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Clinical Pathology > Cytology & Effusions > Flashcards

Cytology & Effusions Flashcards

1
Q

What are the 3 major types of samples used for cytology?

A
  1. FNA (22G needle and 5cc syringe) and impression smears
  2. washes - prostatic, transtracheal
  3. fluids - peritoneal, pericardial, pleural, synovial, CSF, bronchoalveolar lavage, urine
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2
Q

What are the pros to running cytology?

A
  • minimally invasive
  • fast, simple, inexpensive
  • better cellular detail than histopathology
  • can observe infectious organisms
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3
Q

What are some cons to running cytology?

A
  • cannot evaluate tissue architecture
  • poorly exfoliating lesions, like sarcomas, are difficult to observe
  • can rupture cells
  • can’t always be used to make a diagnosis
  • difficult to differentiate reactive mesenchymal cells from neoplastic cells
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4
Q

What are the 3 major components of a cytological evaluation?

A
  1. overall cellularity - high vs. low (low cellularity samples make interpretation difficult)
  2. cell components/types - uniform populations vs. mixed
  3. background components - blood, proteinaceous material, organisms

(best to send organ aspirates and bone marrows to pathologists)

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5
Q

What is the first approach to evaluating a cytology sample?

A

scan the slide at low magnification (10x) and find cellular area where cells are well spread out and intact

  • where the appearance of nuclei and cytoplasm of individual cells can be evaluated
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6
Q

What is done on cytology evaluations at high magnification (50x, 100x oil)?

A

characterizing cells - normally found in the location of the sample?

  • types of inflammatory cells
  • organisms presence
  • non-inflammatory cells: epithelial, mesenchymal, round
  • do non-inflammatory cells exhibit criteria of malignancy
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7
Q

How are inflammatory lesions classified?

A
  • suppurative = neutrophils
  • mononuclear = lymphocytes, plasma cells, macrophages
  • histiocytic/granulomatous = macrophages
  • pyogranulomatous = neutrophils + macrophages
  • eosinophilic
  • lymphoplasmacytic = lymphocytes + plasma cells
  • mixed
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8
Q

What is evaluated on suppurative inflammation?

A

neutrophil morphology —> degeneracy (larger than normal with distended vacuolated cytoplasm and a slightly swollen enlarged nucleus)

  • if yes, search for bacteria
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9
Q

What infectious cause of suppurative inflammation? What if an eosinophilic component is also seen?

A

bacterial infection —> especially if there are degenerate neutrophils (septic suppurative)

parasitic or allergic component to inflammatory response

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10
Q

What are 4 possible non-inflammatory causes of suppurative inflammation?

A
  1. severe irritants/chemicals - uroperitoneum, bile peritonitis
  2. immune-mediated inflammation
  3. trauma
  4. ruptured follicular/epidermal cysts
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11
Q

What are 3 infectious causes of histiocytic/granulomatous inflammation?

A

MACROPHAGES

  1. protozoa - Leishmania, Toxoplasma
  2. atypical bacteria - Mycobacteria, Nocardia, Actinomyces
  3. fungi - Histoplasma, Blastomyces, Cryptococcus, Coccidioides
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12
Q

When is fungal infection especially indicated with histiocytic/granulomatous inflammation?

A

if epithelioid macrophages and/or multinucleated giant cells are found

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13
Q

What are 3 non-infectious causes of histiocytic/granulomatous inflammation?

A
  1. foreign bodies/materials - plants (grass awns), vaccine adjuvants
  2. acral lick dermatitis (lick granuloma)
  3. late stage chronic/resolving inflammation
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14
Q

What makes up pyogranulomatous inflammation? What are the 3 most common causes?

A

50-70% neutrophils, 30-50% mononuclear cells (macrophages, multinucleated giant cells, lymphocytes, plasma cells, mast cells)

  1. foreign body
  2. fungal infections
  3. chronic/resolving suppurative inflammation
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15
Q

What are 2 infectious causes of eosinophilic inflammation?

A
  1. parasites: Dracunculiasis, Demodicosis, Dirofilaria, Dermatophytes
  2. oomycosis and algal organisms: Pythium, Prototheca
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16
Q

What is commonly also seen with non-infectious eosinophilic inflammation? What are 3 common causes?

A

mast cells and basophils

  1. eosinophilic plaque/granuloma
  2. flea bite or food allergies, atopy
  3. arthropod bite reaction
17
Q

What are the 3 categories of neoplasia? Why is cytological criteria evaluated?

A
  1. epithelial
  2. mesenchymal
  3. round

detects criteria of malignancy to determine if the neoplasia is benign or malignant (NOT reliable for round cell tumors)

18
Q

What are the 6 criteria for malignancy?

A
  1. anisocytosis - variation in cell size between cells of the same origin
  2. anisokaryosis - variation in nuclear size
  3. immature chromatin
  4. multinucleation
  5. abnormal mitotic figures
  6. nucleolar changes - enlarged, prominent, multiple, variably shaped nucleoli
19
Q

What are the 3 main characteristics of epithelial cell tumors?

A
  1. tightly cohesive clusters
  2. polygonal to round
  3. distinct intercellular junctions
20
Q

What are the 6 categories of round cell tumors?

A
  1. plasma cell
  2. histiocytoma
  3. lymphoma
  4. transmissible venereal tumors
  5. mast cell tumors
  6. melanoma
21
Q

What are the 4 major characteristics of round cell tumors?

A
  1. exfoliate well, samples are highly cellular
  2. round shape/borders
  3. can be in clusters or individually distributed
  4. criteria of malignancy are not reliable
22
Q

What are the 3 major characteristics of mesenchymal tumors?

A
  1. exfoliate poorly, better suited for histopathology
  2. distributed both in clusters and individually
  3. wispy, attenuated to stellate, abundant cytoplasm
23
Q

What are the 4 basic parts to fluid analysis?

A
  1. color, clarity
  2. cell count
  3. total protein
  4. cytological evaluation - differential cell count, cell morphology, organisms

additional tests may be indicated

24
Q

How should fluids be collected? What if they’re being cultured? How are they sent out?

A

in an EDTA (purple top) tube to prevent clotting

collect a separate aliquot from into a red top tube, since EDTA is bacteriostatic and can cause false negatives

since the fluid will likely not be process within 2 hours, make direct smears and send a purple top AND a red top tube to the lab

25
Q

How does color of the fluid give indications of etiology? What does turbidity indicate?

A
  • clear to pale yellow = normal
  • red = iatrogenic or true hemorrhage
  • yellow to dark green = bile
  • bright yellow = urine

increased cellularity, bacteria, fibrin, lipids, ingesta from GI rupture or accidental enterocentesis

26
Q

What are the 2 ways that protein counts are done on fludis?

A
  1. refractometry: peritoneal, pericardial, pleural, synovial
  2. biochemical: CSF
27
Q

What are the 2 major cell counts done on fluids?

A
  1. total nucleated cell count via automated hematology analyzer
  2. WBC differential count obtained by counting leukocytes on a stained cytology slide
28
Q

How are effusions classified? What are the 3 types?

A

total nucleated cell count and protein concentration

  1. pure transudate = < 2.5 g/dL protein, < 1500 TNCC/µL
  2. exudate = > 2.5 g/dL protein, > 5000 TNCC/µL
  3. modified transudate = somewhere in between
29
Q

How do true hemorrhage and blood contamination in effusions compare?

A

TRUE HEMORRHAGE = erythrophagocytosis (macrophages contain RBCs), hemosiderin-laden macrophages, supurnatent will be pink, yellow, or orange (unless acute), PCV and protein close to peripheral blood values

CONTAMINATION = platelets, absence of erythrophagocytosis, protein and cell counts will be less than peripheral blood, clear supernatant

30
Q

True hemorrhage, effusion:

A
31
Q

What are traumatic and non-traumatic causes of hemorrhagic effusions?

A

TRAUMATIC = blunt or penetrating trauma (HBC, gunshot wounds)

NON-TRAUMATIC = malignant neoplasia (HSA), hematoma, organ torsion, rodenticide toxicosis, coagulopathies

32
Q

What is seen in chylous effusion? What causes it? What levels are measured and compared to serum for diagnosis?

A
  • small lymphocytes with acute with incrasing numbers of neutrophils and macrophages over time
  • chylomicrons —> white-pink, opaque, no clearing with centrifugation

modified transudate from leakage of thoracic duct or other lymphatics

triglyceride level in effusion will be 2-3x that in the serum

33
Q

What are some causes of chylous effusion in the pleural cavity?

A
  • cardiovascular disease
  • neoplasia (lymphoma, thymoma)
  • heartworm disease
  • diaphragmatic disease
  • lung lobe torsion
  • fungal granulomas
  • idiopathic
34
Q

What are some causes of chylous effusion in the peritoneal cavity?

A
  • cardiovascular disease
  • FIP
  • neoplasia
  • steatitis
  • biliary cirrhosis
  • lymphatic rupture or leakage
35
Q

How are biochemical tests used on fluids?

A

confirm or differentiate between causes of an effusion by comparing the fluid analyte level to the serum or plasma

36
Q

What 2 biochemical analytes are used to diagnose septic effusions?

A
  1. GLUCOSE: fluid glucose will be less than serum glucose because bacteria consume glucose to survive
  2. LACTATE: fluid lactate will be higher than blood concentrations (product of respiration)
37
Q

What biochemical analytes are used to diagnose chylous, bilious, and uroperitoneal effusions?

A

CHYLOUS - triglycerides in fluid > 3x serum triglycerides

BILIOUS - fluid bilirubin > serum bilirubin

UROPERITONEUM - fluid creatinine and potassium > 2x serum levels

Clinical Pathology (33 decks)

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