Cytopathology of head and neck

Question 1

Why is cytopathology used?

Answer 1

quick - direct smears spread immediately
can be stained within a couple of mins
Giemsa stain/pap stain
Immediate reporting frequently possible
Extra material can be taken for ancillary techniques (lymphomas)

Question 2

State the benefits of cytopathology

Answer 2

Quick
• Cheap
• Simple technique
• Rarely requires even local anaesthetic
• Serious complications rare
• With fine needles (21G or smaller), negligible risk of tumour seeding

Question 3

When is cytopathology the best option?

Answer 3

Best with well demarcated mass lesions
• Frequently unhelpful with diffuse lesions
• Localisation by palpation frequently adequate
• Imaging techniques valuable, especially ultrasound

Question 4

Describe the technique used for FNA

Answer 4

• 21-25G needle
• 20 ml syringe
• Pistol grip usually used
• Lesion fixed with one hand
• Needle inserted into lesion
• 15-20 ml suction applied
• Move needle a few mm backwards and forwards for up to 20-30 seconds
• Change direction of needle track
Release suction
• Withdraw needle
• Remove syringe from needle and draw in air
• Replace needle on syringe and gently expel material on to microscope slide
• Spread by capillary action with a second slide
• Rapidly air dry or fix in alcohol and stain
• Flush needle into collection fluid
• Allows specimen to be clotted
• Process clot as a histology specimen
Gives ‘tissue’ for immunocytochemistry and molecular techniques

Question 5

What are some of the advantages of fine needle non-aspiration cytology and how does it work?

Answer 5

• Needle only used to sample lesion
• Cellular material drawn up by capillary action
• Material expelled on to slide with syringe as for FNA • Advantages: less bleeding, greater sensitivity of feel • Good for superficial lesions

Question 6

Describe the use of ultrasound images for lumps in the neck

Answer 6

mproves on clinical evaluation
• Reveals impalpable abnormalities
• Targeting and aspiration in realtime enhances sampling accuracy
• Allows avoidance of blood vessels
• Loses sensitivity with depth and does not
penetrate bone
• With practice, targeting of lesions down to 5mm diameter possible

Question 7

Describe a pleomorphic adenoma

Answer 7

Commonest primary salivary gland neoplasm seen in our practice
• Characteristic connective tissue mucin background with mixed spindle, polyhedral and epithelial cells
• Correlates closely with histology

Question 8

List salivary gland tumours and lumps

Answer 8

• Warthins tumour
• Other neoplasms
• Non neoplastic lesions
• Sialadenitis, abscess
• Actinomyces

Question 9

Name the pathologies related to lymph node hyperplasia

Answer 9

• Reactive lymphadenopathy very common
• Specific inflammation (TB etc)
• Lymphoma – Hodgkin’s and non- Hodgkin’s • Metastatic carcinoma

Question 10

Name the common pathologies associated with the thyroid gland

Answer 10

• Cysts
• Thyroiditis
• Solitary nodules
• Confirmation of clinically obvious thyroid malignancy