Cytology

Question 1

What should you be assessing when looking at a cytological sample at x10 magnification?

Answer 1

Quality:
- any/many cells?
- well preserved?

Background:
- haemorrhage?
- debris?

Predominant cells

Question 2

What should you be assessing when looking at a cytological sample at x40 magnification?

Answer 2

Individual or organised

Single or mixed population?

Cell size, shape, variation?

Nuclear size, shape, variation, abnormal mitoses?

Question 3

What are the considerations when assessing an unknown mass?

Answer 3

1. Sample adequacy – Is it sufficient for diagnosis?
2. Inflammation present?
   - What type? (e.g. neutrophilic, eosinophilic, granulomatous)
   - Is it septic (bacteria/fungi visible)?
3. Cystic features?
   - If so, what type of fluid/content?
4. Neoplastic features?
   - What type of cells? (epithelial, mesenchymal, round cell)
   - Benign or malignant features?

Question 4

What are the categories of cavity effusions?

Answer 4

Protein poor transudate
Protein rich transudate
Exudate (Inflammatory)

Question 5

What should we assess on cytology of a cavity effusion?

Answer 5

Neutrophils – look for degeneration and bacteria (suggests sepsis)

Mesothelial cells – assess for reactivity (can mimic neoplasia)

Other cells – e.g. macrophages, lymphocytes, neoplastic cells

Question 6

What is the cytological criteria of malignancy?

Answer 6

Cellular
Nuclear
Cytoplasmic

Question 7

What are the cellular criteria of malignancy?

Answer 7

Cells appear alien in location

Pleomorphism (variation in cell shape) within cell type (except lymphoid)

Anisocytosis (variable cell sizes).

Monomorphic population when variation is expected (e.g. lymphoid)

High nuclear-to-cytoplasmic ratio

Question 8

What are the nuclear criteria of malignancy?

Answer 8

Anisokaryosis (variation in nuclear size/shape)

Multiple, fragmented, or molded nuclei

Clumped chromatin

multiple/irregular nucleoli

Abnormal mitotic figures.

Question 9

What are the cytoplasmic criteria of malignancy?

Answer 9

Basophilia (increased blue staining)

Vacuolation or granularity

Phagocytosis of other cells.

Question 10

What is lymphadenopathy?

Answer 10

Swollen lymph nodes

Question 11

What are the 4 main causes of lymphadenopathy?

Answer 11

Reactive hyperplasia
Lymphadenitis
Metastatic neoplasia
Lymphoma

Question 12

What are the key differences between:
Reactive hyperplasia
Lymphadenitis
Metastatic neoplasia
Lymphoma

Answer 12

Reactive Hyperplasia:
- Normal lymphoid structure
- increased small lymphocytes
- occasional plasma cells/macrophages
- very few neutrophils, eosinophils & mast cells

Lymphadenitis:
- Increased neutrophils, eosinophils, or macrophages

Metastatic Neoplasia:
- Presence of carcinoma, mast cells, melanoma, or myeloproliferative cells

Lymphoma:
- Increased large, immature lymphocytes
- increased mitoses
- tingible body macrophages
- more lymphoglandular bodies

Question 13

What are tingible body macrophages?

Answer 13

type of macrophage that remove apoptotic cells from lymph nodes