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HISTOPATH 2 Flashcards

1
Q

Branch of general cytology; deals with microscopic study of cells desquamated (shed) from epithelial surfaces

A

EXFOLIATIVE CYTOLOGY

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2
Q

step required to be performed STAT in exfoliative cytology

A

Fixation
(cells decompose/degenerate easily)

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3
Q

PURPOSE OF EXFOLIATIVE CYTOLOGY

A
  • Detect cancerous / malignant conditions
  • Detect asymptomatic CA in women or pre-CA cervical lesions
  • Genetic sex determination
  • Detection of infection (i.e HPV, trichomoniasis, yeast infection)
  • Evaluate female hormonal status in case of sterility
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4
Q

3 DIFFERENT TYPES OF SPECIMENS PROCESSED IN HISTOPATH

A
  • Autopsy
  • Biopsy
  • Cytology specimens
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5
Q

TYPES OF CYTOLOGY SPECIMENS

A

Gynecological
Non-gynecological (fluid specimens)

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6
Q

Example of Gynecological spx

A

Cervicovaginal smear (PAP smear)

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7
Q

Example of Non-gynecological (fluid specimens)

A
  • Sputum
  • Smears of urine sediments
  • Endometrial and endocervical smears
  • Prostatic and breast secretions
  • Pleural and peritoneal fluids
  • Gastric and bronchial secretions
  • CSF
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8
Q

THREE TYPES OF PREPARATION FOR NON-GYNECOLOGIC (FLUID) SPECIMENS

A
  1. Smears
  2. Cell block – BEST
  3. Cytospin
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9
Q

type of preparation for non-gynecological (fluid) spx that requires 2 slides

A

Smears

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10
Q

type of preparation for non-gynecological (fluid) spx that is known to be the BEST method to collect cells in fluids

A

Cell block

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11
Q

type of preparation for non-gynecological (fluid) spx that includes centrifugation at 1000 rpm for 1 minute

A

Cytospin

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12
Q

Enumerate RESPIRATORY TRACT SPECIMENS

A

BAL
Bronchial washings
Bronchial brushings
Sputum

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13
Q

Specimen used to detect pneumocystis jirovecii (among AIDS px)

A

BRONCHOALVEOLAR LAVAGE (BAL)

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14
Q

Manner of collection for SPUTUM

A

deep cough, 3 consecutive mornings

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15
Q

Used to confirm SPUTUM

A

microscopic evaluation of ALVEOLAR MACROPHAGE

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16
Q

Indicator cell for satisfactory sputum collection

A

Alveolar macrophage

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17
Q

Fixative used for SPUTUM in exfoliative cytology

A

Saccomano’s fluid

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18
Q

Fixative used for BRONCHIAL BRUSHING in exfoliative cytology

A

Spray fixative or
95% ethanol

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19
Q

These specimen requires at least 8 hours fasting prior collection

A

GASTRIC SECRETIONS / ASPIRATES / LAVAGE

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20
Q

These specimen requires immediate transport to the lab; no delay beyond 30 minutes

A

GASTRIC SECRETIONS / ASPIRATES / LAVAGE

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21
Q

Requirement for GASTRIC SECRETIONS / ASPIRATES / LAVAGE prior to collection

A

at least 8 hours fasting

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22
Q

Specimen with LOW diagnostic yield for breast CA diagnosis

A

BREAST SECRETION
(NIPPLE DISCHARGE)

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23
Q

T/F
Discharge during and post lactation may be abnormal

A

FALSE
NORMAL

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24
Q

Nipple discharge during these conditions may be normal

A

during and post lactation

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25
Q

Discharge from breast nipple is usually _______ & may be due to ________________

A

benign
lesion like duct ectasia & papilloma

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26
Q

Smear preparation for breast secretion

A

Pull apart technique

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27
Q

Fixative of breast secretion for exfoliative cytology

A

Spray fixative or
95% IPA

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28
Q

Other methods to detect breast CA

A

Mammography
Breast ultrasound
Biopsy if lump is present

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29
Q

SMEAR PREPARATION TECHNIQUES

A

Streaking
Spreading
Pull-apart
Touch prep. (Impression smear)

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30
Q

SMEAR PREPARATION TECHNIQUE:
Apply spx at one corner of the slide, spread in a zigzag manner

A

Streaking

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31
Q

SMEAR PREPARATION TECHNIQUE:
Apply spx at the center, spread by teasing

A

Spreading

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32
Q

SMEAR PREPARATION TECHNIQUE:
Recommended for thick secretions
Apply spx at the center then place another slide (two slides used), slides are moved in opposite direction

A

Pull-apart

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33
Q

SMEAR PREPARATION TECHNIQUE:
Gentle smearing of the specimen across the slide

A

Touch prep. (Impression smear)

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34
Q

BODY CAVITY FLUIDS

A

Peritoneal-Pleural-Pericardial Fluids

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35
Q

Common problem in body cavity fluids (Peritoneal-Pleural-Pericardial Fluids)

A

JELLY CLOTS

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36
Q

Remedy for Jelly clots in body cavity fluids (Peritoneal-Pleural-Pericardial Fluids)

A

add 300 units heparin/100 mL of aspirate

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37
Q

Types of urinary tract specimens for exfoliative cytology

A

Voided
Catheterized
Washing from bladder/renal pelvis

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38
Q

Urinary tract specimens are used to detect

A

urothelial malignancies

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39
Q

Guidelines for proper urinary specimen collection

A
  • First voided urine must be discarded (overnight cell degeneration)
  • Second void is preferred
  • Delay: refrigeration
  • NO preservative

AMOUNT: 50 ml

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40
Q

BODY CAVITY EFFUSIONS

A

CSF, ascitic fluid

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41
Q

Guidelines for proper body cavity effusion collection

A
  • Submitted fresh
  • Formalin or alcohol should NOT be used

CSF AMOUNT: 1 mL

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42
Q

rpm and duration of centrifugation of spx for exfoliative cytology

A

1000 rpm for 1 minute

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43
Q

Extra sediments obtained after centrifugation is used for

A

cell block technique

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44
Q

METHODS OF CELL BLOCK PREPARATION

A

Direct Filtration – ROUTINELY PERFORMED
Plasma Thrombin method
Carbowax method

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45
Q

Routinely performed method of cell block preparation

A

Direct Filtration

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46
Q
  • Centrifuge fluid, decant, collect sediment
  • Add 10% formalin to sediment
  • Embed using paraffin
A

Direct Filtration

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47
Q

Disadvantage of Direct Filtration

A

easily washed out

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48
Q
  • Centrifuge fluid, decant, collect sediment
  • Add 1 ml plasma and add thrombin → forms gel-like substance
  • Place in a filter paper (reduces washing out)
  • Add 10% formalin
A

Plasma Thrombin method

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49
Q

Advantage and disadvantage of Plasma Thrombin method

A

Advantage: reduced washing out
Disadvantage: expensive

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50
Q
  • Centrifuge fluid, decant, collect sediment
  • Add carbowax to sediment
  • Place in a paraffin block
A

Carbowax method

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51
Q

Advantage and disadvantage of Carbowax method

A

Advantage: no dehydration step
Disadvantage: expensive

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52
Q

T/F
Smears should be prepared from fresh material and must be prepared and FIX while moist. We must prevent drying of specimens.

A

T

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53
Q

Duration of smear fixation for cytology

A

10-15 minutes

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54
Q

ensure that the cells attach to the slides

A

Adhesives

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55
Q

Spx not requiring adhesives

A

Specimens with ↑ proteins

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56
Q

Spx requiring adhesives

A

▪ Urinary sediments
▪ Bronchial lavage
▪ Concentrated sputum
▪ Specimens with trypsin

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57
Q

ADHESIVES FOR CYTOLOGY

A
  • Pooled serum or plasma
  • Celloidin ether alcohol
  • Leuconostoc culture
  • APES – 3 aminopropyltriethoxysilane
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58
Q

Bacteria used in Leuconostoc culture

A

gram positive cocci

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59
Q

most common TISSUE adhesive

A

Mayer’s egg albumin

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60
Q

T/F
Mayer’s egg albumin is also used in cytology as an adhesive

A

F
NOT used in cytology: stained intensely by the PAP counterstain

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61
Q

Best fixative for Cytology

A

95% ethanol with ether (not commonly used, ether is flammable)

62
Q

Best tissue fixative

A

10% buffered neutral formalin

63
Q

Commonly used fixative for Cytology

A

95% ethanol

64
Q

May be used but slide must be kept at a distance of 1 foot (12 inches or 30. 5 cm) from the spray

A

Spray fixative

65
Q

Combination of 50% alcohol and 20% carbowax

A

Saccomano’s fixative

66
Q

Composition of Saccomano’s fixative

A

50% alcohol
20% carbowax

67
Q

Used fixative for ALL types of effusions

A

50% alcohol

68
Q

Fixative for peritoneal and pleural fluids

A

50% alcohol

69
Q

Fixative for sputum

A

70% alcohol

70
Q

Fixative for urine, gastric, and bronchial aspirates

A

95% alcohol

71
Q

Best fixative for bloody specimens (in tissue processing)

A

Carnoy’s fluid

72
Q

Composition of Carnoy’s fluid

A

Equal parts of tertiary butyl alcohol and 1 part of 95% ethanol

73
Q

Other fixatives for exfoliative cytology

A

Carnoy’s fluid
Schaudinn’s fluid

74
Q

Purpose of PAP smear

A

screening test for cervical CA
hormonal evaluation

75
Q

Gold standard stain for cytology

A

PAPANICOLAU STAIN

76
Q

PAP STAIN COMPONENTS

A

Harris Hematoxylin
OG6
EA 50

77
Q

Nuclear stain of PAP stain

A

Harris Hematoxylin

78
Q

Counterstains of PAP stain

79
Q

PAP counterstain
Stains the cytoplasm of superficial cells

80
Q

PAP counterstain
Stains the cytoplasm of both parabasal and intermediate cells

81
Q

Stain for routine tissue processing

82
Q

H&E COMPONENTS – for routine tissue processing

A

Hematoxylin - Nuclear dye
Eosin - Cytoplasmic dye

83
Q

PAP stain result:
Vesicular nucleus

84
Q

PAP stain result:
Pyknotic nucleus

A

dark blue to black

85
Q

PAP stain result:
Cytoplasm (superficial)

A

orange + hint of green
*using OG6

86
Q

PAP stain result:
Cytoplasm (parabasal and intermediate)

A

olive green + hint of brown and red
*using EA36-50

87
Q

PAP stain result:
Bacteria

88
Q

PAP stain result:
Mycelia

89
Q

PAP stain result:
T. vaginalis

A

pale greenish blue

90
Q

PAP SMEAR METHODS

A

Conventional PAP’s
Liquid Based PAP’s

91
Q

Ob-gyne collects specimen from the patient directly smeared using an Ayre’s spatula on to the slide; spread in disorderly manner
Disadvantage: Difficult for pathologist to view individual cells microscopically (crowded/overlapping cells)

A

Conventional PAP’s

92
Q

Use of spatula or brush/broom to collect specimen → vial with preservative. Thin cell layer is placed on a slide.

A

Liquid Based PAP’s

93
Q

COLLECTION SITES FOR PAP SMEAR

A

T-zone (Transformation zone)
Endocervix (simple columnar epithelium)
Ectocervix (stratified squamous non-keratinized epithelium)
Upper third of the vaginal wall

94
Q

Collection site for PAP smear; junction between the endocervix and ectocervix

A

T-zone (Transformation zone)

95
Q

Collection site for evaluation of endocervical or intrauterine lesions

A

Endocervix (simple columnar epithelium)

96
Q

Most common site for cancer screening

A

Ectocervix (stratified squamous non-keratinized epithelium)

97
Q

Collection site for evaluation of inflammatory conditions

A

Upper third of the vaginal wall

98
Q

Based on the specific response of vaginal epithelium to steroid hormones

A

HORMONAL CYTOLOGY

99
Q

4 MAIN VAGINAL CELLS (presence of these cells in PAP smear are based on the steroid hormones)

A
  1. Superficial
  2. Intermediate
  3. Parabasal
  4. Basal
100
Q

Vaginal cell NOT NORMALLY SHED

101
Q

STEROID HORMONES

A

ESTROGEN
PROGESTERONE

102
Q

Steroid hormones that influence desquamation of superficial cells

103
Q

Steroid hormones that influence desquamation of intermediate cells

A

PROGESTERONE

104
Q

most predominant steroid hormone in menopause

A

E1 (Estrone)

105
Q

most predominant steroid hormone in reproductive years

A

E2 (Estradiol)

106
Q

most plenty steroid hormone, but least potent

A

E3 (Estriol)

107
Q

✓ Performed regularly even in pregnant women without undue risk (especially when sexually active)
✓ Inexpensive
✓ No lubricant or vaginal wash must be used
✓ Smears are taken from the upper lateral third of vaginal wall

A

PAP smear for hormonal cytology

108
Q

Largest; most mature cells in PAP smear with pyknotic (smallest) nuclei

A

SUPERFICIAL CELLS

109
Q

Size of superficial cells

110
Q

Polyhedral flat cells and cytoplasm may be acidophilic or basophilic

A

SUPERFICIAL CELLS

111
Q

Medium sized cells in PAP smear

A

INTERMEDIATE CELLS

112
Q

INTERMEDIATE CELL size

113
Q

Polyhedral cells; basophilic cytoplasm with vacuoles

A

INTERMEDIATE CELLS

114
Q

Types of intermediate cells

A

Navicular cells
Pregnancy cells

115
Q

Intermediate cell, boat-shaped cells with a tendency to fold or curl on edges

A

Navicular cells

116
Q

Navicular cells are seen during these conditions

A
  • Latter half of menstrual cycle, during pregnancy or menopause
  • Progesterone-estrogen effect
  • Abnormal androgen stimulation
117
Q

Round to oval with translucent basophilic cytoplasm observed greatest at the center of the cell due to glycogen accumulation

A

Pregnancy cells

118
Q

Round to oval cells in PAP smear with strongly basophilic cytoplasm

A

PARABASAL CELLS

119
Q

PARABASAL CELLS are found in

A

– 2 weeks of age to puberty
– after childbirth
– abortion
– after menopause

120
Q

Smallest cells in PAP smear; NOT normally shed (shed traumatically)

A

BASAL CELLS

121
Q

Size of PARABASAL CELLS

122
Q

Size of BASAL CELLS

123
Q

Round to slightly oval cells with large nucleus occupying half or more of cell volume, with strongly basophilic cytoplasm

A

BASAL CELLS

124
Q

Found only before pregnancy and ff> menopause

A

BASAL CELLS

125
Q

Cells found during and 1-4 days after menstruation

A

ENDOMETRIAL CELLS

126
Q

Occurring in groups of >3, shed in response to ovarian hormone

A

ENDOMETRIAL CELLS

127
Q

If seen in post-menopausal women, it may indicate possible endometrial carcinoma or endometrial hyperplasia

A

ENDOMETRIAL CELLS

128
Q

Indicated when endometrial cells are seen in post-menopausal women

A

Endometrial carcinoma
Endometrial hyperplasia

129
Q

Cells occurring in large groups or sheets

A

ENDOCERVICAL GLANDULAR CELL

130
Q

Cells forming honeycomb appearance

A

ENDOCERVICAL GLANDULAR CELL

131
Q

ABNORMAL CELLULAR COMPONENTS IN PAP’S

A

Yeast (Candida albicans)
Trichomonas vaginalis
Clue cells
Koilocytes
Doderlain bacillus

132
Q

Yeast (Candida albicans) are seen in these conditions:

A

Diabetic patients
Oral contraceptives
Prolonged steroid therapy
Immunocompromised patients

133
Q

Pear shaped parasite causing trichomoniasis

A

Trichomonas vaginalis

134
Q

squamous cells with attached bacilli – gram variable Gardnerella vaginalis

A

Clue cells

135
Q

indicative of bacterial vaginosis

A

clue cells

136
Q

abnormal squamous with atypical nucleus surrounded by non-staining halo, indicative of HPV infection

A

Koilocytes

137
Q

Normal flora; but abnormal if increased in last trimester of pregnancy, infection, estrogen deficiency, and DM

A

Doderlain bacillus

138
Q

Doderlain bacillus is INCREASED in:

A

▪ Last trimester of pregnancy
▪ Infection
▪ Estrogen deficiency
▪ DM

139
Q

Involves evaluation of hormonal status based on the distribution of cells

A

CYTOHORMONAL MATURATION INDEX (CHMI)

140
Q

Cells included in CHMI

A

Parabasal, Intermediate, Superficial cells (total of 100)

141
Q

T/F
In CHMI, result should be correlated with age and LMP of the patient

142
Q

CHMI in Newborns

A

0 / 90 / 10

143
Q

CHMI in Menopause

A

0 / 80 / 20

144
Q

CHMI in Post ovulatory

A

0 / 70 / 30

145
Q

Old method, obsolete manner of reporting PAP’s

A

Class System

146
Q

In Class system, this indicates negative for malignancy

147
Q

In Class system, this indicates conclusive for malignancy

148
Q

New system of reporting cervical, vaginal cytologic smears

A

Bethesda System

149
Q

Developed at national Cancer Institute December 1988

A

Bethesda System

150
Q

REPORT FORMAT OF PAP SMEAR

A

A) Specimen Adequacy
B) General Categorization
C) Descriptive Diagnosis

MTAP 2 (23 decks)

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