Diagnostic Cytology Flashcards
Microscopic examination of cells from different body sites for diagnostic purposes
Diagnostic Cytology
Diagnostic Cytology [2]
Exfoliative Cytology
Fine Needle Aspiration [FNAB]
For preparation of mucoid secretions such as _______ secretion aspirated from the posterior ______, _______ and _______ secretion.
vaginal
fornix
sputum
gastric
For preparation of thick mucoid secretions, for smears of fresh sputum and _____.
Spreading
CSF
Pull apart is for the secretions of
concentrated sputum
serous fluids
enzymatic lavage
urinary sediment
vaginal pool
breast
Cut the surface of tissue such as the lymph node and other surgical or biopsy specimens are imprinted on your glass slide
Touch/Impression/Imprint/Abraded Smear
Cells are directly taken from the surfaces of excised/incised specimens by touching them with a clean glass slide.
Touch/Impression/Imprint/Abraded Smear
Deals with the microscopic study of cells that have been desquamated from epithelial surfaces
Exfoliative Cytology
has been proven to be of great value in the early detection of cancer (routinely done)
Exfoliative Cytology
Either came from spontaneously or physically removed from epithelial or mucous membrane
Exfoliated cells
Purposes of Exfoliative Cytology:
- Detection of _______ cells in body _____, mainly used for ____.
—Proceed first with _______. - Detection of __________ in women
- Assessment of female hormonal status in case of [2]
- For determination of genetic ____.
—If there is a presence of _______, then the specimen is from a female - Diagnosis of _______.
—- Used to find if the specimen harbors a
[2]
malignant cells
body fluids
cervix
PAP smear
precancerous cervical lesions
female hormonal status
infertility
endocrine disorders
sex
barr bodies
infection
bacteria
fungi
5 Techniques in Processing Fluids for Cytologic Evaluation:
Smear technique
Cell Block technique
Membrane filter method
Concentration technique
Aspiration Cytology
➔ Smear is the product of a diagnostic technique in which cells and other components are spread out thinly in a clean glass slide.
➔ Centrifuge the sample and then get the precipitate and then spread it in the surface of the glass slide
Smear technique
Example of Smear Technique
BM aspirates
Smears are allowed to be completely air dried and stained using:
[3]
Diff-Quick
Giemsa
May-Grunwald-Giemsa
Specimens are allowed to air dry first to avoid the _________ of the specimen.
Air dry first before you proceed with ______.
air dry
washing out
staining
A _______ is a paraffin embedded specimen derived from different fluids and aspirated materials
cell block
Considered as a “microbiopsy”
Cell Block Technique
It is mainly used with smears as an adjunct for
establishing a more definitive cytopathologic
diagnosis
Cell Block Technique
Cell Block Technique:
Place an equal parts of _______ and _____ and mix and centrifuge and get the precipitate and this precipitate is the one that is placed in the______.
alcohol
spx
filter paper
It is a technique for collecting cells using a filter with a specialized pore size.
Membrane Filter Method
In Membrane Filter Method, filter is made up of [2]
polycarbonate
cellulose esters
________
It is also utilized in any procedure that requires body fluids in very small amounts in sex chromatin determination on ______ fluids.
Membrane Filter method
amniotic
This method uses cytospin and ______ preparations.
Concentration Technique
sedimentation
➔ The cells are isolated via a series of centrifugation steps to concentrate the cells into a small suspension
Concentration Technique
Example of Concentration Technique
Pap’s smear
This is a good technique because the specimen is
centrifuged harboring all the cells in the sample
Concentration Technique
It is used to obtain specimens that do not shed cells spontaneously.
Aspiration Cytology
It can be carried out in diagnosing any _________ (FNAB/Cytology) and __________ (image guided biopsy).
palpable lesions
deep-seated/non-palpable
Aspiration Cytology can also be guided with [2]
ultrasound
CT-scan
Example of Aspiration Cytology
FNAB in the px’s breast
Preparation of cell block and smear is a must
Aspiration Cytology
If the breast mass is cystic → what do we do?
If not → ?
aspiration cytology
core biopsy
Collection and Preparation of Specimen
Cervicovaginal smear
Nipple discharge
Urine sediment
Sputum
Pleural/Peritoneal fluids
CSF spx
If you received _______, the cells are few that’s why after centrifugation, get the precipitate and then spread it all throughout (no need for pull-apart)
urine/CSF
Smears should be made from [fresh/frozen] materials and smeared evenly on a clean slide.
fresh
In smear preparation, for _________, it is spinned (centrifuged)
effusion/fluids
it is for supernatant, sediments and extra sediments
Smear preparation
Common Fixatives Used for Cytologic Smears are:
95% ethyl alcohol + ether
95% ethyl alcohol
Fixation
➔ Through _____ solution and _____.
fixative
spray
If smear cannot be made immediately, the collected material should be placed in (for
prolonged processing of specimen):
50% alcohol
Saccomano fluid
I. Gynecological Specimens
➔_________.
◆ Where most cancer cell arise
◆ Can be found in
[2]
Transformational Zone
Endocervix
Ectocervix
An optimal sample should included in Gnyecological spx: [3]
Squamous
Columnar
Metaplastic cells
Collection Devices included in Gnyecoological spx: [3]
Wooden Spatula [A]
Plastic spatula
Plastic “Broom type” samplers [C]
Endocervical brush
Has cilia at the end
Plastic “broom-type” samplers [C]
It is the staining method for exfoliative cytology.
Papanicolau Method
Advantages of Papanicolau Method
- Transparent blue staining of cytoplasm obtained due to the action of high alcoholic content of the cytoplasmic counterstain, allowing overlapping cells to be seen & identified.
- Excellent nuclear detail
- Color range is predictable & great value in cell ID and classification , producing a good differential coloring of basophilic and acidophilic cells
4.Valuable in comparing cellular appearances in smears w/ counterpart in similarly stained sections
Cells Found in Cervico-Vaginal Smears are Usually Divided Into:
Mature Superficial cells
Intermediate Cells
Basal cells
Parabasal cells
Navicular
Pregnancy
Endometrial
Endocervical
The polygonal squamous cells: 45-50um
mature superficial cells
Have pale pink staining cytoplasm and dark
pyknotic nuclei (<6 um).
Mature superficial cells
Are medium sized polyhedral or elongated cells [20-30 um]
intermediate cells
basophilic vacuolated cytoplasm
intermediate cells
Round oval cells (15- 30)
parabasal cells
dense basophilic cytoplasm
parabasal cells
larger vesicular nucleus
parabasal cells
Is smaller than intermediate cells
parabasal
Found from:
2 weeks of age of puberty
after childbirth
abortion
after menopause
parabasal cells
boat-shaped intermediate cells with a strong tendency to fold or curl on edges.
navicular cells
Their presence suggests a combined estrogen-progesterone effect.
navicular cells
Found in the latter half of the menstrual cycle, during pregnancy & menopause.
navicular cells
Are round, oval or boat-shaped cells
pregnancy cells
__________
translucent basophilic cytoplasm observed greatest at the center of the cell, due to _________, pushing the nucleus to the side or towards the cell membrane.
pregnancy cells
glycogen accumulation
Are small cells, slightly cylindrical
endometrial cells
This appearance is characteristic due to a deeper blue stain of the cytoplasm at the periphery.
pregnancy cells
less basophilic cytoplasm, occurring in tightly packed groups of [#] or more.
endometrial cells
Found during & 1-10 days after menopause.
endometrial cells
Cytoplasm is usually stained and is finely vacuolated, often with indistinct cell borders
endocervical glandular cells
nuclei with finely granular chromatin
endocervical glandular cells
They may present a honeycomb appearance when viewed on end.
endocervical glandular cells
Gram positive, slender rod shaped
Doderlein bacillus
Most common organism of the normal vaginal
flora
Doderlein bacillus
PAP’S STAIN in Doderlein bacillus
blue to lavender
Numerous naked nuclei with many Doderlein
bacilli may suggest:
last trimester of pregnancy
infection
estrogen deficiency
DM
Quantitation in Vaginal Cytology
- Acidophilic index
- Pyknotic index
- Maturation index
percentage of cells staining pink orange to red with Pap’s method.
Acidophilic index
percentage of cells having shrunken,
dark, small (less than 8um), structureless nuclei.
pyknotic index
Maturation Index
➔ Consist of the proportion of cells from the three layers of the _________, the _______, __________ and ______.
vaginal epithelium
superficial
intermediate
deep
Provided pyknotic nuclei of [#] um in diameter are taken as criteria for mature superficial cells
<6um
This index, based on careful differential counts, is probably the most accurate index available
Maturation index
Reporting of Cytologic Smears by Papanicolau
Class system 1959
Obtained to exclude the possibility of malignancy or infectious agents, especially from patients with immunodeficiency syndrome
Respiratory Tract Specimens
Specimens under respiratory tract specimens
Sputum
Bronchoalveolar lavage
Bronchial Washing [BAL/BW]
Bronchial Brushing [BB]
Collection and Preparation of Respiratory tract spx:
➔ Obtain consecutive [morning/night] sputum specimens.
◆ Up to [3] collection
➔ In a [close/wide] mouthed jar containing __________
morning
2
wide
Saccomano fluid
Sputum induction of Respiratory Tract Spx
aerosol 20min
In Respiratory Tract Spx, for a more extensive study, it requires ____, one is air dried for _______. At least 2 slides should be stained with ______.
slides
Giemsa
Pap’s smear
In Respiratory Tract Spx, Sputum are examined first for _____ – for [2]
blood
flecked
solid particles
In Non-gynaecologic spx, with the end of the wooden applicator stick, samples are evenly spread on the slides and immediately placed in fixative for a minimum of [#] hr.
1
Prepared by pull-apart technique and fix immediately.
bronchial brushing
Specimens are freshly collected in the bronchoscopy collection container and hand delivered to the laboratory.
bronchial washing
Collected by aspiration or by washing and submit directly to laboratory
bronchial aspirates
From the direct tap of pleural/ peritoneal effusions, CSF, and synovial fluid.
cell suspensions
optimum amount of cell suspensions
20mL
Cells can remain viable for up to [#] days if the specimen is kept refrigerated at [degree]
2 days
4C
In the preparation of cytospln slides,
the specimen is ______ ASAP at [RPM] for [#] min., and the ______ fluid is removed
2000RPM
2mins
supernatant
In the preparation of cytospln slides, a smear is made of the sediment on a glass slide which has been previously coated with a_______, spreading the smear with another slide as evenly as possible.
thin layer of egg albumin
In the preparation of cytospln slides, when it begins to dry around edges but is still moist in the center, the smear is fixed in__________.
fixed in 95% ethyl alcohol
In the preparation of cytospln slides, if smears cannot be prepared immediately, the sediment should be covered with ______ and placed in the ______.
absolute alcohol
refrigerator
Gastrointestinal Specimens [3]
Gastric lavage
Gastric brush
FNAB
Gastric smear preparations are quite [easy/difficult] to
make, because it’s like ______
difficult
water
In Gastrointestinal specimens, spx should be examined ASAP since any delay of _____ mins will digest the cell making it
unsatisfactory for evaluation
30
In Gastrointestinal specimens, the patient should have ___ for ___ hours before
gastric washing is performed.
fasted
6 hrs
The presence of malignant cells in serous fluid usually indicate ?
metastasis
If there is a malignant cells in ____, the higher
the staging of cancer
fluid
_______ can formed after collection, it can be
prevented by ______.
clots
heparin
has an extremely low diagnostic yield for diagnosis of breast cancer.
nipple discharge
When secretion is bloody in breast secretions a __________ should be considered.
Except during _____ and immediate______, any discharge from the nipple is abnormal.
benign intraductal papilloma
lactation
post lactation period
Collection Technique in breast secretions
- Gently strip the _______ & _____ using [2]
- Place the ____ upon the nipple & _____ it quickly across the nipple
- Immediately drop the slide in a bottle of [2]
- Secretions obtained from both breasts should be properly _____ as left or right.
sub-areolar
nipple
thumb
forefinger
slide
draw
95% isopropyl alcohol
spray fixative
labelled
When submitting a specimen in the lab from the breast secretions, make sure that the ______ is included
laterality
Major goal of Urinary Tract Spx
urothelial malignancy
Spx types of urinary tract spx [3]
- voided urine
- catheterized spx
- washing from bladder/renal pelvis.
To obtain a more reliable cytological evaluation in Urinary Tract Specimens, spx may have to be collected and examined [frequency]. At least [#] mL is needed
twice
2
In general ______ alone offers a very low diagnostic yield for detection of urothelial carcinomas
urine cytology
The collection technique in _______ , should be always mentioned on the requisition form
urinary tract
A ____________ is the first presentation of cancer of unknown origin
positive effusion for malignancy
Has a diagnostic value in patients with known history of cancer.
Body cavity effusions
Spx in body cavity effusions
[5]
Cavity fluids [+PF]
Ascitic/AF
CSF
Peritoneal washing
Pericardial
In Body Cavity Effusions
➔ Placed it in a ____, ________ container, and submitted ____ to the lab.
➔ For delay, place the specimen to ______.
➔ Avoid _____, except to: _______.
clean, non-sterile dry
fresh
isopropyl alcohol
preservatives
heparin
For CSF, a minimum of [#] mL is necessary for cytologic evaluation.
◆ Usually for ______ studies, not really
subjected in cytology
2
microbiology
stain used in Body cavity effusions
Wright-Giemsa staining
This is especially useful when diagnosis
of:lymphoma
body cavity effusions
It is also useful for Cerebrospinal fluid
body cavity effusions
________ is stained to enhance cytoplasmic details in the body cavity effusiona
air dried material
