Cytology

Question 1

cytology

Answer 1

microscopic examination of tissue samples on slides

Question 2

types of cytology

Answer 2

FNA - solid tissues
impression smear - eg mucosa, biopsies
wash/lavage - trachea, BAL, nasal, prostate
ultrasound guided (care not to sample lube)

Question 3

benefits of cytology

Answer 3

no anaesthetic
quick
less invasive
rapid results
tumour grading and chemo planning
surgical planning
fluid classification
identify infections
can use slide for ancillary tests (hasn’t been put in formalin)

Question 4

FNA

Answer 4

non-suction - use syringe to push sample onto slide
suction - use syringe to pull out cells - more likely to damage sample cells
don’t put needle into middle of tumour (probably necrotic)

indication - cutaneous or subcutaneous mass, lymph nodes, intra-thoracic or abdominal mass, fluid analysis

pros - quick, easy, inexpensive, safe
cons - limitation of cytology

Question 5

greasy slide

Answer 5

usually lipoma but could be:

panniculitis/steatis - inflamed fat
perinodal fat - sampled the wrong thing
mast cell tumour
liposarcoma - malignant
other soft tissue sarcoma

Question 6

stains

Answer 6

diff-quik - in practice - 3 agents
1. fixative - blue - methanol
2. orange - eosinophilic
3. blue - basophilic
can’t identify mast cell granules - mistaken for benign histocytoma

may-grunwald glemsa quick stain (MGG) - in practice
can identify mast cell granules

modified wright’s - in lab
stainer machine, sample in the middle because machine misses edges

Question 7

haemodilution

Answer 7

too many RBs
interferes with view of target cells
platelet clumps - platelets present in fresh blood but not old (old blood from haemorrhages found in tumours)

Question 8

inflammation

Answer 8

WBCs

degenerate neutrophils - well preserved, may be normal
non-degenerate neutrophils - swollen nucleus - infection, necrosis

macrophages - activated (vacuoles) - phagocytosis
indicative of infection, cell debris or previous haemorrhage

acute/suppurative inflammation - neutrophils
chronic active/pyogranulomatous - neutrophils and macrophages
chronic/granulomatous - multinucleated macrophages
specific - eg. eosinophilic - allergies, parasites
concurrent tissue reaction - hyperplasia/dysplasia
infection - rods/cocci/coccobacili, yeasts, fungi etc

Question 9

hyperplasia

Answer 9

increase in the number of cells in a tissue
higher cellularity
larger nucleus to cytoplasm (mild)
darker blue cytoplasm
more prominent nucleoli
finer chromatin

Question 10

dysplasia

Answer 10

disordered cell growth
common in epithelial tissue secondary to inflammation
asynchronous nucleus to cutoplasm
increased basophils
ansiokaryosis (varying nucleus size and shape) and anisocytosis (variation in RBC size and shape)

Question 11

neoplasia

Answer 11

abnormal and excessive growth of tissue
abnormal growth relative to surrounding tissue
irreversible - not the result of a stimulus

4 types - epithelial, mesenchymal, round cell, neuroendocrine

Question 12

epithelial neoplasia

Answer 12

normal - regular arrangement and shape, cohesive with tight junctions and clear lines between cells, and round or oval nuclei

benign - adenomas
malignant - squamous cell carcinomas

Question 13

mesenchymal neoplasia

Answer 13

connective tissue

normal - loosely arranged, different shapes, wispy indistinct borders, oval nuclei

usually poorly cellular in benign tissues but can be very cellular if malignant

benign - fibromas, lipomas
malignant - sarcomas, osteosarcomas, haemangiosarcomas

Question 14

round cell neoplasia

Answer 14

normal - round, individually arranged, not clustered, round, central nucleus

mast cell tumours, lymphoma, leukemia, histiocytoma/histiosarcoma, transmissible venereal tumour

Question 15

mast cell tumour

Answer 15

round cell tumour
lots of pink granules
eosinophils in response to histamine release
fibroblasts, eosinophils and ribbons of pink matrix

Question 16

lymphoma

Answer 16

round cell tumour
low nucleus:cytoplasm ratio - more nucleus than normal

Question 17

neuroendocrine neoplasia

Answer 17

normal - free nuclei (no cytoplasm), round nucleus, arranges in rosettes/sheets

thyroid tumours, pheochromocytomas

Question 18

describing nuclear feature

Answer 18

size and shape
chromatin
nucleoli - number, shape
nuclear membrane
relationship with each other
mitotic figures

Question 19

describing cytoplasmic features

Answer 19

vacuolation
basophilia
product
n:c ratio
nuclear position

Question 20

criteria of malignancy

Answer 20

anisocytosis - variation in cell size
anisokaryosis - variation in nuclear size
increased n:c ratio
increased/atypical mitotic figures
multinucleation
nuclear moulding
angular nuclei
coarse and clumped chromatin
big cells
necrotic cells between neoplastic cells (smudges)
phagocytosis
emperipolesis - neutrophils stuck in cells
crowded cells, badly oragnised
cells stuck together

Question 21

punch biopsy

Answer 21

indication - cutaneous mass, subcutaneous mass

pros - quick, easy, inexpensive, safe, doesn’t require anaesthesia, can be collected from juncture of normal and abnormal tissue
cons - sample size and depth limited

precaution if coargulopathy

Question 22

needle core (tru-cut biopsy)

Answer 22

indication - cutaneous or subcutaneous mass, intra-thoracic or abdominal mass

pros - quick, easy, safe
cons - small sample size, instrument cost

place sample in formalin, sections can be processed for electron microscopy (kidney) or sent fresh for toxin or copper levels (liver)

Question 23

bacteriology - post mortem samples

Answer 23

indication - bacteremia

pros - easy
cons - easily contaminated, may be post mortem bacterial overgrowth, only works for bacterial and fungal culture, not for some endotoxemias

Question 24

vasculopathy

Answer 24

vascular abnormalities caused by degenerative, metabolic and inflammatory conditions, embolic diseases, coagulative disorders and functional disorders

Question 25

vasculitis

Answer 25

inflammation of blood vessels

Question 26

arteritis

Answer 26

inflammation of arteries

Question 27

phlebitis

Answer 27

inflammation of veins

Question 28

lymphagitis

Answer 28

inflammation of lymphatics