Cytopathology Flashcards
What is cytopathology?
The study of cell morphology to establish underlying disease processes
Name some different cytology samples
- Cervical Cytology: NHS Cervical Screening Programme
- Non-gynaecological samples : Exfoliative samples (brushes, washes, scrapes, fluids) and Fine Needle Aspirates
What happens in the NHS cervical screening programme?
- Women between the ages of 25 – 65 years are invited for screening
- Repeated every 3-5 years
- Cervical sample collected into fluid filled bottle, Liquid Based Cytology (LBC)
- Sample viewed microscopically looking for precancer and cancer cells
- HR-HPV triage and test of cure testing
- Future will be primary HR-HPV testing
What is Squamous Dyskaryosis/CIN?
Squamous Dyskyosis is defined as abnormal cytologic changes of squamous epithelial cells characterized by hyperchromatic nuclei and/or irregular nuclear chromatin
- Look for dyskaryosis, pre-cancerous changes in the outermost squamous cells of the cervix
- Called cervical intraepithelial neoplasia, CIN
What are the different grades of squamous dyskaryosis and their links to cancer?
- There are different grades of CIN according to how severe the changes are, CIN1, CIN2 & CIN3
- The risk of developing cancer is related to the grade of CIN. Most cases of CIN1 will go back to normal without any treatment.
- CIN2 and CIN3 may develop into cancer in some cases, if left untreated
Describe Cervical Glandular Intraepithelial Neoplasia (CGIN) as a precursor of cervical adenocarcinoma
- There is a rare abnormality called ‘Cervical Glandular Intraepithelial Neoplasia’ or cGIN
- This is the pre-cancerous change involving the inner glandular cells of the cervix.
- Treatment of cGIN is usually the same as CIN.
Describe the NHS cervical screening programme triage when abnormal cells are abnormal?
- Low grade and borderline abnormalities have a HR-HPV test.
- If HR-HPV positive – refer to colposcopy
- If HR-HPV negative – routine recall
- High grade abnormalities refer to colposcopy – no HR-HPV test
What causes CIN? (Cervical intraepithelial neoplasia)
- Human papillomavirus (HPV), family of over 150 viruses
- Usually don’t cause any problems. When they do, most frequent effect is the common wart, found on the hands and feet
- About 30 HPV types are spread through genital contact
Describe and identify the low risk type HPV
- About 12 types are called “low risk“
- They cannot cause cervical cancer. They cause genital warts or very minor cell changes on the cervix.
- Low-risk types are 6, 11, 40, 42, 43, 44, 53, 54, 61, 72, 73 and 81.
Which types of HPV cause 90% of genital warts?
•Types 6 and 11 – cause about 90 percent of genital warts
Describe and identigy high risk type HPV
- Over dozen types of “high-risk” HPV
- cause abnormal cells to form on the cervix that may develop into cervical cancer if not removed.
- Of most concern 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68.
Which types of HPV cause 70% of cervical cancers?
•Types 16 and 18 cause about 70% of cervical cancers.
Why does some HPV infection lead to cervical cancer? (environmental factors)
- HPV only causes cervical smear abnormalities if it is not cleared from the body over a period of years
- Smoking can make clearing HPV from the body less effective and can make clearance of minor smear abnormalities slower and less efficient
**About 4 out of 5 adult men and women have had HPV infection at some time in their lives, but only a small minority of women with an HPV infection ultimately have an abnormal smear and a tiny fraction of these get cervical cancer
When is the HPV vaccination given?
•Immunisation against HPV started in September 2008 for girls aged 12 to 13 with a catch up for girls up to 18 in the following 3 years
What are two diagnostic/non-gynaecological samples?
- Exfoliative
- Fine needle aspirations
What is exfoliative cytology and some examples?
•This is when cells are dislodged or spontaneously shed from a surface ie.
- Bronchial washings and brushings, serous cavity effusions such as pleural effusions, ascitic fluid, peritoneal fluid, urine …etc
How are fine needle aspirations done?
- If palpable – by hand
- Radiologist guided – ultrasound, CT
- Endoscopist – EUS, TBNA, EBUS TBNA
What are some common sites for Fine needle aspirations?
- Breast lesions
- Lung
- Thyroid
- Lymph nodes
- Head and neck lesions
- Pancreas
- Deep seated lymph nodes
What can fine needle aspirations be used for?
- Immediate on site evaluation
- Primary diagnosis
- Rules out other diagnoses
- Staging
- Post adjuvant therapy staging
- Differentiate a new primary from recurrence
What are the current applications of Fine needle aspirations?
- Morphologic diagnosis
- Material for ancillary tests
–Microbiology
–Immunophenotyping
–Flow cytometry
–Molecular studies, mutation analysis
Molecular mutation analysis
Match the following genes, which can become mutated, to the cancer
- EGFR, ALK-1
- BRAF
- BRAC1/2, CERB-B2
- APC, KRAS
- EGFR, ALK-1 for lung adenocarcinoma
- BRAF for melanoma
- BRAC1/2, CERB-B2 for breast cancer
- APC, KRAS for colon cancer
What are the side effects of fine needle aspiration?
- Typically nothing
- Bruising
- Fainting
- (Pneumothorax – site dependent!)
- (Infarction of lesion)
What are the advantages of cytology fine needle aspiration?
- Accurate
- Quick
- Acceptable to patient
- Rapid turnaround time
- Organised into fast access clinics run by cytopathologists for aspiration of palpable swellings
- Cheap
- Triage material for ancillary tests
- On-site diagnosis allows immediate patient management
