Cytology Principles

Question 1

Questions to ask when assessing cytology

Answer 1

1. Is the sample adequate?
2. Are there inflammatory cells present?
3. Is there neoplasia present?
4. What is the neoplasia cell type?

Question 2

Unknown Mass Approach

Answer 2

1. Is the sample sufficient for diagnosis
2. Inflammatory
   ○ What type?
   ○ Septic?
3. Is there cystic content?
   ○ What type?
4. Mainly tissue cells - neoplasia
   ○ What type (epithelial, round, mesenchymal)
   ○ Benign or malignant?

Question 3

Known Tissue Approach

Answer 3

• E.g. lymph node, prostate, spleen, liver
• Is the sample sufficient for diagnosis?
• Think about the normal cell population in that tissue;
  ○ Does what you have on the slide match that
  ○ E.g., should it be epithelial, round or mesenchymal or a mixture, what functional cells should be present
• Think about possible pathologies:
  ○ What 4 things cause lymph nodes to enlarge?
  ○ What 4 things cause prostatic enlargement?
  ○ Which does the cytology best fit with?
• Is there evidence of inflammation?
• Which of my narrowed list of possibilities fits best?

Question 4

Cellular Criteria of Malignancy

Answer 4

Cells are ‘alien’ to where they are found
Pleomorphism (non lymphoid)
Variable cell size (anisocytosis)
Monomorphic cell population where there should be variation (lymphoid)
High/variable nuclear:cytoplasmic ratio

Question 5

Nuclear Criteria of Malignancy

Answer 5

Variation in shapes/sizes (anisokaryosis)
Multiple, fragmented or moulded nuclei
Clumped chromatin
irregular nucleoli
abnormal mitotic figures

Question 6

Cytoplasmic Criteria of Malignancy

Answer 6

Basophilia/hyperchromasia due to high RNA content
Vacuolation (‘see through bubbles’
Granularity
Phagocytosis of other cells

Question 7

Lymphadenopathy

Answer 7

Enlarged lymph nodes

Question 8

Lymphadenopathy causes

Answer 8

Reactive hyperplasia
Lymphadenitis
Metastatic hyperplasia
Lymphoma

Question 9

Lymphadenitis

Answer 9

Inflammation of lymph node
Increased neutrophils (>5%) or eosinophils
Increased macrophages (>3%)

Question 10

Reactive Hyperplasia

Answer 10

Cytologically indistinguishable from ‘normal’
Heterogenous cell population
75-95% small mature lymphocytes
Low % of immature lymphocytes

Question 11

Lymphoma

Answer 11

Increased % of large immature lymphocytes
More mitoses