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302 Scientific basis of medicine > Histopathology 3) Cytopathology > Flashcards

Histopathology 3) Cytopathology Flashcards

1
Q

What are examples of gynaecological cytopathology?

A

NHS CSP smears

Diagnostic smears and endometrial sampling

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2
Q

What are examples of non-gynaecological cytopathology?

A

Exfoliative - serious effusion, joint, respiratory, GI, CSF

Aspiration - lymph node, salivary gland, skin and soft tissue masses, cyst, breast, thyroid

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3
Q

Where are serous membranes found?

A

Pericardium
Pleura
Abdominal cavity (peritoneum)
Tunica vaginalis of testes

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4
Q

How is a serous effusion formed?

A

Serous membranes well supplied with capillaries with high fluid turnover
Effusion is an imbalance between formation and resorption
Hydrostatic pressure in capillaries, oncotic pressure, vascular permeability
Resorption via lymphatics, capillaries and venules

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5
Q

Why is a transudate effusion formed?

A

Increased mechanical pressure - increased hydrostatic pressure or decreased oncotic pressure

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6
Q

What is a transudate effusion?

A

Clear, pale yellow, low protein, doesn’t clot
Single bland degenerate mesothelial cells and a few macrophages and lymphocytes
Cardiac, cirrhosis, nephrotic, hypoproteinaemia

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7
Q

What is an exudate effusion?

A 
Unfiltered plasma
Changes in vascular permeability
Cloudy, yellow or bloody, high protein, clots
Many cells with proteinaceous background
Inflammation
May be malignant
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8
Q

What do pale yellow and watery cells indicate?

A

Transudates from CCF, cirrhosis, decreased protein

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9
Q

What do turbid and yellow to white cells indicate?

A

Infection
Malignancy
Pancreatitis

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10
Q

What do milky white / greenish cells indicate?

A

Chylous effusion from thoracic duct, obstruction

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11
Q

What do milky green with a silky sheen cells indicate?

A

Pseudochylous effusion caused by cholesterol from TB, rheumatoid disease or an old effusion

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12
Q

What do brown cells indicate?

A

Haemorrhage or melanin

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13
Q

What do green cells indicate?

A

Bile from biliary tract disease or ruptured bowel

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14
Q

What do gelatinous cells indicate?

A

Hyaluronic acid from mesothelioma or mucin in pseudomyxoma

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15
Q

What do mesothelial cells in effusions look like?

A 
Mesodermal epithelium
Microvilli
Single and grouped
Clusters, balls, papillae, cell-in-cell
Vary in size
Lacy edges
Windows
Molding
Variable nuclear number, size, N:C ratio
Perinuclear cytoplasmic density
Vacuoles - glycogen, fat, degeneration
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16
Q

What do macrophages in effusions look like?

A 
Usually present
Can be difficult to separate from mesothelial cells
Usually single or in loose aggregates
Foamy pale cytoplasm
Eccentric bean shaped nucleus
Lack holding, windows
17
Q

What do lymphocytes in effusions look like?

A

Usually a few present
More frequent in longstanding effusions
May be a range of maturation

18
Q

What are lymphocyte effusions associated with?

A

Obstructed circulation through lymph nodes and associated with tuberculosis and lymphoma

19
Q

What are eosinophils in effusions indicate?

A

Mostly pleura
Generally non-specific
Mostly benign

20
Q

What do neutrophils in effusions indicate?

A

Often find a few
If non-infectious, may be well-preserved
If infectious, often degenerate
If masses, usually benign

21
Q

What other cells can be found in effusions?

A 
Plasma cells
Ciliated cells
Micro-organisms
Megakaryocytes
Stranges - LE cells and ferruginous bodies
22
Q

What are the features of malignant cells?

A 
Architecture
 - groups
 - dispersed single cells
Nuclei of malignant cells
 - increased N:C ratio
 - irregular membrane
 - inclusions
 - coarse irregular chromatin
Cytoplasm
 - various vacuoles
 - mucin
 - melanin
 - keratinisation
23
Q

What do malignant breast cells look like?

A 
Several patterns (often clustered)
Proliferation spheres
Diffuse cell pattern
Small single cells of lobular carcinoma
 - intracytoplasmic lumina
 - microvilli and mucin
 - indian files
24
Q

What do malignant lung cells look like?

A

Range of patterns of differentiation
Dense cytoplasm
Papillary groups
May be highly vacuolated

25
Q

What do malignant stomach cells look like?

A

Dispersed single cells but may form papillae or acini
Signet ring of columnar cells
Signet ring cells have many tiny vacuoles
Can be bland with cells like macrophages

26
Q

What do malignant colorectal cells look like?

A

Papillary and acing aggregates
Tall columnar cells
Nuclear palisading with nuclear membrane irregularities

27
Q

Why is fine needle aspiration good for patients?

A

Minimal past and post-procedural discomfort
Anaesthesia requirement is minimal, outpatient procedure
Rapid result

28
Q

Why is fine needle aspiration good for clinical management?

A

Easily repeated
Minimal distribution of tissue planes
Confirms malignancy leaving lesion intact
Therapeutic for cysts and abscesses
Quick feedback allows planning of other investigations

29
Q

Why is fine needle aspiration good for pathologists?

A

Simple and cheap equipment
Excellent cell preservation due to rapid fixation
Fresh tissue available

30
Q

What are the features of fixed fine needle aspiration?

A 
Nuclear detail
Transparent
Keratinisation
Squamous differentiation
Hyperchromasia
Necrosis
Similar to histology
Stain papnicoloau or H&E
31
Q

What are the features of air-dried fine needle aspiration?

A 
Cytoplasmic features
Background substance
Mucin, granules
Glandular and lymphoid
Metachromasia
Microbial agents
Bit like marrow
Stain MGG
32
Q

What are alternative causes of reactive lymphadenopathy?

A 
Non-specific lymphoid hyperplasia
HIV-associated
Mononucleosis
RA, SLE, syphilis
Dermatopathic changes
33
Q

What can cause granulomatous lymphadenitis?

A 
TB
Cat scratch, leprosy, paracoccidioidomycosis, histoplasmosis, LGV
Foreign body
Lymphoma
Carcinoma
Sarcoid
34
Q

What is required for a lung cancer diagnosis?

A

Adequate aspirate
Morphologic diagnosis
Immunophenotypic confirmation
Material to permit molecular genetic evaluation

35
Q

What is the accuracy of fine needle aspiration diagnosis?

A

Specificity 94-100%

Sensitivity 81-100%

36
Q

What are false negatives of fine-needle aspiration associated with?

A

Non-representative sampling

302 Scientific basis of medicine (28 decks)

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