HISTOPATHOLOGY Flashcards
Branch of general cytology which deals with the microscopic study of cells desquamated
(Study of cell shed) from epithelial surfaces
EXFOLIATIVE CYTOLOGY
3 purpose of exfoliative cytology
Detect cancerous / malignant conditions
Detect asymptomatic cancer in women
or pre-cancerous cervical lesions
Determination of genetic sex
2 types of specimen for cytology
Gynecological
NON-gynecological
which is for fluid specimen?
NON-gynecological
3 preparations for non-gynecological specimen
Smears (2slides)
Cell block
Cytospin (Centri @ 1000rpm for 1min)
The best method to collect cells from body fluids
cell block
5 specimens for NON-GYNECOLOGIC
RESPIRATORY TRACT SPECIMEN (BAL, SPUTUM, GASTRIC SECRETIONS)
BREAST SECRETION
PERITONEAL-PERICARDIAL-PLUERAL FLUIDS
URINARY TRACT SEDIMENT
BODY CAVITIY EFFUSION (CSF, ASCITIC FLUID)
4 METHOD IN SMEAR
1.Streaking
2. Spreading
3. Pull Apart
4. Touch preparation
recommended for thick fluid
Pull Apart
Also called: Impression Smear
TOUCH PREPARATION
This may be submitted to cytology to detect or rule out Pneumocystis Jirovecii particularly among AIDS patients
BRONCHOALVEOLAR LAVAGE (BAL)
MOST COMMON RESPIRATORY TRACT SPECIMEN
SPUTUM
Sputum must be collected from a _____ and collect at least ______
DEEP COUGH
3 CONSECUTIVE MORNINGS
Sample must be evaluate if it’s a real sputum , we can do it microscopically. Cell that would indicate satisfactory collection: We look for ______
Alveolar macrophages
TRUE OR FALSE
- We do fixation ASAP, because the cell will decompose immediately
TRUE
FIXATIVE FOR SPUTUM
SACCOMANO FLUID
FIXATIVE FOR BRONCHIAL BRUSHING
Spray fixative or 95% Ethanol
GASTRIC SECRETIONS / ASPIRATES (Gastric Lavage)
-Required prior to collection: patient must do fasting at least ____
8 HOURS
GASTRIC SECRETION Immediate transport to the lab is required no delay beyond ____
30 MINS
This is submitted for testing to rule out possible breast cancer, but compared to mammography and ultrasound it has less chance to detect the breast cancer
BREAST SECRETION (Nipple discharges)
TRUE OR FALSE
discharge during and post lactation may be abnormal
FALSE (NORMAL)
TRUE OR FALSE
discharge from breast nipple is usually malignant & may be due to lesion like duct ectasia & papilloma
FALSE ( benign)
SMEAR PREP FOR BREAST SECRETION
PULL APART
FIXATIVE FOR BREAST SECRETION
spray fix or 95% IP
When collecting this sample usually clotted
PERITONEAL-PLEURAL-PERICARDIAL FLUIDS (Body cavity fluid)
To prevent jelly clots: we add ____ per _____
300 units of HEPARIN
100ml of aspirates
URINARY TRACT SPECIMENS Sample is submitted to detect what?
UROTHELIAL MALIGNANCY
3 URINE SPECIMEN
Voided urine, catheterized urine,
washing from bladder or renal pelvis
____ urine must be DISCARDED due to
overnight degeneration of cells. ____ is preferred
FIRST VOIDED URINE
SECOND COLLECTION
IF THERE IS A DELAY IN URINE EXAMINATION WE DO ______
REFRIGERATION
TRUE OR FALSE
preservatives should not be added in urine specimens.
TRUE
For best result ____ URINE specimen must be collected
50mL
BODY CAVITY EFFUSIONS Specimen MUST BE SUBMITTED _____. amount of CSF ATLEAST _____
FRESH
1mL
in CELL BLOCK we will not embed the tissue but the _______
sediments
3 METHODS OF CELL BLOCK PREPARATION
DIRECT FILTRATION
PLASMA-THROMBIN
CARBOWAX
Centrifugation fluid, add 1 ml of plasma and add thrombin. This will form gel like substance, place it in a filter paper and
add 10% formalin
(Used filter paper do reduce washing out of the cell)
Advantage – reduce washing out, but expensive
PLASMA-THROMBIN
Centrifugation fluid, add 10% formalin to sediment.
Disadvantage – easily washed out
DIRECT FILTRATION
Following centrifugation of fluid, add carbowax to sediment and place in a paraffin block
Advantage – no dehydration step but expensive
CARBOWAX
ROUTINE METHOD OF CELL BLOCK PREPARATION
DIRECT FILTRATION
TRUE OR FALSE
1st- Smears should be prepared from old material and must be prepared and FIX while dry.
2nd- We must prevent drying of specimens
1st- FALSE (spx. should be prep fresh, and prep while moist.
2nd- TRUE
TRUE OF FALSE
There is specimen that contains Increase Proteins, if specimen contains increase proteins NO need to use Adhesives
TRUE
4 specimens requiring adhesives
Urinary sediments
Bronchial lavage
Concentrated Sputum
Specimens with trypsin
after smear we do fixation, In cytology fixation must be ___mins only
10-15mins
4 ADHESIVES FOR CYTOLOGY
1.Pooled serum or plasma
2.Celloidin ether alcohol
3.Leuconostoc culture (leuconostoc is a bacteria: Gram positive cocci)
4.APES – 3 aminopropyltriethoxysilane
Most common tissue adhesive
MAYER’S EGG ALBUMIN
We DO NOT used mayers egg albumin in cytology because this can be stained intensely by?
counter stain used in paps
THE BEST FIXATIVE FOR CYTOLOGY
95% Ethanol with Ether(but ether is hazardous because it is flammable)
COMMONLY USED FIXATIVE FOR CYTOLOGY
95% Ethanol
TISSUE FIXATIVE
10% buffered neutral formalin
CAN ALSO BE USED FIXATIVE FOR CYTOLOGY (2 ANSWERS)
1.SPRAY FIXATIVE
2.SACCOMANO PRESERVATIVE
May be used but slide must be kept at a distance of 1 foot (12 inches or 30. 5 cm) from the spray
SPRAY FIXATIVE
This is a combination of 50% alcohol and 20% carbowax
SACCOMANO PRESERVATIVE
4 OTHER EXAMPLE OF FIXATIVE IN CYTOLOGY
50% alcohol is for all types of effusion
50% Peritoneal and Pleural fluids
70% Sputum specimen
95% Urine, Gastric and bronchial aspirates
Best FIXATIVE for bloody specimen
Carnoy’s fluid
It is the Gold standard
staining for cytology
PAPANICOLAU STAIN
3 dyes in pap’s smear
HARRIS HEMATOXYLIN
OG6
EA 50
This is the Nuclear Stain
HARRIS HEMATOXYLIN
Counter stain. used to stain cytoplasm of superficial cells
0G6
Counter stain. used to stain cytoplasm of both parabasal and intermediate cell
EA 50
STAINING RESULT OF Cytoplasm of the superficial
GREEN
STAINING RESULT OF OG6
ORANGE WITH HINT OF GREEN
STAINING RESULT OF Cytoplasm of the parabasal intermediate
BROWN AND RED
STAINING RESULT OF EA 50
olive green with a hint of brown and red
STANING RESULT OF BACTERIA
DARK BLUE
STAINING RESULT OF T.VAGINALIS
GREENINSH BLUE
STANING RESULT OF VESICULAR NUCLEUS
BLUE
STAINING RESUT OF PYKNOTIC NUCLEUS
DARK BLUE TO BLACK CYTOPLASM
STAINING RESULT OF MYCELIA
VIOLET
It is a screening test for cervical cancer
PAP’S SMEAR
THE ONE WHO PREPARE SMEAR
OBGYN
TWO METHODS OF PREPARING PAPS SMEAR
CONVENTIONAL PAP’S
LIQUID BASED PAP’S
IN CONVENTIONAL PAP’S WHAT INSTRUMENT IS USED BY THE OB TO COLLECT THE SPECIMEN
AYRE’S SPATULA
Directly spread on the slide then send to lab to be process. Crowded cell can be seen microscopically
CONVENTIONAL PAP’S
use of spatula or brush/broom to collect specimen. Placed in a vial containing preservative. A thin layer of cells is placed on a slide
LIQUID BASED PAP’S
4 COLLECTION SITES IN LIQUID BASED PAP’S
UPPER 3RD OF THE VAGINAL WALL
ENDOCERVIX
ECTOCERVIX
T-ZONE
for evaluating of inflammatory conditions
Upper 3rd of the vaginal wall
SITES FOR THE Detection of endocervical lesions or intrauterine lesions
ENDOCERVIX
Endocervix is lined up with _______
SIMPLE COLUMNAR EPITHELIUM
The most common site for cancer screening
ECTOCERVIX
Ectocervix is lined up with ________
Stratified Squamous Non-Keratinized epithelium
This Zone is the usual site for collection of Pap’s Smear
T-ZONE
junction between the Endo and Ectocervix
T-ZONE
4 MAIN VAGINAL CELLS
SUPERFICIAL
INTERMEDIATE
PARABASAL
BASAL
LARGEST AND MATURE 30-60U WITH PYKNOTIC NUCLEI
SUPERFICIAL
MEDIUM SIZED 20-30 U
INTERMEDIATE
ROUND AND OVAL 15-30 U
PARABASAL
SMALLEST 13-20 U
BASAL
-it is the steroid that influence desquamated (Shedding) of Superficial cells
ESTROGEN
3 TYPES OF ESTROGEN
E1 (ESTRONE)
E2 (ESTADIOL)
E3 (ESTRIOL)
The most predominant in Menopause
E1 ESTRONE
the most predominant in Reproductive years
E2 ESTRADIOL
the most plentiful but least potent
E3 ESTRIOL
COLOR OF CYTOPLASM IN SUPERFICIAL CELLS
PINK
Polyhedral flat cells and cytoplasm may be acidophilic or basophilic
SUPERFICIAL
Polyhedral cells with basophilic cytoplasm with vacuoles
INTERMEDIATE
CELLS IN PAP’S THAT HAS THE SMALLEST NUCLEUS
INTERMEDIATE CELL
2 TYPES OF INTERMEDIATE CELL
NAVICULAR IC
PREGANANCY IC
boat shaped cells with a tendency to fold or curl on edges
Navicular Intermediate Cells
Found in the latter half of menstrual cycle, during pregnancy or menopause
Navicular Intermediate Cells
May be found as a result of abnormal androgen stimulation. May suggest progesterone-estrogen effect
Navicular Intermediate Cells
With strongly basophilic cytoplasm
PARABASAL CELL
Found from 2 weeks of age to puberty, after childbirth, abortion and after menopause
Parabasal
____ is most predominant cell after birthchild
Parabasal
This vaginal cell normally shed or desquamated
Superficial
Intermediate
Parabasal
NOT normally shed, they shed traumatically
basal
Round to slightly oval cells with large nucleus occupying half or more of the cell volume, with strongly basophilic cytoplasm
BASAL
Found only before pregnancy and following menopause
BASAL
This is normally seen but only few and if its many the patient has problem because ____ is not normally shed
BASAL
2 NORMAL CELLULAR COMPONENTS IN PAP’S
- ENDOMETRIAL CELL
- ENDOCERVICA GLANDULAR CELL
This can be Found during and 1-4 days after menstruation
ENDOMETRIAL CELL
This cell is Occurring in groups of 3 or more shed in response to ovarian hormone
ENDOMETRIAL CELL
If seen in post menopause women it may indicate possible endometrial carcinoma or endometrial hyperplasia
ENDOMETRIAL CELL
Occurring in large groups or sheets
ENDOCERVICA GLANDULAR CELL
Forms the characteristic HONEYCOMB APPEARANCE
ENDOCERVICA GLANDULAR CELL
5 ABNORMAL CELLULAR COMPONENT IN PAP’S
- CANDIDA ABLICANS (OCCURING YEAST)
- T. VAGINALIS
- CLUE CELLS
- KOILOCYTES
- DODERLAIN BACILLUS
CANDIDA ABLICANS IS SEEN IN ? 4 ANSWERS
1.seen in diabetic patients
2.those taking oral contraceptives
3.patients under prolonged steroid therapy
4. among immunocompromised patients
pear shaped parasite. can also be detected in UA
T.VAGINALIS
Indicate of bacterial vaginosis
CLUE CELLS
abnormal squamous with atypical nucleus surrounded by non-staining halo. May be indicative of HPV infection
KOILOCYTES
It is actually normal finding, because this is a normal flora
DODERLAIN BACILLUS
TRUE OR FALSE
Increased number of doderlain bacillus is normal
FALSE (NOT NORMAL)
DODERLAINE BACILLUS USUALLY INCREASE IN 4 CONDITIONS, THESE ARE:
- Last trimester of pregnancy
- Infection
- Estrogen deficiency
- Diabetes
(LIED)
Involves evaluation of hormonal status based on the distribution of cells
CYTOHORMONAL MATURATION INDEX (CMI)
CMI= 0/90/10
New born (Predominant is Intermediate)
CMI= 0/80/20
Menopause (Predominant is Intermediate)
CMI= 0/70/30
POST OVULATION
Old method, obsolete manner of reporting PAP’s
CLASS SYSTEM
New system of reporting cervical and vaginal cytologic smears
BETHESDA SYSTEM
WHEN AND WHERE IS BETHESDA SYSTEM DEVELOPED?
ON DECEMBER 1988 AT NATIONAL CANCER INSTITUTE
REPORT FORMAT: (satisfactory, limited, unsatisfactory)
SPECIMEN ADEQUACY
REPORT FORMAT: Negative for Intraepithelial lesion or
malignant cell
Epithelial cell abnormality
Benign cellular changes
GENERAL CATEGORIZATION
REPORT FORMAT:
-Infection / Radiation effects
-Atypical squamous cells of unknown
significance
-Low Grade Squamousintraepithelial lesions
-High Grade squamous intraepithelial lesions
-Squamous cell carcinoma
-Glandular cell abnormality
-Atypical Glandular cells
-Adenocarcinoma
DESCRIPTIVE DIAGNOSIS
3 SPECIMEN USED IN HISTOLOGY
AUTOPSY
BIOPSY
CYTOLOGY
