Gastrointestinal tract Flashcards
White mucosal lesions appearing on the
lips, palate, tongue and lining of the cheeks.
Hyperkeratosis without atypia.
Leukoplakia
Painful fever blisters on the lips or in the vicinity of the nostrils.
These blisters exude a clear fluid or are covered by a scab.
Herpetic stomatitis
Small, painful, shallow ulcers surrounded by red borders
Aphthous ulcers (canker sores)
This does not occur in the oral cavity, but on the lip.
only found on the skin and is caused by sun exposure.
The cells are hyperchromatic, crowded and oval in shape.
The nuclei are oval with evenly distributed chromatin.
No nucleoli are visible.
Basal cell carcinoma
Salivary gland cells that appear as single layer of cuboidal or columnar.
Either:
- few oval or elongated nuclei arranged in a parallel or rosette formation at the centre of the acinar clusters.
- frequently arranged in sheets or in a honeycomb
pattern, and have uniform, round or oval nuclei and scant cyanophilic cytoplasm.
Ductal cells
These cells form one layer of flat cells around the ducts and acini.
These cells have oval or spindle nuclei with vesicular chromatin.
They frequently appear as round to oval naked nuclei, lymphocyte-size, on a
different plane of focus from the remaining cells in a sheet.
Myoepithelial
These cells can be serous, mucinous or oncocytic
Acinar cells
These cells form groups/clusters of cuboidal cells with round, eccentric or basal nuclei that are slightly larger than red blood cells.
The small nuclei is uniform, containing finely or coarsely granular chromatin and
one/two prominent round nucleoli.
The abundant ill-defined cytoplasm stains blue or green with the Pap or Diff-Quik methods, and may show refractile purple-blue cytoplasmic granules.
Serous Cells
These cells are oval or round, with eccentrically located nuclei that have
uniform finely granular chromatin and single nucleoli.
Their cytoplasm has a lacy appearance due to the presence of multiple fine
vacuoles, although large single vacuoles may also be present
Mucinous cells
Cells are large with well-defined cell borders, large round nuclei (may also be
pyknotic) with occasional prominent nucleoli, and an abundant finely granular
eosinophilic cytoplasm.
Oncocytes
FNA produces a clear liquid that may form froth on shaking, or it can be mucoid if derived from a mucocele.
The specimen is almost acellular, apart from inflammatory cells, few cuboidal or
flattened epithelial cells.
Occasionally the fluid may be turbid and contain histiocytes with granular or
refractile material in their cytoplasm.
Sialocysts
The cyst wall contains lymphoid and epithelial cells.
On aspiration, the cysts produce abundant mature and transformed lymphoid
cells, clusters of small cyanophilic epithelial cells, and some squamous cells.
These cysts contain only a few mucinous cells, if any.
Benign lymphoepithelial cysts
This is characterized by the presence of acute inflammatory cells, frequently associated with debris, strands of fibrin and few plasma cells, lymphocytes and
histiocytes
Acute sialadenitis
The aspirate is scant, and consists of lymphocytes, plasma cells, acellular
proteinaceous debris, mucus and usually a few acute inflammatory cells.
Atrophy results in condensation of the acini and ducts, with the development of
complex 3D structures.
Eventually, fibrous tissue predominates and only a few ducts with cuboidal
epithelium remain.
Reparative changes are frequently evident
The epithelial cells, endothelial cells and fibroblasts may show reactive changes
associated with healing, and the nuclear enlargement may be worrisome.
However, these cells have fine delicate uniform chromatin, thin nuclear
membranes, prominent nucleoli and often multiple cytoplasmic processes.
Chronic sialadenitis
The acinar cells show severe degenerative changes in the form of degranulation,
ballooning of the cytoplasm, and nuclear hyperchromasia.
In the chronic phase, the acini are atrophic and aspiration yields scant material.
Few fragments of stroma and ductal epithelium, some with atypical nuclei, are
seen together with a few lymphocytes.
Post-radiation sialadenitis
It forms non-caseating granulomas.
Smears shows small rounded masses of plump epithelioid cells with vesicular nuclei containing small single/multiple nucleoli and abundant light eosinophilic illdefined cytoplasm.
In addition smears also show lymphocytes, histiocytes and multiinucleated giant stromal cells.
The stromal and endothelial cells are frequently arranged in fascicles
Sarcoidosis
Caseous necrosis/epitheloid granulomas are found.
Smears show aggregates of epithelioid histiocytes with ill-defined borders admixed with necrotic debris, lymphocytes and Langhans’ giant cells.
Tuberculosis
Aspirate: thick, gelatinous consistency.
Cellular aspirate with two components melted into each other: epithelial/myoepithelial cells and stroma.
Ductal epithelial cells: cords and few acini of uniform round/oval cells, with
central/eccentric uniform nuclei, fine chromatin and micro nucleoli. Cytoplasm
is abundant, well-defined moderate amount, green/reddish-brown.
Myoepithelial cells: look like “out-of-focus” lymphocytes, or spindly/elongated with oval bland nuclei.
Stroma fragments: amorphous, mycoid, fibrillary or chondroid matrix.
Focal squamous, mucinous, oncocytic or sebaceous metaplasia.
Hyaline cell variant with refractile cytoplasm, plasmacytoid eccentric nucleus
Pleomorphic adenoma
Cystic, brown with mucoid contents.
Mixture of oncocytic cells and lymphoid cells.
Oncocytic cells: polyhedral cells in flat irregular sheets, honeycomb, and rare
papillae with distinct borders. Nuclei are round/vesicular with uniformly distributed, finely granular chromatin, distinct nuclear membrane and small central nucleoli. The cytoplasm is abundant glassy red or green and granular.
Lymphocytes: small or large, reactive.
Few mast cells within epithelium in most cases.
May show squamous or mucinous metaplasia.
Warthin’s tumour
Clean/slightly bloody background.
Cells appear in sheets/cords/solid plugs in a sparse delicate fibrovascular
stroma.
Large uniform polygonal cells with well-defined cell borders.
Nuclei: small, single, round, central/eccentric (maybe pyknotic) with one/more
prominent nucleoli.
Cytoplasm: abundant granular eosinophilic
Oncocytoma
Cystic, soft painless swelling with a bluish-grey or pink appearance and produces
a mucinous aspirate.
Background of mucin, granular on Diff-Quik and PAS positive.
Mucinous cells: abundant, loosely cohesive, uniform central or eccentric nuclei
with fine vesicular chromatin, and a single nucleolus, abundant cytoplasm with one or more mucin vacuoles.
Squamous cells: fewer than mucinous, uniform metaplastic, rarely keratinizing
Intermediate cells: polygonal, tight clusters, scant or moderate cytoplasm, small dark nuclei.
LOW GRADE MUCOEPIDERMOID CARCINOMAS
Aspirate yields malignant squamous cells, with nuclear pleomorphism, coarse
granular chromatin, and keratinization.
Few columnar mucinous cells or vacuolated metaplastic squamous cells
present.
HIGH GRADE MUCOEPIDERMOID CARCINOMAS
Epithelial cells are usually cohesive and tightly packed in the form of cords and
solid nests.
Cells are generally uniform with small, uniform, round, oval or angulated nuclei.
The chromatin is finely or moderately coarse and many cells have single
eosinophilic nucleoli.
The poorly defined cyanophilic cytoplasm is scant to moderate in volume.
Within the epithelial cell masses, a few round or oval punched-out holes may be
seen.
These characteristic holes contain homogeneous glassy material, which stains
pale blue or green with the Pap method, and pink with PAS, Diff-Quik and Wright-
Giemsa stains.
Fibrillary or hyaline stroma of similar staining characteristics surround the
epithelial nests and extend between the cells to form the glassy material in the
central holes.
Adenoid cystic carcinoma
Aspirates are cellular and consist of a monomorphic population of round/polygonal
neoplastic cells arranged in small cohesive sheets/clusters or singly with
numerous acinar units and cystic spaces.
Nuclei: uniform, normochromatic, round/oval, central/basal, bland, but
occasionally pleomorphic. Numerous naked nuclei are usually also found
(delicate cytoplasm easily ruptures during smear preparation).
Nucleoli as well as intranuclear glassy inclusions may be evident.
Cytoplasm: clear or has fine zymogen granules, which stain red by Quik-Diff or
Wright-Giemsa and purple with the Pap method.
These granules are PAS positive.
Acinic cell carcinoma
