EXFOLIATIVE CYTOLOGY Flashcards
Branch of General Cytology which deals with the microscopic study of cells that have been desquamated from epithelial surfaces
Exfoliative cytology
Spontaneously shed or physically removed from epithelial and mucous membranes
Exfoliated cells
Smear preparations
Spreading
Streaking
Pull-apart
Touch preparations
Slide is fixed unto a horizontal tube filled with the test fluid, as the centrifuge spins, the fluid is pushed against the slide, coating the slide with a monolayer of cells
Cytospin
Fluid is centrifuged, decanted, button is transferred unto piece of filter paper and processed like tissue
Cell block
What should be done if smears cannot be made immediately
Collected material should be placed in alcohol, and refrigerated
How to fix viscid secretions?
Should be fixed in Ether Alcohol solution immediately
How to fix specimens with excessive mucus?
Allowed to dry at the edges before fixing
How to fix specimens with excessive blood?
RBC’s should be hemolyzed before fixing by adding 2 to 5 ml glacial HAc/100 ml
Fixation time of cytologic smears
Minimum of 1 hour
Best fixative for cytology
Equal parts of 95% ethyl alcohol and ether
Most common fixative for cytology
95% ethyl alcohol
Ideal specimen for sputum smears
Fresh, unfixed, early morning sputum comprising of a “deep cough” specimen should be collected every day for 5 days, into a wide- mouth bottle containing the fixative
Number of epithelial cells and neutrophils in acceptable sputum sample
Epithelial cells should be <10/LPO and neutrophils >25/LPO
Sputum exam is more commonly performed than bronchial aspiration. True or False?
True
Sputum demonstrates abnormal cells early in the disease, while bronchial secretions show evidences of malignancy late in the disease
For gastric secretions and aspirates. Patient should have fasted for
At least 8 hours
Urine sample for males
Voided urine
Recommended urine sample for females
Catheterized specimen
How to examine urine for a more reliable cytological evaluation?
Examined 2x, one early morning urine and one later in the day
Originally indicated for vaginal smears to detect human uterine and cervical cancers
Papanicolau Method (Pap’s Smear)
Stains for Pap’s smear
Harris Hematoxylin
OG 6
EA 50
Modified Papanicolau Staining Method
More distinct color differentiation between eosinophilic and orangeophilic cytoplasmic stain by omitting Bismarck Brown dye from the EA 50 formula
LPO examination
Assess the quality of smear and staining
Detect the presence of RBC’s and WBC’s, type of exfoliated cells
Rough assessment of the proportion of mature superficial pyknotic acidophilic cells
HPO examination
Quantitative evaluation of the smear
Dark pyknotic nuclei, <6 u in diameter
True acidophilia under estrogen influence
Mature Superficial Cells
Drying of the smears especially before fixation, prolapse and drying of the vaginal epithelium, infection and chemicals
Pseudoacidophilia
Medium-sized polyhedral or elongated cells with basophilic cytoplasm showing vacuoles
Intermediate Cells
Boat-shaped with strong tendency to fold or curl on edges
Navicular cell
Formation of Navicular cell is due to
Combined estrogen-progesterone effect
Navicular cells are found in during
Latter half of the menstrual cycle, during pregnancy and early menopause
Thick, round to oval, smaller than intermediate cells with strongly basophilic cytoplasm and a larger vesicular nucleus
Parabasal cells
Parabasal cells are found during
2 weeks of age to puberty, after childbirth, abortions, and late menopause
Similar in appearance to parabasal cells, slightly cylindrical with less basophilic cytoplasm, occurring in groups of 3 or more cells
Endometrial cells
Endometrial cells are found in
During and I to 4 days after menstruation
Small, round to slightly oval cells with relatively large nuclei, occupying more than half of the cell volume, and strongly basophilic cytoplasm
Basal cells
Basal cells are found in
Before puberty and after menopause
Gram positive, slender rod-shaped microorganisms commonly found in a normal vaginal flora
Lactobacillus acidophilus
Lactobacillus acidophilus are most numerous in
Corpus luteum phase and during pregnancy
Mucus, on drying exhibits a “fern” or palm-leaf pattern (arborization)
Ferning
Presence of ferning signifies
A high persistent estrogen effect in the absence of progesterone
Formation of salt crystals in high NaCI concentration in cervical mucus under the influence of estrogen, inhibited by progesterone
Percentage of cells from the main layers of vaginal epithelium
Maturation index
Percentage of cells staining pink-orange to red with Pap’s smear
Acidophilic index
Not a reliable index due to possible psuedoacidophilia
Percentage of cells with shrunken, dark, small structureless nuclei
Pyknotic index
Autonomous uncontrolled growth of new cells continuously proliferating without any cause or purpose, lacking any orderly structural arrangement, and producing no beneficial effect on the body
Tumor or Neoplasia
2 main groups of Tumor or Neoplasia
Benign
Malignant
Absence of atypical or abnormal cells
Class I
Atypical cytologic picture but no evidence of malignancy
Class II
Cytologic picture suggestive but not conclusive of malignancy
Class III
Cytologic picture strongly suggestive of malignancy
Class IV
Cytologic picture conclusive of malignancy
Class V
Dense, dark-staining spot or dot of sex chromatin about 1µ in dia on the inner aspect of the nuclear membrane of each somatic cell in the human female
Barr bodies
Appearance of Barr bodies in PMNs
Drumstick appearance
Segment of one of the two X chromatin or formed by the fusion of the two X chromatins
Sex chromatin
Rapid and differential stain for cytology
Polychrome staining method
Simple and rapid with clarity of morphologic cellular details
Cresyl Violet method
Binds nucleic acids DNA and RNA, and when irradiated by UV light in fluorescence microscopy
Acridine Orange Flourescence Technique
Best microscope for routine cytologic examination
Florescence microscope
RNA in cytoplasm and nucleus stains
Brick to orange-red
DNA stains
Green and yellow
Second best choice for routine cytologic examination, with greater possibility for immediate microscopic examination
Phase Contrast Microscopy
Used for hormonal evaluation of gynecologic specimen and for cancer detection
Phase Contrast Microscopy
Determines the dry weight of individual cells or cellular constituents, cancer cell nucleus and cytoplasmic dry weight content less than that of normal cells
Interference Microscopy
