Cytology (FNA) Flashcards
1
Q
Describe the cytologic features of epithelial cells.
A
Cohesive clusters of sheets.
*Distinct borders
round/oval/polygonal cells
can be acinar/glandular
2
Q
Which epithelial neoplasms require histopath to determine malignancy?
A
Mammary
Hepatocellular (Circumanal gland adenoma v. carcinoma)
3
Q
Most common epithelial tumor in dog?
A
Adnexal (includes epithelioma, trichoblastoma, sebaceous adenoma)
(But technically MCT is most common?)
4
Q
most common route for metastatic spread of epithelial tumors?
A
lymphatics
5
Q
two types of perianal neoplasms? How do they differ cytologically and in malignancy?
A
- Circumanal gland (or hepatoid) - looks epithelial
2. Anal sac apocrine gland (AGASACA) - looks neuroendocrine
6
Q
common paraneoplastic syndrome associated with AGASACA?
A
Hypercalcemia of malignancy
7
Q
cytologic features of neuroendocrine tumors?
A
high N:C
uniform nuclei
cells appear lysed/indistinct borders (unless handled very carefully)
8
Q
How to determine biological behavior of a neuroendocrine neoplasm?
A
Histopath
9
Q
Tumors with vacuolization
A
Epithelial: sebaceous
Neuroendocrine: insulinoma, adrenal
10
Q
Defining features of thyroid neoplasms?
A
- neuroendocrine
2. Colloid(pink) and tyrosine granules(purple granules)
11
Q
species with functional thyroid tumors?
A
cats
12
Q
breeds with nonchromaffin chemoreceptor tumors?
A
heartbase(aortic body tumors)
Brachycephalic (boxer, boston terrier)
13
Q
often incidental neuroendocrine tumor?
A
Pheochromocytoma
14
Q
Tumor often seen with other concurrent neoplasms?
A
Pheochromocytoma
15
Q
What are follicular cysts composed of?
When does it becomes inflamed?
A
- keratinized cells, amorphous material, cholesterol crystals.
- when ruptures (leads to self trauma/pyoderma)
16
Q
Pigment seen with hemorrhage
A
hemosiderin, hematoidin
17
Q
What are degenerative changes? (What part of the cell and where to they occur?) What are the implications of degenerative changes?Can they be artifact?
A
Nuclear changes that occur in the tissues
(toxic changes affect the cytoplasm and occur in the marrow)
- karyolysis can happen if in tube too long (ARTIFACT)
- karyorrhexis and pyknosis can happen with normal cell death or bacterial
18
Q
8 criteria for malignancy
A
anisokaryosis pleomorphism high/variable N:C(not for round) mitotic figures prominent nuclei coarse chromatic nuclear molding multinucleation
19
Q
Why use cautian when interpretting mixed cell populations?
A
neutrophils make cells look atypical;
reactive hyperplasia mimics malignancy
20
Q
Cytology in reactive lymphoid hyperplasia
A
small cells predominate
increased intermediate/large cells but not over 20%. Plasma cells, neuts, eos, phages due to Ag stimulation.
21
Q
cytology in lymphadenitis
A
increased neuts/eos/phages. Neutrophillic if >5% neuts Eosinophilic if over >3% Or Pyogran look for bacteria, fungi, protozoa
22
Q
cytology in lymphoma of peripheral lymph node
A
suspicious when >30% are blasts. 50-90% usually on clinical presentation
23
Q
metastatic neoplasia to LN
A
cells not normally seen, usually with malignant characteristics. Easy to miss early disease
24
Q
Signalment and important clinical findings of Feline Hodgkins-like lymphoma
A
- Adults with enlarged nodes in neck, then works it way to the nodes in the chest and so on.
- (mixed enlargement on cytology, with mirrored nuclei)
- good prognosis when nodes removed
25
Signalment of Distinctive perif lymphoid hyperplasia (DPLH) of cats
young cats <2yrs
with peripheral lymphadenomegaly
(mimics multicentric lymphoma)
26
Signalment of cats with small cell lymphoma
```
Old cats (often geriatric)
FeLV negative
```
27
Multiple Nodes with Reactive lymphoid hyperplasia implies what?
non-specific
| Ag stimulation with many etiologies
28
Lymphoglandular body
basophilic cytoplasmic fragments
29
tests to determine lymphoma phenotype
Flow is best
also IHC/ICC
(PARR determine if lymphoma or reactive [clonality] )
30
Which conditions are associated with false positive PARR
chronic Ag stimulation (like ehrlichia)
| false negatives are more common
31
Test to diagnose feline hodgkin's like lymphoma
IHC
32
3 types of feline alimentary lymphoma
small cell
large granular (Cytotoxic T cell)
large B cell
33
Which alimentary lymphoma may present as a mass (of colon/stomach)
Large B cell
34
lymphocytic IBD is hard to differentiate from what on GI cytology and histology?
small cell alimentary lymphoma
35
Which is worse t or b cell
T cell lymphoma
36
which substage of lymphoma has a better prognosis?
A, its subclinical
37
which phenotype of lymphoma is associated with hyper Ca more commonly
T cell
38
What is PARR used for?
Determining if neoplastic or not. monoclonal v. polyclonal.
39
What is Flow used for?
phenotype. B v. T cell
40
Differentials for benign and neoplastic lymphoid proliferation:
1. LGL in circulation
2. Lymphocyte rich fluid with mediastinal mass
3. lymphoblasts predominate splenic aspirate
4. expanded small lymphocytes in GI
1. ehrlichia v. Leukemia
2. chyloud effusion v. small lymphoma or thymoma
3. aspirating germinal center of lymphoid follicle vs. lymphoma
4. IBD v. small lymphoma
41
Is the thymus able to be aspirated in adult animals
no
42
mast cells are present in ____ numbers in the thymus
moderate
43
paraneoplastic syndromes associated with thymic neoplasia
hyper Ca
megaesophagus
myasthenia gravis
44
Which biopsy is more representative of hepatic architecture?
wedge biopsy (needed to diagnose hepatitis/cirrosis, fibrosis, portovascular anomaly)
45
Blind FNA can yield diagnostic samples for which diseases?
diffuse diseases:
- hepatic lipidosis
- vacuolar hepatopathy
- lymphoma
- neutrophilic hepatitis
46
why use ultrasound guided FNA of focal hepatic lesions?
distinguish inflammatory, hyperplastic, and neoplastic (may not be possible with FNA alone)
- good screening tool before getting a biopsy
47
What is the significance of nuclear crystals in hepatic cytology?
Nothing (they can in the kidney too though)
48
When can hepatocellular binucleation be observed?
normally, and with hyperplasia
49
2 types of hepatocellular vacuolar degeneration and why do each occur?
distinct (fat / hepatic lipidosis)
| indistinct = rarifaction (glycogen or water accumulation)
50
What type of vacuolar degeneration is more common in cats? in dogs?
cats - distinct
| dogs - indistinct
51
What liver pigments are most commonly observed?
bile (from cholestasis)
lipofuschin (wear and tear)
hemosiderin (hemorrhage, iron breakdown)
Cu (certain breeds)
52
What are bile casts? When do they occur?
Cholestasis. when bile backs up
53
Can you differentiate hepatitis and cholangitis on cytology?
no need histology
| both have a normal sized liver and low number of lymphocytes
54
what type of inflammation in the liver is cytology sensitive to?
neutrophillic and macrophage inflammation
55
nodular hyperplasia v. hepatocellular regeneration
nodular hyperplasia is normal in older dogs, no clinical signs, cytology has vacuolar degeneration, bile, lipofuscin, and EMH.
vs. Regeneration is chronic, also vacuolar degeneration, bile and bile CASTS, clumped FIBROBLASTS
- cant always tell difference on cytology
56
metastatic rates of hepatocellular carcinoma
1. diffuse 100% (more aggressive)
2. nodular 90% (more aggressive)
3. Massive 5-35%
57
most common hepatic neoplasia?
metastatic lymphoma
58
most common primary hepatic tumor in DOGS and its site predilection
hepatocellular carcinoma - massive form
59
Most common primary hepatic tumor in cats
bile duct carcinoma
60
Which tube do you use for cytology and culture of cavitary effusions?
cytology - EDTA
| Culture - Red Top
61
most common clinical sign of severe effusion
dyspnea
62
If there is delay is processing a fluid sample (transport >30 minutes) What should you do?
make a (direct smear) slide at time of collection, and keep the fluid refrigerated
63
What is the predominate cell type in normal cavity fluid of dogs and cats?
mononuclear cells (macrophages)
64
What is the predominate cell type in normal cavity fluid of horses?
mature neutrophils
65
How to classify types of cavity effusions?
1. Transudate - (Low, Low) TP <2.5, <1,500 cells
2. Modified Transudate - (Intermediate) TP ABOVE 2.5, 1,000-7,000 cells
3. Nonseptic exudate - (High, High) TP >3, >5,000 cells (NEUTROPHILS)
4. Septic exudate - "" "" with intracellular bacteria
5. Chylous - variable TP, cells, LYMPHOCYTES
6. Hemorrhagic - Erythrophagia, hemosiderin
7. Neoplastic
66
Horses have ____ cell counts in cavity effusions
higher
67
How do transudates form and what are some clinical conditions that would cause it?
- Reduced oncotic pressure, increased hydrostatic pressure.
| - Liver disease, Intestinal disease(Maldigestion, PLE), Renal (PLN), Iatrogenic
68
Which biochemical test is used to diagnose chylous effusion?
triglycerides, 100 mg/dL
69
How do exudates form and what are some clinical conditions that would cause it?
- increased vascular permeability and inflammation
- Septic exudate: Wounds, GI perforation, abscessed organs, iatrogenic
- Non-Septic: long standing mod transudate, peritonitis (uroperitoneum, bile), FIP, FB, Neoplasia, pancreatitis
70
What must be present to diagnose a septic exudate?
degenerate neutrophils
| intracellular organisms
71
Distinguish true hemorrhage from iatrogenic blood contamination in an effusion
Hemorrhage - phagocytized RBCs, hemosiderin (chronic)
Iatrogenic - platelets present
72
most common neoplastic effusions?
```
lymphoma
carcinoma
hemangiosarcoma
mesothelioma (binucleated)
visceral MCT
```
73
How to classify synovial fluid?
inflammatory - neutrophils
| noninflammatory - mononuclear (in increased number)
74
causes of decreased synovial fluid viscosity
- breakdown by proteases
- dilution (plasma fluid influx, lavage, injections)
- synovium damage
75
What is the cytologic appearance and predominant cell type in
1. normal fluid
2. non inflammatory joint disease
3. inflam joint disease
1. pink background(dense granular eosinophilic background) mononuclear cells predominate, neutrophils <10%
2. too many mononuclear cells, or extremely reactive
3. neutrophils predominate
76
normal protein in joint fluid
>2.5
77
differentials for noninflammatory joint fluid
DJD!!!
| Trauma, hemarthrosis, neoplasia
78
how to diagnose DJD
need radiographs!!!
| joint fluid is non-inflammatory, diagnosis often doesn't include fluid sample
79
What joint is usually affected in dogs with lymphoplasmacytic synovitis and with what orthopedic finding is it associated?
stifle, ligament pathology (CCL rupture)
80
Reactive Polyarthritis (ex. ehrlichia infection)
immune complexes get stuck in capillarys -> joints -> inflammation and tissues destruction
81
types of inflammatory neutrophilic joint inflammation?
infectious
immunologic
nonimmunologic
82
most common inflammatory joint disease in dogs?
immunologic nonerosive idiopathic polyarthropathy
83
erosive immunologic inflammatory arthropathy
**idiopathic (Rhuematoid)
or greyhounds(EPG)
or Feline chronic progressive (FCPP)
84
The RF test
not very useful in diagnosing rhuematoid arthritis (Idiopathic erosive)
85
Most common inflammatory joint disease in cats and what is its etiology?
Feline chronic progressive polyarthropathy
- male cats
- Viral associated, immune complexes lead to neutrophilic infiltration
86
most common inflammatory joint disease of large animals
Septic Arthritis
87
Respiratory washes are typically most useful for what type of infiltrate?
peribronchial infiltrate (bronchiolar/alveolar)
88
What is the preferred additive for preserving respiratory wash samples during transport (>24h)?
add serum (4 drops per mL of BAL) or EDTA
89
differentials for neutrophilic TTW
nonseptic: irritation/necrosis, ARDS, inflam airway in horses
Septic: bact, fungal, viral, nematode
90
differentials for Mixed TTW
chronic inflammation or infection/FB. Bronchitis in dogs, heaves in horses, lipid pneumonia
91
differentials for Eosinophilic TTW
allergy hypersensitivity, parasite migration, eos bronchopneumopathy, lymphomatoid granulomatosis, heaves
92
differentials for hemorrhagic TTW
**Exercise induced pulmonary hemorrhage, asthma, trauma, coagopathies, thromboembolic disease, neoplasia
93
common tumors of eyelids?
meibomian gland adenoma
| sebaceous epithelioma
94
species affected by ocular chlamydiosis
cats, horses, guinni pigs
95
viral conjunctivitis affects which species? and causes what type of inflammation?
cats, dogs, horses
lymphoplasmocytic in acute stages and neutrophilic when chronic
96
Eosinophilic conjunctivitis/keratitis affects which species?
What cells are present?
cats
horses
mast cells infiltrate with eosinophils
97
which species are more commonly affected by squamous cell carcinoma of the cornea?
horse and cow
98
Normal leukocyte on CSF
<5
99
T or F
CNS ds causes consistent changes to CSF that are reproducible from animal to animal, and correspond to cause and severity of disease
false
100
When is there a increased protein concentration with normal leukocyte count?
= albuminocytologic disocciation
| - lesions that obstruct CSF flow, damage BBB, localized damage
101
When is there increased neutrophils with normal leukocyte count
- early/mild inflammatory ds
- lesions don't involve meninges
- blood contamination
- steroids
102
Which diseases cause types of pleocytosis?
- Neutrophilic
- lymphocytic
- eosinophilic
- mixed
- Neutrophilic: bacterial, acute alphaviral (EEE), GME, meningioma, SRMA
- lymphocytic: viral, necrotizing, nonsuppurative meningoencephalitis, feline polioencephalomyelitis
- eosinophilic: aberrant parasites
- mixed: GME, chronic FIP
103
In which situations would you prefer a AO vs. LS CSF tap?
sample distal to a lesion
| LS if there's a T3-L3 ruptured disk
104
route of spread for mesenchymal cells
hematogenous
105
what tumors can feel like lipomas
soft tissue sarcoma
| MCT
106
cells present in injection site sarcomas
lymphocytes
107
what must synovial cell sarcoma be distinguished from?
histiocytic and soft tissue sarcoma
108
synovial cell sarcomas
elbow, stifle, shoulder , locally invasive met 25% of the time
109
breeds that get
histiocytic sarcoma
synovial myxoma
histiocytic sarcoma - rotties
synovial myxoma - doberman
both in stifle
110
osteosarcoma is more malignant in which species?
dog
| can be benign in cat/horse
111
osteomas and chondromas like which bones
scull and flat bones
112
6 round cell tumors
- lymphoma
- MCT
- histiocytic
- Melanoma
- plasma cell
- TVT
113
how do round cell tumors typically met?
lymphatics
114
defining features of plasma cells
eccentric nucleus, may see binucleation, marked anisocytosis
115
difference histiocytoma and histiocytic sarcoma
cytoma - benign, hairless, hard or trunk, regresses spontaneously
sarcoma - bernese, secondary site liver and lung
116
locations for TVTs
external genitalia
nasal cavity
mucous membranes
117
poorer prognosis for MCT when at which locations
nailbed, scrotal, mucocutaneous
118
which melanocytic tumors are more aggressive
digits
| oral
