Cytology Flashcards
Procedure for fine needle aspirate
1) Dont attach syringe
2) Insert needle, redirect more peripherally
3) Make smear - use enough but not too much presusure
Guage for FNA
22-25
Indications for FNA
1) Cutaneous mass of unknown origin
2) Enlarge LN
3) Masses on internal organs – use ultrasound
When do you make touch impression smear
Before dropping sample in formalin
1) Cut lesion in half
2) Ensure cut surface is free of fluid
3) Touch cut surface to slide (several per slide)
What do you collect fluid samples in
- EDTA
- Sterilin/red tops
Give six factors that make samples undiagnostic
- Placing near formalin
- Refridgerating smears
- Contaminated sample –> needs to be fresh
- Poor sampling and smearing techniques
- Breakage/leakage
- Staining (over, under)
Is this a diagnostic preparation? Describe it
No - there is nuclear streaking/debris
Is this a diagnostic preparation? Describe it
No - blood contamination
Is this a diagnostic preparation? Describe it
No - lack of spread
Is this a diagnostic preparation? Describe it
No - free or naked nuclei
Advantages of cytology (3)
1) Quick, easy (cheaper and faster than histopath)
2) Minimal risk to patient
3) Important screening tool – form diagnostic and treatment plans
Disadvantages of cytology (6)
1) Results depend on quality of sample
2) Diagnosis depends on skill of cytologist
3) Lack of tissue architecture – diagnosis limited to inflammation and neoplasia
4) Unable to grade neoplasm
5) Few diagnostic options for carinomas and sarcomas
6) False pos/False neg
What type of lesion is characterized by presence of inflammatory cells
Inflammatory lesions
Your sample has non-degenerate neutrophils, some lymphs and macs, but no bacteria. What kind of lesion is this? What are some expamples of its cause
Non-purulent (non-septic) inflammation
Causes:
- Seroma
- Foreign body
- Necrosis
Describe degenerate neutrophils
Swollen nucleus, karylozyed (blobbed nucleus, rather than multi-segmented)
Cytoplasm stains more pink than purple
Your sample has mainly neutrophils which are noted to be degenerate. You also observe microorganisms. What type of sample is this? What follow up tests can you run
Neutrophilic septic inflammation
Caused by infectious microorganisms
Next step
- Mixed or single bacterial population
- Special stains (modified ZN, fontana, PAS)
Your sample is found to be neutrophilic septic inflammation, which you suspect is due to fungal infection. Which stains can you use to confirm? *
Fontana
Periodic acid schiff (PAS)
Your sample has mixed population of neutrophils and macrophages. What type of sample is this
Chronic-Active inflammation
(aka neutrophilic macrophagic inflammation)
Your sample is composed mainly of macrophages and multinucleated giant cells. What is going on?
Granulomatous inflammation
Your sample has a mixed cel population with neutrophils and eosinophils. What is going on?
Eosinophilic inflammation
Due to hypersensitivity (allergic reactions)
Neoplasms are characterized by changes in what
- Changes in nucleus
- Changes in cytoplasm
What’s a benign round cell neoplasm called?
All round cell neoplasms are malignant
What are epithelial cell neoplasms called
Benign = oma
Malignant = carcinoma
What are spindle cell neoplasms called
Benign = oma
Malignant = sarcoma
Main features of benign neoplasms (3)
1) Orderly cell proliferation - monomorphism
- Uniform size/shape of cells
- Uniform N:C ratios
- Uniform size, shape, number of nuclei
2) No inflammatory cells
3) No malignant cells
Your lesion is a bloody, non-clotting fluid. You notice an absence of platelets. What is this?
Hematoma
What cells are present in hematomas
First, RBCs
Then - erythrophages (= RBCs in macs)
Finally - hemosiderophages (= macs with hemosiderin (RBC products))
The mass you sampled is hypocellular with few squames and few RBCs. What do you suspect?
Lipoma
Which stains can you use for lipomas *
Sudan III
ORO
You see clumps of benign tissue. This is indicative of….
Lipoma
Your patient has a firm, painless mass in the submaxillary space. You remove a red-black, viscous fluid with clumps of mucin. What do you suspect?
Sialoceles
Your sample has cell debris and squames. You also observe cholesterol crystals. What does this indicate?
Epithelioma/Epidermal cyst
Name the benign neoplasms *
Hematoma
Lipoma
Siacoele
Epidermal cyst/Epithelioma
Does this show a feature of malignancy?
Yes - anisocytosis (different sized cells)
Does this show a feature of malignancy?
Yes - polymorphism
Does this show a feature of malignancy?
Yes - cytoplasmic granules (red arrow) and cellular molding (green arrow)
Mast cell tumor!
Does this show features of malignancy
Yes - cytoplasmic vacuoles, reduced N:C ratio, basophilic cytoplasm
List cytoplasmic featuers of maligancy (6)
- Cellular molding - flattening out due to unregulated growth. Grow into each other
- Basophilia – blue cytoplasm
- Vacules - TVT
- Granules - MCT
- Various nucleus:cytoplasm ratio
- Pseudopod formation - lymphoma
Cytoplasmic granulation is often seen in which malignant neoplasms
Mast cell tumors
Melanomas
Cellular vacuolating is a sign of which tumor
TVT!
Pseudopods are common in which tumor
Lymphomas
Name nuclear features of malignancy (6)
- Poikilokaryosis: abnormal nucleus shape, nuclear fragmentation
- Anisokaryosis: different nucleus size
- Nuclear modling: nucleus molding into neighboring nucleus, concave appearance
- Binucleation/Multi-nucleation
- Prominent nucleolus
- Mitotic figures
What’s this
Mitotic figure (nuclear feature of malignancy)
Is this a malignant sample?
Are these cells malignant
Yes - poikilokaryosis, anisokaryosis, nuclear molding
Are these cells malignant
Yes - nuclear molding, multinucleation, chromatin clumping
What are two consequences of using excessive pressure when making cytology slides
- Free/naked nuclei
- Nuclear streaking/debris
