Cytology For The Endocrinologost Flashcards
Which stain is used in cytology slides?
Diff Quick
Which preservative is used in cytology slides?
Formalin of Cytolyt
How is a direct smear done?
Can be done like a peripheral blood smear or “book technique”
What is cytospin?
Centrifugation of needle washings onto a slide, to concentrate material.
What is a cell block?
Needle washing is spun down and clotted to embed and cut like tissue.
What are the two fixation techniques used in preparing slides?
- Air drying
- Alcohol fixed
Which stains need the air drying method for fixation?
- Diff-Quick
- Wright-Geimsa
What is the disadvantage of air drying method of fixation?
Cells tend to ‘spread out’ introducing some distortion.
What two types of alcohol fixation methods are they?
- Dip
- Spray
Which stains are best with the alcohol method for fixation?
- Pap
- Hematoxylin and Eosin
What is the advantage of alcohol fixation method?
Preserves the cytomorphologic detail.
What is Diff-Quick good for?
Good for nuclear size and shape.
What color is cytoplasm in Diff-Quick?
Pink
What color are nuclei in Diff-Quick?
Purple
What color is cytoplasm in Papanicolaou?
Pink-orange to green-grey
What color are nuclei in Papanicolaou?
Purple to blue
What is Papanicolaou good for?
Nuclear detail
What is Hematoxylin and Eosin stain good for?
Classic tissue stain for cell block material.
What color is cytoplasm on Hematoxylin and Eosin stain?
Pink
What color are nuclei on Hematoxylin and Eosin stain?
Purple
What are the three stains in the Diff-Quick?
First - 95% alcohol
Second - Orange G
Third - Hematoxylin
How long is the slide dipped into each of the three solutions in Diff-Quick?
30 seconds each.
What four things are assessed with checking for adequacy?
- Cellularity
- Cell types
- Colloid
- Architecture
Adequate:
____ groups of well-preserved cells with each group having at least _____ cells.
5 - 6 groups
10 to 15 cells
Adequate:
Greater than ____ cell groups with at least ____ well-preserved cells per group.
8 cell groups
10 cells per group
The Papanicolaou Society of Pathology defines an adequate thyroid FNA biopsy as:
_____ groups of well-preserved follicular cells (____ cells per group)
6 - 8 groups
10 or more cells
The Papanicolaou Society of Pathology defines an adequate thyroid FNA biopsy as:
_____ groups of follicular cells on at least ____ slides from separate passes with a minimum of _____ clusters of follicular cells (____ cells/cluster)
6 groups
2 slides
10 clusters
20 cells/cluster
What four things are needed for ROSE (rapid on-site evaluation)?
- Patient sample on immediately prepared slides
- Diff Quick stains
- Microscope
- Ability to recognize and count follicular cell and Hurthle cell clusters
What is the billing code for the first pass?
88172
What is the billing code for each subsequent pass after the second?
88177
Billing for ROSE
Documentation must exist stating what was seen on each pass and if it was adequate or not.
True or false?
True
Is a CLIA license needed for FNA biopsy with ROSE (rapid on-site evaluation)?
No
What 6 categories exist in the Bethesda system for reporting thyroid cytopathology?
- Non-diagnostic or Unsatisfactory
- Benign
- Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance
- Follicular Neoplasm or Suspicious for a Follicular Neoplasm
- Suspicion for Malignancy
- Malignant
If Bethesda system reports:
Non diagnostic or Unsatisfactory
Then what’s the usual management?
Repeat FNA with ultrasound
If Bethesda system reports:
Benign
Then what’s the usual management?
Clinical follow-up
If Bethesda system reports:
Atypical of undetermined significance or follicular lesion of Undetermined Significance…
Then what’s the usual management?
Repeat FNA
If Bethesda system reports:
Follicular neoplasm or Suspicious for a follicular neoplasm…
Then what’s the usual management?
Surgical lobectomy
If Bethesda system reports:
Suspicious for malignancy…
Then what’s the usual management?
Near-total thyroidectomy or surgical lobectomy
If Bethesda system reports:
Malignant…
Then what’s the usual management?
Near-total thyroidectomy
What should the glass slides be labeled with?
Pencil
What four things can cause unsatisfactory / non-diagnostic classification of FNA sample?
- Cyst fluid
- Acellular
- Blood only
- Foreign material
What four things can cause benign classification of FNA sample?
- Hyperplastic nodule
- Lymphocytic thyroiditis (Hashimoto’s or Graves’ disease)
- Granulomatous thyroiditis (Reidels)
- Acute thyroiditis
What four types of cells / cellular material do you see in lymphocytic thyroiditis?
- Follicular cells
- Hurthle cells
- Variable colloid
- Lymphocytes
What five things can cause ‘follicular neoplasm or suspicious for a follicular neoplasm’ classification of FNA sample?
- Follicular adenoma
- Follicular carcinoma
- Hurthle cell adenoma
- Hurthle cell carcinoma
- Rare hyperplastic nodules
What four things can cause ‘suspicious for malignancy’ classification of FNA sample?
- Papillary carcinoma
- Medullary carcinoma
- Metastatic carcinoma
- Lymphoma
What should you check for medullary carcinoma?
Calcitonin
What 7 things can cause ‘malignant’ classification of FNA sample?
- Papillary thyroid carcinoma
- Poorly differentiated carcinoma
- Medullary thyroid carcinoma
- Undifferentiated (Anaplastic) carcinoma
- Squamous cell carcinoma
- Metastatic carcinoma
- Non-Hodgkin lymphoma
What are four histological signs of papillary thyroid carcinoma?
- Enlarged follicular cells
- Nuclear pseudo-inclusions
- Nuclear grooves
- Psammoma bodies
Where does medullary thyroid cancer originate from?
C-cells
What are five histological signs of medullary thyroid carcinoma?
- Salt and pepper neuroendocrine nuclei
- Abundant granular cytoplasm
- Multi-nucleation
- More discohesive
- Plasmacytoid, follicular or spindled
What is the only way to diagnose follicular carcinoma?
On surgical pathology
What two types of follicular carcinoma are they?
- Follicular type
- Hurthle
What are five histological signs of follicular thyroid carcinoma?
- Back to back follicles
- Over-lapping nuclei
- Scant colloid
- Invasion through capsule
- Lymphovascular space involvement
What two possible diagnoses show pleomorphic atypical cells?
- Anaplastic thyroid carcinoma
- Metastatic carcinoma
