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Histology > Cytology > Flashcards

Cytology Flashcards

1
Q

What is a laboratory diagnosting test dependant on

A

Good history
Quality of sample
Proper identification of sample

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2
Q

How do you choose what sampling technique to use for histology

A

Anatomic location
Patient’s overall health
Suspected tumor type
Clinician’s preference

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3
Q

What are the pretreatment biopsy types

A

Needle core biopsy
Punch biopsy
Wedge biopsy

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4
Q

How do you obtain additional information about a tumor

A

treatment planning (surgical, medical)

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5
Q

What is excisional biopsy

A

Surgical removal of the tumor

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6
Q

what is a post treatment biopsy method

A

excisional biopsy

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7
Q

How do you obtain a more complete picture about a growth

A

Grading
Lymphatic/vascular invasion
Margins

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8
Q

Is a biopsy a good first step?

A

No

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9
Q

What is the disadvantage to not doing a biopsy first when a lump is removed

A

can result in incomplete removal, more morbidity and costs

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10
Q

What are the advantages to pre-treatment biopsies

A

Can help clients make an informed decision
Can consult with oncologist and surgeon
Can plan treatment sooner after surgery

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11
Q

When are pre-treatment biopsies not indicated

A

Treatment or Sx would not change (spleen, testicle)

As risky as removal (spinal cord)

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12
Q

What are needle core biopsies done on

A

external palpable masses (no highly inflamed or necrotic)

deep (kidney, liver)

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13
Q

Describe the needle core biopsy punch

A

manual or spring/pneumatic powered

Small sample size still enough for pathologic exam

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14
Q

what is the size of the needle core biopsies needle

A

1 mm wide biopsy

1.0 – 1.5 cm long

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15
Q

What does a needle core biopsy require

A

local anesthesia and sedation

sterile preparation

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16
Q

Why do you use a small scalpel incison for the needle core biopsy

A

Prevents dulling
Facilitates tru-cut mechanism
Can be sutured

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17
Q

How do you handle the tissue from the needle core biopsy

A

Tissue can be removed with blade, needle or saline
Can be rolled on glass slide for cytology
Place in formalin (in cassette)

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18
Q

What is a possible risk when you do a needle core biopsy

A

minimal risk of seeding but you should plan ahead and remove original incision tract
consider hemorrhage and fluid leakage

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19
Q

Why do you use a punch biopsy

A

Typically for skin
Skin, oral, perianal
Direct access with laparoscopy
Liver, GIT, etc.

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20
Q

What is the size of a punch biopsy

A

2-8mm

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21
Q

What is required for punch biopsy

A

local anesthesia and sedation

usually no sterile preparation

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22
Q

what is the ideal size of a punch biopsy

A

6mm
4 mm only for nose, footpad
8 mm slight more chances of infection

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23
Q

What can cause tissue compression and artifacts when doing a punch biopsy

A

dull punches

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24
Q

how do you handle a tissue sample from a punch biopsy

A

handle sample very gently

place in formalin, no cassette

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25
Q

what is important for punch biopsies if you’re doing dermatology

A

draw line in direction of hair

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26
Q

When do you do an incisional biopsy

A

When cytology and/or biopsy is unsuccessful

For ulcerated and necrotic lesions (larger sample)

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27
Q

What do you need to do for an incisional biopsy

A

Surgical preparation + drapes
Local anesthesia
Tumors are usually POORLY innervated
Skin is incised and tumor wedge removed

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28
Q

Is it necessary to remove intact skin with the incisional biopsy?

A

NOT necessary to remove intact skin (next or over)
Margins evaluated with removal of tumor
Can compromise
Careful not to sample just the reactive tissue surrounding the tumor
Imprint cytology can be done

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29
Q

Describe endoscopic biopsy

A

Convenient, cost-effective, safe

Limited sample, inadequate visualization

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30
Q

Describe laparoscopy, thoracoscopy

A

Very good, can always convert to laparotomy

Needs specialized tools & skills

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31
Q

How do you properly identify margins

A

tissue ink is preferred but sutures can also be used.

need to write: color = which margin.

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32
Q

when should tissue ink be done

A

before fixation, to orient the sample and identify areas of concern

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33
Q

describe the tissue inking process

A

Tissue should be blotted with paper towel before
Ink can be applied with gauze on surface or cotton swab for precision
Allow to dry 20 min before formalin

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34
Q

describe proper tissue fixation

A

10% buffered neutral formalin
Special fixative for eyes, testicles

1 part tissue to 10 part fixative

Ideally 1 container per lesion
done within 30 minutes

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35
Q

describe containers for fixation

A 
Wide container, secure lid
No glass
No more than 1L
In secure plastic bag (ziploc)
With absorbent packing material
Insulated (avoid freezing)
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36
Q

Descriibe large unusual specimen fixation

A

Amputated limbs, spleen
Can overnight on ice
Can pre-fix 48-72h with partial parallel incisions approximately 1 cm apart (‘‘bread loafing’’)
Then shipped without formalin (double-bag) or in 1:1 formalin
Can section and fix/send in individual containers
An annotated digital image or sketch of the original specimen to depict sectioning and orientation should accompany the samples

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37
Q

describe very small unusual specimen fixation

A

Labeled cassettes

Do not use gauze sponges or cardboard because tissue may become compromised upon retrieval

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38
Q

describe luminal organs unusual specimen fixation

A

Flush the intact lumen with formalin
Partial longitudinal incision
3 labeled sections (cranial/proximal, mass and caudal/distal) can be submitted

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39
Q

describe thin flat sample fixation

A

Small: placed in a tissue cassette with a foam pad to minimize tissue curling
Larger samples can be tacked onto a flat piece of cardboard presoaked in formalin or water with suture through edges of tissue not needed for examination

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40
Q

What do you need to write about the lesion in the mass submission form

A

Lesion-specific clinical history (eg, anatomic site, date first noticed, rate of growth)
Potentially lesion-associated clinical signs (eg, lameness, vomiting)
Type of lesion (eg, new lesion, recut following incomplete excision, excisional biopsy following previous incisional biopsy, local recurrence)
Results of prior lesion-associated diagnostic tests - cytology, prior biopsy reports, imaging (radiographs, ultrasound, MRI, CT); access to radiographs may be especially important for bone and gingival tumors.

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41
Q

What general information do you need to put on the mass submission form

A

General clinical history—previous neoplastic diseases, previous or current nonneoplastic conditions of relevance
Treatment history—local and systemic, current and previous (eg, chemotherapy, radiation, corticosteroids)
Previous unrelated treatments or potential tumor-inducing historical events at tumor site (eg, previous radiation, vaccination, implants)

42
Q

What other abnormalities should you include on the mass submission form

A

CBC, biochemical, and hormonal (eg, hyperinsulinemia) abnormalities

43
Q

What else should be on the submission form

A

Working clinical diagnosis and/or list of differentials

Thorough gross lesion description.

Indication whether the submitted sample is an incisional or excisional biopsy.
Excisional biopsy indicates assessment of surgical margins is necessary, whereas for incisional biopsies the margin evaluation is null.

Anatomic site should be thoroughly described

Features appreciated during diagnostic imaging or perioperatively should be described
tissues involved or associated with the mass (eg, thyroid mass invading subjacent skeletal muscle).

44
Q

What is cytology

A

examination of cells having exfoliated from tissue or having accumulated in body fluid

45
Q

what can cytology provide

A

May provide definitive diagnosis

Very dependent on sample quality!

46
Q

is cytology invasive?

A

Not invasive

47
Q

How quickly does cytology need to be processed

A

rapidly

48
Q

What should be in the cytology kit

A

Clippers
Cleansing & disinfectant wipes
Syringes: 6 – 12 ml, up to 20 ml
Needles: 1 – 1.5 in (20g to 22g), 2.5 – 3.5 in spinal needle with stylet
Bone Marrow aspiration needle & core biopsy material
Scalpel blades
Culture swabs & applicator sticks for slide preparation
Box of slides (frosted)
EDTA and red top tubes
Rigid, flat surface for 6 -10 slides (foam tray)
Butterfly catheter, IV extension tubing
Pencil or slide marker
Sterile EDTA

49
Q

What is the skin prep for a FNA

A

Minimal for cutaneous, subcutaneous

Shave, clean & disinfect for internal

50
Q

Where can you do an FNA

A

Cutaneous, subcutaneous, internal organs

51
Q

What are the benefits of going needle only, vs aspiration

A

Should start with no aspiration

Less blood contamination

52
Q

What is the best FNA size needle

A

22g

53
Q

What do you do if a FNA sample is liquid

A

place in edta

54
Q

what do you do if an FNA sample is solid

A

prepare slides immediately

55
Q

Describe imaging guided aspiration

A

typically ultrasound guided
complications are rare
thoracic samples can be taken.

56
Q

Should ascites and pleural effusion be sampled via US

A

yes

57
Q

Describe the squash preparation

A

Most common
For semi-solid, mucus-like, or pelleted (via centrifugation)
Place sample close to frosted edge and use second slide to spread sample

58
Q

What do you do with fluid cytology samples

A 
Keep in EDTA
Prevents clotting (fibrin)
Preserves cellular morphology
Facilitates cell count
Refrigerated
Up to 24h in general
CSF needs special measures

Make slide as soon as possible
Send unstained slide with EDTA tube

59
Q

How do you prepare a fluid slide if the sample is cloudy

A 
direct smear (like blood smear)
squash
60
Q

how do you prepare a fluid slide if the sample is clear

A 
If lower cellularity
Need to concentrate
Similar to urine sediment
Via special centrifuge (CSF, BAL)
Buffy Coat
Still do a direct smear
61
Q

What hematology methods can you use with cytology fluid

A 
Cell counts
Can be automated (hematology machine)
Flush with saline after
Manually
Total proteins
Refractometer
Conversion tables for low TP
62
Q

Describe the touch imprint

A

Permits evaluation of a biopsy
With surface lesions is often of poor diagnostic utility
Superficial inflammation, secondary bacterial infection
Exception for fungal diseases

Need to blot aggressively the sample
Until tacky
Then imprint on slide
Fibrous lesions can be scraped
Scalpel blade
63
Q

How do you prepare joint-synovial fluid cytology

A

Surgical preparation
Normally viscous

Ideally small EDTA tube
To get cell count
To be able to use hyaluronidaze
Direct smear (like seen previously)
Culturette for microbiology
64
Q

What are miscellaneous types for doing cytology

A 
Always air dry – do not use flame
Do not freeze
Do not expose to formalin
Label properly all tubes & slides
Always submit an unstained smear with a tube (also for hematology)
65
Q

When do you do bone marrow evaluation

A

Bone marrow evaluation is indicated when peripheral blood abnormalities are detected
persistent neutropenia, unexplained thrombocytopenia, poorly regenerative anemia
To stage neoplasia
Lymphoma, plasma cell tumor, mast cell tumors, other

66
Q

What is the difference between aspiration and core biopsy

A

Aspirates are easier, faster, and less expensive to perform than are core biopsies.
Bone marrow core biopsies require special needles.
Core biopsy sections provide a more accurate way of evaluating marrow cellularity and examining for metastatic neoplasia than do aspirate smears, but cell morphology is more diffcult to assess.

67
Q

How can you classify inflammation

A 
purulent
pyogranulomatous
macrophagic
eosinophilic
lymphocytic
68
Q

Describe purulent inflammation

A

predominance of neutrophils (>85%)

Try to say if degenerated or not

69
Q

Describe pyogranulomatous inflammation

A

mix of neutrophils and macrophages

70
Q

Describe macrophagic inflammation

A

predominance of macrophages (>50%)

71
Q

Describe eosinophilic inflammation

A

important component of eosinophils (>10 – 30%)

72
Q

describe lymphocytic inflammation

A

need to rule out lymphoma

73
Q

What does it mean if you have degenerate neutrophils in your purulent inflammation

A

Degenerate neutrophils:
Bacterial infections
Need to see to call septic

74
Q

What are the causes of degenerate neutrophils in purulent inflammation

A

Degenerate neutrophils:
Immune-mediated
Neoplastic
Sterile irritants (bile, urine)

75
Q

What are granulomatous lymphocytes associated with

A 
Foreign body
Fungal infection
Mycobacterial infection
Panniculitis
Lick granuloma
Other chronic lesions
76
Q

what is eosinophilic inflammation due to

A 
Eosinophilic granulomas
Hypersensitivity
Parasites
Fungal
Mast cell tumors
Some neoplasms
77
Q

what is lymphocytic inflammation due to

A

Rare
Immune reaction
Viral
Chronic lesion

78
Q

What is the infectious agent blastomycosis associated with

A 
Pyogranulomatous or granulomatous
Dogs mostly
“hunting”
Nose, legs
Found in the environment
79
Q

What is the infectious agent cryptococcus associated with

A

Granulomatous
Dogs & Cats
Nose

80
Q

where is the aspergillus fungi found

A

Opportunistic
Dog: nose
Horse: cornea

81
Q

Describe mycobacterium

A

Fairly rare
Granulomatous
Very slow to grow in microbiology

82
Q

How do you classify a neoplasm

A

need to say the cell type

if it is benign or malignant

83
Q

what are the 4 cell types of neoplasms

A

epithelial cells
mesenchymal cells
round cells
neuroendocrine cells

84
Q

how do you classify if a cell is benign or malignant

A

Set of criterias
Cytoplasmic
Nuclear

85
Q

what are the cellular features of malignancy

A 
Cellular 
Crowding 
Pleomorphism
 Different shapes
Anisocytosis
Different cell size
Giant cells
Basophilia

High N/C ratio (nuclear/cytoplasmic)
Not always

86
Q

what are the nuclear features of malignancy

A 
Nuclear 
Nuclear molding
More than 1
Pleomorphisme
Anisocaryosis
Within a cell also
Mitotic figure
Number and shape
87
Q

what are the nucleolus features of malignancy

A

multiple
varied within one nucleus
may be normal

88
Q

Describe the organization of mesenchymal cells

A

Weak cohesion, loosely arranged

Often extra-cellular matrix

89
Q

describe the cellular types of mesenchymal cells

A

Cellular types

Eg. fibroblasts, osteoblasts, chondroblasts…

90
Q

describe the morphology of mesenchymal cells

A

Morphology
Spindled, stellate, oval
Poorly defined cytoplasmic margins

91
Q

describe the exfoliation for mesenchymal cells

A

Exfoliation

Moderate to weak

92
Q

describe the organization of epithelial tumors

A

Cohesive clusters

93
Q

describe the cell types of epithelial tumors

A

Glandular and parenchymal tissue
Surface lining
Eg. Basal cells, squamous cells, hepatocytes, tubular cells, renal cells

94
Q

describe the morphology of epithelial tumors

A

Variable: round to polygonal +/- elongated

Distinct cytoplasmic borders

95
Q

describe the exfoliation of epithelial tumors

A

very easy

96
Q

What are all the round cell types

A

Lymphome

Plasmocytome

Mastocytome

Histiocyte

Sarcome histiocytaire

Transmissible veneral tumor

97
Q

What does it mean when you see lymphoglandular bodies

A

Cytoplasm fragment
Mostly seen with lymphocytes
lymphoma

98
Q

what does it mean when you see collagen breakdown

A

Mostly seen in mast cell tumors

Some soft tissue sarcoma

99
Q

what does it mean when you see a hematoidin crystal

A

Hematoidin crystal
Hemoglobin breakdown
Indicates chronic bleeding

100
Q

what does it mean when you see cholesterol crystals

A

Cholesterol crystals
Cell membrane damage
Frequent in
Follicular cysts

101
Q

what does it mean when you see skeletal muscle

A

Skeletal muscle
Normal
Incidental finding

Histology (3 decks)

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