Cytology (FNA) Flashcards
Describe the cytologic features of epithelial cells.
Cohesive clusters of sheets.
*Distinct borders
round/oval/polygonal cells
can be acinar/glandular
Which epithelial neoplasms require histopath to determine malignancy?
Mammary
Hepatocellular (Circumanal gland adenoma v. carcinoma)
Most common epithelial tumor in dog?
Adnexal (includes epithelioma, trichoblastoma, sebaceous adenoma)
(But technically MCT is most common?)
most common route for metastatic spread of epithelial tumors?
lymphatics
two types of perianal neoplasms? How do they differ cytologically and in malignancy?
- Circumanal gland (or hepatoid) - looks epithelial
2. Anal sac apocrine gland (AGASACA) - looks neuroendocrine
common paraneoplastic syndrome associated with AGASACA?
Hypercalcemia of malignancy
cytologic features of neuroendocrine tumors?
high N:C
uniform nuclei
cells appear lysed/indistinct borders (unless handled very carefully)
How to determine biological behavior of a neuroendocrine neoplasm?
Histopath
Tumors with vacuolization
Epithelial: sebaceous
Neuroendocrine: insulinoma, adrenal
Defining features of thyroid neoplasms?
- neuroendocrine
2. Colloid(pink) and tyrosine granules(purple granules)
species with functional thyroid tumors?
cats
breeds with nonchromaffin chemoreceptor tumors?
heartbase(aortic body tumors)
Brachycephalic (boxer, boston terrier)
often incidental neuroendocrine tumor?
Pheochromocytoma
Tumor often seen with other concurrent neoplasms?
Pheochromocytoma
What are follicular cysts composed of?
When does it becomes inflamed?
- keratinized cells, amorphous material, cholesterol crystals.
- when ruptures (leads to self trauma/pyoderma)
Pigment seen with hemorrhage
hemosiderin, hematoidin
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?
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
8 criteria for malignancy
anisokaryosis pleomorphism high/variable N:C(not for round) mitotic figures prominent nuclei coarse chromatic nuclear molding multinucleation
Why use cautian when interpretting mixed cell populations?
neutrophils make cells look atypical;
reactive hyperplasia mimics malignancy
Cytology in reactive lymphoid hyperplasia
small cells predominate
increased intermediate/large cells but not over 20%. Plasma cells, neuts, eos, phages due to Ag stimulation.
cytology in lymphadenitis
increased neuts/eos/phages. Neutrophillic if >5% neuts Eosinophilic if over >3% Or Pyogran look for bacteria, fungi, protozoa
cytology in lymphoma of peripheral lymph node
suspicious when >30% are blasts. 50-90% usually on clinical presentation
metastatic neoplasia to LN
cells not normally seen, usually with malignant characteristics. Easy to miss early disease
Signalment and important clinical findings of Feline Hodgkins-like lymphoma
- 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
Signalment of Distinctive perif lymphoid hyperplasia (DPLH) of cats
young cats <2yrs
with peripheral lymphadenomegaly
(mimics multicentric lymphoma)
Signalment of cats with small cell lymphoma
Old cats (often geriatric) FeLV negative
Multiple Nodes with Reactive lymphoid hyperplasia implies what?
non-specific
Ag stimulation with many etiologies
Lymphoglandular body
basophilic cytoplasmic fragments
tests to determine lymphoma phenotype
Flow is best
also IHC/ICC
(PARR determine if lymphoma or reactive [clonality] )
Which conditions are associated with false positive PARR
chronic Ag stimulation (like ehrlichia)
false negatives are more common
Test to diagnose feline hodgkin’s like lymphoma
IHC
3 types of feline alimentary lymphoma
small cell
large granular (Cytotoxic T cell)
large B cell
Which alimentary lymphoma may present as a mass (of colon/stomach)
Large B cell
lymphocytic IBD is hard to differentiate from what on GI cytology and histology?
small cell alimentary lymphoma
Which is worse t or b cell
T cell lymphoma
which substage of lymphoma has a better prognosis?
A, its subclinical
which phenotype of lymphoma is associated with hyper Ca more commonly
T cell
What is PARR used for?
Determining if neoplastic or not. monoclonal v. polyclonal.
What is Flow used for?
phenotype. B v. T cell
Differentials for benign and neoplastic lymphoid proliferation:
- LGL in circulation
- Lymphocyte rich fluid with mediastinal mass
- lymphoblasts predominate splenic aspirate
- expanded small lymphocytes in GI
- ehrlichia v. Leukemia
- chyloud effusion v. small lymphoma or thymoma
- aspirating germinal center of lymphoid follicle vs. lymphoma
- IBD v. small lymphoma
Is the thymus able to be aspirated in adult animals
no
mast cells are present in ____ numbers in the thymus
moderate
paraneoplastic syndromes associated with thymic neoplasia
hyper Ca
megaesophagus
myasthenia gravis
Which biopsy is more representative of hepatic architecture?
wedge biopsy (needed to diagnose hepatitis/cirrosis, fibrosis, portovascular anomaly)
Blind FNA can yield diagnostic samples for which diseases?
diffuse diseases:
- hepatic lipidosis
- vacuolar hepatopathy
- lymphoma
- neutrophilic hepatitis
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
What is the significance of nuclear crystals in hepatic cytology?
Nothing (they can in the kidney too though)
When can hepatocellular binucleation be observed?
normally, and with hyperplasia
2 types of hepatocellular vacuolar degeneration and why do each occur?
distinct (fat / hepatic lipidosis)
indistinct = rarifaction (glycogen or water accumulation)
What type of vacuolar degeneration is more common in cats? in dogs?
cats - distinct
dogs - indistinct
What liver pigments are most commonly observed?
bile (from cholestasis)
lipofuschin (wear and tear)
hemosiderin (hemorrhage, iron breakdown)
Cu (certain breeds)
What are bile casts? When do they occur?
Cholestasis. when bile backs up
Can you differentiate hepatitis and cholangitis on cytology?
no need histology
both have a normal sized liver and low number of lymphocytes
what type of inflammation in the liver is cytology sensitive to?
neutrophillic and macrophage inflammation
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
metastatic rates of hepatocellular carcinoma
- diffuse 100% (more aggressive)
- nodular 90% (more aggressive)
- Massive 5-35%
most common hepatic neoplasia?
metastatic lymphoma
most common primary hepatic tumor in DOGS and its site predilection
hepatocellular carcinoma - massive form
Most common primary hepatic tumor in cats
bile duct carcinoma
Which tube do you use for cytology and culture of cavitary effusions?
cytology - EDTA
Culture - Red Top
most common clinical sign of severe effusion
dyspnea
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
What is the predominate cell type in normal cavity fluid of dogs and cats?
mononuclear cells (macrophages)
What is the predominate cell type in normal cavity fluid of horses?
mature neutrophils
How to classify types of cavity effusions?
- Transudate - (Low, Low) TP <2.5, <1,500 cells
- Modified Transudate - (Intermediate) TP ABOVE 2.5, 1,000-7,000 cells
- Nonseptic exudate - (High, High) TP >3, >5,000 cells (NEUTROPHILS)
- Septic exudate - “” “” with intracellular bacteria
- Chylous - variable TP, cells, LYMPHOCYTES
- Hemorrhagic - Erythrophagia, hemosiderin
- Neoplastic
Horses have ____ cell counts in cavity effusions
higher
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
Which biochemical test is used to diagnose chylous effusion?
triglycerides, 100 mg/dL
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
What must be present to diagnose a septic exudate?
degenerate neutrophils
intracellular organisms
Distinguish true hemorrhage from iatrogenic blood contamination in an effusion
Hemorrhage - phagocytized RBCs, hemosiderin (chronic)
Iatrogenic - platelets present
most common neoplastic effusions?
lymphoma carcinoma hemangiosarcoma mesothelioma (binucleated) visceral MCT
How to classify synovial fluid?
inflammatory - neutrophils
noninflammatory - mononuclear (in increased number)
causes of decreased synovial fluid viscosity
- breakdown by proteases
- dilution (plasma fluid influx, lavage, injections)
- synovium damage
What is the cytologic appearance and predominant cell type in
- normal fluid
- non inflammatory joint disease
- inflam joint disease
- pink background(dense granular eosinophilic background) mononuclear cells predominate, neutrophils <10%
- too many mononuclear cells, or extremely reactive
- neutrophils predominate
normal protein in joint fluid
> 2.5
differentials for noninflammatory joint fluid
DJD!!!
Trauma, hemarthrosis, neoplasia
how to diagnose DJD
need radiographs!!!
joint fluid is non-inflammatory, diagnosis often doesn’t include fluid sample
What joint is usually affected in dogs with lymphoplasmacytic synovitis and with what orthopedic finding is it associated?
stifle, ligament pathology (CCL rupture)
Reactive Polyarthritis (ex. ehrlichia infection)
immune complexes get stuck in capillarys -> joints -> inflammation and tissues destruction
types of inflammatory neutrophilic joint inflammation?
infectious
immunologic
nonimmunologic
most common inflammatory joint disease in dogs?
immunologic nonerosive idiopathic polyarthropathy
erosive immunologic inflammatory arthropathy
**idiopathic (Rhuematoid)
or greyhounds(EPG)
or Feline chronic progressive (FCPP)
The RF test
not very useful in diagnosing rhuematoid arthritis (Idiopathic erosive)
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
most common inflammatory joint disease of large animals
Septic Arthritis
Respiratory washes are typically most useful for what type of infiltrate?
peribronchial infiltrate (bronchiolar/alveolar)
What is the preferred additive for preserving respiratory wash samples during transport (>24h)?
add serum (4 drops per mL of BAL) or EDTA
differentials for neutrophilic TTW
nonseptic: irritation/necrosis, ARDS, inflam airway in horses
Septic: bact, fungal, viral, nematode
differentials for Mixed TTW
chronic inflammation or infection/FB. Bronchitis in dogs, heaves in horses, lipid pneumonia
differentials for Eosinophilic TTW
allergy hypersensitivity, parasite migration, eos bronchopneumopathy, lymphomatoid granulomatosis, heaves
differentials for hemorrhagic TTW
**Exercise induced pulmonary hemorrhage, asthma, trauma, coagopathies, thromboembolic disease, neoplasia
common tumors of eyelids?
meibomian gland adenoma
sebaceous epithelioma
species affected by ocular chlamydiosis
cats, horses, guinni pigs
viral conjunctivitis affects which species? and causes what type of inflammation?
cats, dogs, horses
lymphoplasmocytic in acute stages and neutrophilic when chronic
Eosinophilic conjunctivitis/keratitis affects which species?
What cells are present?
cats
horses
mast cells infiltrate with eosinophils
which species are more commonly affected by squamous cell carcinoma of the cornea?
horse and cow
Normal leukocyte on CSF
<5
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
When is there a increased protein concentration with normal leukocyte count?
= albuminocytologic disocciation
- lesions that obstruct CSF flow, damage BBB, localized damage
When is there increased neutrophils with normal leukocyte count
- early/mild inflammatory ds
- lesions don’t involve meninges
- blood contamination
- steroids
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
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
route of spread for mesenchymal cells
hematogenous
what tumors can feel like lipomas
soft tissue sarcoma
MCT
cells present in injection site sarcomas
lymphocytes
what must synovial cell sarcoma be distinguished from?
histiocytic and soft tissue sarcoma
synovial cell sarcomas
elbow, stifle, shoulder , locally invasive met 25% of the time
breeds that get
histiocytic sarcoma
synovial myxoma
histiocytic sarcoma - rotties
synovial myxoma - doberman
both in stifle
osteosarcoma is more malignant in which species?
dog
can be benign in cat/horse
osteomas and chondromas like which bones
scull and flat bones
6 round cell tumors
- lymphoma
- MCT
- histiocytic
- Melanoma
- plasma cell
- TVT
how do round cell tumors typically met?
lymphatics
defining features of plasma cells
eccentric nucleus, may see binucleation, marked anisocytosis
difference histiocytoma and histiocytic sarcoma
cytoma - benign, hairless, hard or trunk, regresses spontaneously
sarcoma - bernese, secondary site liver and lung
locations for TVTs
external genitalia
nasal cavity
mucous membranes
poorer prognosis for MCT when at which locations
nailbed, scrotal, mucocutaneous
which melanocytic tumors are more aggressive
digits
oral
