    with abnormally
    distributed
    chromosomes
    during metaphase
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14
Q

types of mass lesions that are not malignant cancer but can be tricky to differentiate cytologically

A
  1. inclusion cysts
  2. sialocele
  3. abscess
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15
Q

what is an inclusion cyst?

A

-degenerating epithelial cells, cholesterol crystals, macrophages

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16
Q

what is a sialocele?

A

submandibular swelling due to obstructed salivary duct

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17
Q

how can an abscess trick us into thinking it is a neoplasm

A

chronic
abscessation
may result in
formation of a
firm fibrous
capsule that
feels similar to
some neoplasms

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18
Q

what is the use of a transtracheal wash? do we need a lot of equipment?

A

-to view respiratory cytology
• sample generally representative only of the trachea and larger conducting airways

-sedation may be
necessary, otherwise little equipment

19
Q

what is the use of a bronchoalveolar lavage? what equipment do we need?

A

sedation +/-
general anaesthetic and intubation necessary
• sample generally representative of the smaller bronchi and possibly alveoli

20
Q

are cell counts useful for respiratory cytology

A

-limited value due to cells entrapped in mucus, variable saline recovery

21
Q

is total protein a useful metric for respiratory cytology?

A

questionable value due to variable dilution of respiratory secretions with saline wash

22
Q

what do we often see on a respiratory cytology slide?

A

• normally abundant mucus
• alveolar macrophages if sampled small airways
• cuboidal epithelial cells (pneumocytes) from small
airways
• ciliated columnar cells from larger airways
• goblet cells
• moderate number of lymphocytes
• neutrophils, mast cells, eosinophils - rare

23
Q

what are the diagnostic signs of aspiration pneumonia?

A

• very debilitated animals,
megaesophagus,
myasthenia gravis,
iatrogenic
• marked inflammation,
mixed bacterial
morphologies, plant
material, keratinizing
squamous cells

24
Q

t are some cytologic signs of chronic non-spetic airway inflammation?

A

• suppurative with nondegenerate neutrophils
• or eosinophilic inflammation +/- mast cells
• Curshmanns spirals are dislodged mucus plugs from small airways seen in chronic inflammation

25
Q

When do we want to take a bone marrow cytology sample?

A

-unexplained or persistent cytopenia
-abnormal cells in circulation
-bone marrow infection
-suspect leukemia or metastasis
-iron deficiency

26
Q

what will we find in a acytological sample of body cavity fluids?

A

-cell counts, small animals < horse < cow
-protein

-predominantly mononuclear cells: monocytes, macrophages, lymphocytes
-rarely neutrophils: can have nuclear changes, phagocytosed bacteria

27
Q

what type of fluid samples will require centrifugation ofr analysis?

A

fluids with low cell counts (<20x10^9/L) ie. abdominal fluid, pleural fluid

28
Q

what is effusion? what are the ways it can occur

A

excess fluid accumulation. can be due to transudation or exudate

29
Q

what is exudate?

A

-tissue inflammation leads to increased vascular permeability with leakage and active movement of protein and cells into body cavities

30
Q

what is transudation?

A

-increased intravascualr pressure leads to transudation of small molecules eg. water, electrolytes
-doesnt increase cellularity or protein

31
Q

what will we see with supprative spetic inflammation

A

micro-organisms observed on smear, along with neutrophils

32
Q

how do we judge the state of preservation of a neutrophil cytologically?

A

-state of preservation is judges by nuclear criteria outside of the bloodstream, versus cytoplasmic criteria on blood smears

33
Q

what are the three major nuclear changes we can observe in neutrophils and what do they mean?

A
  1. pyknotic: compact nuclei of dying neutrophils - cell death
  2. karyorrhetic: fragmented nuclei of neutrophils undergoing cell death
  3. karyolytic: lysed nuclei in neutrophils exposed to bacterial toxins - degenerate cells
34
Q

what are mesothelial cells? how can they appear cytologically?

A

lining cells of abdominal and pleural cavity, may resemble macrophages or appear neoplastic

35
Q

what will microbial organisms look like if we see them on a cytological sample?

A

*artifact can look a lot like bacteria
• should be rod-shaped, filamentous, or cocci if bacteria
• should be phagocytosed if in vivo occurrence
• definitive diagnosis may require special stains and/or culture
• protozoa and fungal organisms have unique appearance
… cytology can provide definitive diagnosis

36
Q

what are some common pigments and crystals that we can see cytologically?

A

extravascular red cells are phagocytosed by macrophages
and broken down into heme pigments that stain from
green-black to brown
• iron-free heme is occasionally seen as hematoidin
• cholesterol crystals are common in cysts with chronic
non-inflammatory cell degeneration
• melanin may be seen phagocytosed by macrophages or
in tumor cells (melanoma)

37
Q

What is bile peritonitis? What does its effusion look like?

A

-• “chemical” peritonitis, neutrophils and
macrophages, bile pigment
-bile incites inflammatory response
-exudate

38
Q

what effusion do we see with congestive heart failure?

A

• commonly modified transudates with slightly elevated cell
concentration and protein content
• erythrophagocytosis common

39
Q

what effusion do we see with chronic hepatic disease?

A

• commonly transudates due to low serum albumin
concentration
• low protein and low cell count

40
Q

what are the characteristics of FIP effusion?

A

-exudative
• pyogranulomatous vasculitis
• high protein exudate, yellow color
• low to moderate elevation in cell count
• well preserved neutrophils

41
Q

what are the characteristics of chylothorax and associated effusion?

A

-exudate
• leakage of chylous fluid from the thoracic duct into the thoracic cavity, or, less commonly, into the abdominal cavity
• milky white appearance due to high triglyceride content
• lymphocyte rich

42
Q

when will we see an effusion due to intestinal rupture and what will it look like?

A

-exudate
• secondary to obstruction
• most common in horses
• a mixture of bacteria and plant material
-turbid, brown fluid

43
Q

what will we see with pyothorax or pyoperitoneum, and what does the effusion look like?

A

-exudate
• suppurative inflammation with neutrophil degeneration
according to the toxins elaborated by the organisms
• Actinomyces spp. and/or Nocardia spp. infection result in
grossly visible bacterial colonies (“sulfur granules”)

44
Q

what is uroabdomen and what does the effusion look like?

A

• ruptured urinary bladder or ureter secondary to lower urinary tract obstruction
• diagnosis based on creatinine concentration in abdominal fluid or presence of urinary crystals
• mild chemical inflammation

POD (21 decks)

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