CYTOPATHOLOGY Flashcards
refers to diagnostic techniques that are used to examine cells from various body sites to determine the cause or nature of disease
cytopathology
when does the first era of cytopathology started
19th century
the second era in cytopathology is about the _____ and ____
development and expansion
father of cytopathology
dr.george papanicolaou
the third era in cytopathology is about
consolidation
important ferson in the 3rd era of cytopathology
Dr. Leopold Koss - diagnostic cytology
what is being contributed or invented in the 4th era of cytopathology
the bethesda system for reporting cervical/vaginal cytology diagnosis
microscopic examination of cells from different body sites for diagnostic purposes
diagnostic cytology
refers to the microscopic study of cells that have been desquamated from epithelial surfaces
exfoliative cytology
Exfoliative cytology recommended ___
detection of malignant cells
detection of precancerous cervical lesions in women
assessment of female hormonal status
for detection of genetic sex
for detection of infectious agents
2 categories/type of specimen for cytopathology
gynecologic specimen
non gynecologic specimen
gynecologic specimen
cervicovaginal smear (pap smear)
cervicovaginal smear (pap smear) is can be obtained from what sites/smears
vaginal
endometrial
endocervical
non gynecologic specimens
prostatic and breast secretions
gastric or bronchial secretions
pleural and peritoneal fluids
sputum
smears of urine sediments
csf specimen
methods of smear preparatiosn
streaking
spreading
pull apart
touch/impression/imprint/abraded smear
characteristics of an ideal smear
should be evenly spread
uniformly thin and flat
why should the smear is uniformly thin and flat
to enable rapid drying and fixation
to permit optimal penetration of stain
what are the specimens that require adhesives agent
urinary sediment
bronchial lavage specimen
specimen that utilizes proteolytic enzymes
adhesive agents used for cytologic method
pooled human serum or plasma
celloidin ether alcohol
leuconostoc culture
fixative we use for all types of effusion if there is some delayed in smearing
50% alcohol
saccomano preservative is made up of
50% alcohol and 2% carbowax
common fixatives we use
ether alcohol
95% ethanol
best fixative we can use for cytopathology
ether alcohol
fixative for routine preparation
95% ethanol
this fixative selectively lyses rbc
carnoy’s fluid
this fixative provides a protective waxy coating for postal despatch
polyethylene glycol in alcohol
cell concentration technique uses what preparation
cytospin and sedimentation preparations
the cells are isolated via a series of centrifugation steps to concentrate the cells into a small suspension
cytospin and sedimentation preparations
is a paraffin embedded specimen derived from different fluids and aspirated materials
cell block
used for establishing a more definitive cytopathologic diagnosis
cell block technique
example of a more definitive cytopathologic diagnosis
microbiopsy
serves as a bridge between cytology and histology
microbiopsy
uses of cell block
architectural evaluation
categorization of tumors that are not possible for smear
special stains and IHC
immunophenotyping, molecular studies
as archival material for future studies
stain for air dried slides
romanowsky type stains
romanowsky type stains example
wright’s giemsa stain
may grunwald
giemsa stain
diff-quick
stain for immediate fixated slides
papanicolaou stains
it is a polychrome staining reaction that results in well stained nuclear chromatin, differential cytoplasmic counterstaining and cytoplasmic transparency
papanicolaou staining method
cytoplasmic stains example
OG 6 (monochrome stains)
EA 36 (polychrome stain )
formalin-fixed cytology preparations must be stained with wither
H&E or papanicolaou stain
a cytoplasmic stain for mature (superficial cells)
OG 6
stain for immature vaginal cells (parabasal, intermediate cells)
EA 36 or 50
stains for cytochemistry that is for glycogen
PAS - periodic acid schiff
stains for cytochemistry that is for hemosiderin
perl’s stain
stains for cytochemistry that is for mucins
alcian blue
stains for cytochemistry that is for fungal organism
grocott methenamine silver
stains for cytochemistry that is for acid fast bacilli
Ziehl-Nielsen stain
these specimen are obtained to exclude the possibility of malignancy or infectious agents
respiratory tract specimen
type of specimen for respiratory tract specimen
sputum, bronchoalveolar lavage, bronchial washing, bronchial brushing
cytologic collection and preparation of respiratory tract specimen
collect sputum at least 3 consecutive morning
collect every morning in a wide mounted jar containing saccamomano fluid
the collection is usually done to exclude the possibility of malignant tumors
gastrointestinal specimen
types of specimen for gastrointestinal specimen
gastric lavage
gall bladder
fine needle aspiration
cytologic collection and preparation of gastrointestinal specimen
8 hrs fasting before the gastric washing
the presence of malignant cells in serous effusions usually indicate
metastatic involvement
in peritoneal, pleural, and pericardial fluids
the jelly like clots forming after removal may prevented by adding ____ for every ____ aspirates
300 units of heparin for every 100 ml of aspirates
smears for breast secretion has _____ diagnostic yield for diagnosis of breast carcinoma
extremely low
spontaneous nipple discharge is usually a result of ____ in young patients
hormonal imbalance
Spontaneous nipple discharge is usually a result of hormonal imbalance in young patients, and when the secretion is bloody a __ should be considered clinically
benign intraductal papilloma
a sample of breast secretion must be smeared on a clean glass slide and immediately placed in fixative
t or f
truellau
urinary tract specimen is for the diagnosis of
malignancy in urothelial orgin
are prostatic carcinoma usually found in urinary specimens?
nope, rarely found
types of specimen for urinary tract specimen/smearing
voided urine
catheterized specimen
washing from bladder or renal pelvis
this type of specimen is important in diagnostic value in patients with a known history of cancer
body cavity effusions
___ is the first presentation of cancer of unknown origin
positive effusion of malignancy
types of specimen for body cavity effusions
pleural fluid
ascitic/abdominal fluid
peritoneal washing
pericard
cerebrospinal fluid
Cytologic Collection & Preparation of body cavity effusions
specimen is collected in a clean non sterile dry container
specimen place in a refrigerator if there is a delay
heparin does not interfere with cytologic preparation
1ml of csf is necessary for cytologic evaluation
is the study of cellular samples obtained from organs that do not shed cells spontaneously
fine needle aspiration
fine needle aspiration is obtained from organs that do not shed cells such as
breast
thyroid
lymph nodes
liver
lungs
skin
soft tissues
bones
useful in lesions that are easily palpable, like growth of skin, subcutaneous soft tissue tumors
thyroid, lymph nodes, salivary glands, and breast
fine needle aspiration
slide preparation of fine needle aspiration
recommend preparation of maximum 4 slides:
using 1-2 drops on each slide and using slide-pull technique (similar to the technique used for peripheral blood smears )
slide fixation for FNA
immediate fixation is important
95% alcohol
spray fixative
alcohol-acetone(papstain)
formalin
junction of endocervical and ectocervical mucosa
T-zone (transformation zone)
T zone is used for the detection of
dysplasias and carcinomas
type of specimen for T zone
squamous, columnar, and metaplastic cells
for Gynecologic specimen ___ is used for sample of endocervical canal
endocervical brush
for Gynecologic specimen ___ is used for patient with hysterectomy
vaginal scrape
for Gynecologic specimen ___ is used for hormonal evaluation
lateral vulvar scrape
for Gynecologic specimen ___ is used for localization of vaginal adenosis
four quadrant vulvar scrape
for Gynecologic specimen ___ is used for detetcion of herpectic lesions of carcinoma
vulvar scrape
this staining method will stain the cytoplasm a transparent blue
papanicolaou method
color range is predictable and of great value in identification and cell classification
papanicolaou method
staining method which is valuable in comparing cellular appearances in smears
papanicolaou method
characteristic of a mature superficial cell(cells found in cervico-vaginal smear)
polygonal squamous cells with 45-50um in diameter
pseudoacidophilia is observed due to
drying of smears especially before fixation
prolapse and drying of vaginal epithelium
infection
chemicals
true acidophilia of cervico-vaginal smear is when if it’s under what influence
estrogen
medium polyhedral or elongated cells with basophilic vacuolated cytoplasm
intermediate cell
boat shaped intermediate cells with strong tendency to fold or curl on edges
navicular cells
suggest of the combined estrogen-progesterone effect
navicular cells
seen in latter half of menstrual cycle, durinhg pregnancy, and menopause
navicular cells
pregnancy cells are shaped ___
round, oval, or boat shaped cells
nucleus pushed aside or towards cell membrane
pregnancy cells
with double walled boundary appearance (deep blue stain of the cytoplasm at the periphery )
pregnancy cells
round to oval cells with small dense basophilic cytoplasm
parabasal cells
Similar to fried fresh eggs with sunny side up
Parabasal cells
Parabasal cells size
15-30 um in diameter, smaller than IC, have a larger vesicular nucleus
Found from two weeks of age to puberty
Parabasal cells
After childbirth, with abortions and after
menopause
Parabasal cells
- Small cells, slightly cylindrical with less basophilic
cytoplasm
Endometrial cells
- tightly packed groups of 3 or more
Endometrial cells
- found during and 1-10 days after menstruation
Endometrial cells
shed in response to ovarian hormone
Endometrial cells
occur in large groups or small sheets
Endocervical glandular cells
cytoplasm stained pale blue/gray, finely vacuolated
Endocervical glandular cells
- present a honeycomb apperance
Endocervical glandular cells
G(+), slender rod-shaped m.o.
Doderlein Bacillus (Lactobacillus acidophilus)
comprising the most commont
organism found in a normal
vaginal flora
Doderlein Bacillus (Lactobacillus acidophilus)
staining blue to lavender with
Pap’s stain
Doderlein Bacillus (Lactobacillus acidophilus)
numerous in the Corpus luteum
phase a during pregnancy
Doderlein Bacillus (Lactobacillus acidophilus)
candidiasis commonly seen in
diabetic patients,
pt’s taking oral contraceptives,
immunocompromised states,
leukemia and lymphoma
pear shaped bacteria found in woman’s genital
Trichomonas vaginalis
Mucus on drying, exhibit a “fern” or palm-leaf
pattern (arborization)due to formation of salt
crystals in high NaCl concentration in cervical
mucus under the influence of estrogen.
Ferning
is the percentage of cells staining pink-orange to red with Pap’s smear
Acidophilic Index
not reliable index due to the possible pseudoacidophilia
Acidophilic Index
Quantitation Evaluation for Vaginal Cytology
acidophilic index
pyknotic index
maturation index
is the percentage of cells with shrunken, dark, small structureless nuclei
Pyknotic index
is the percentage of cells from the main layers of vaginal epithelium: superficial, intermediate and deep (parabasal and basal) cells
Maturation index
__is used as criterion for mature superficial cells
Pyknosis
classification of pap test results
class I means
negative for malignant cells
classification of pap test results
class II means
atypical cells present but negative for malignancy
classification of pap test results
class III means
suspicious for malignant cells
classification of pap test results
class IV means
strongly suggestive for malignant cells
classification of pap test results
class V means
conclusive for malignant cells
specimen adequacy categories
satisfactory
limited
unsatisfactory
pap smear specimens are considered satisfactory for interpretation if there are:
- Adequate numbers of well-visualized squamous cells
present - Adequate numbers of well-visualized endocervical cells or
squamous metaplastic cells (from the transformation zone) - Less than 50% of the cells obscured by blood or
inflammation - Properly labeled specimens
pap smear specimens are considered unsatisfactory for interpretation if there are:
- Inadequate numbers of well-visualized squamous cells
present - Inadequate numbers of well-visualized endocervical cells or
squamous metaplastic cells (from the transformation zone) - More than 75% of the cells obscured by blood or
inflammation - Improperly labels specimens
- Usually, these specimens are recommended for repeat
sampling
pap smear specimens are considered rejected for interpretation if there are:
- Specimen is submitted without a requisition
- Specimen is not labeled with the patient’s name
- The patient’s name (or other identifying information) on the
specimen and requisition do not correspond - The specimen is labeled appropriately but the requisition is
not labeled - The specimen slide is irreparably broken
- Specimen is submitted from an unauthorized source
