respiratory cytopathology

Question 1

4 major histological subtypes of bronchogenic carcinoma

Answer 1

Non Small Cell Lung Carcinoma (NSCLC)

1. Squamous cell carcinoma (SCC)
2. Adenocarcinoma (ACA)
3. Large cell undifferentiated carcinoma (LCLC)
4. Small Cell Carcinoma (SCA or SCLC)

Question 2

Significance of finding TTF-1, BerEp4, EMA & CK7

Answer 2

• TTF-1: SCC
• BerEp4: BCC (adenoca.)
• EMA: epithelial marker (adenoca.)
• CK7: indicates location of tumour in hte body e.g. +ve= upper ab. of body

Question 3

3 ways of obtaining cytological material for diagnosis of lung carcinoma

Answer 3

1. Exfoliative: non-invasive, passive
2. Abrasive: slightly invasive
3. Fine needle aspiration: very invasive

Question 4

Features of keratinising squamous cell carcinoma

Answer 4

• orangeophilic

- Caudate cytoplasm (tadpole cells bc has tail)

Question 5

What makes a poor/unsatisfactory sample (when coming from respiratory)?

Answer 5

<10 pulmonary macrophage in a FOV

• lots of squamous cells
• lots of PMN & blood
• evidence of malignancy

Question 6

what does eosinophilia (& charcot Leydin crystals) indicate?

Answer 6

asthma, allergy

Question 7

What can streaks of lymphocytes indicate?

Answer 7

viral infection

Question 8

what are the non-specific reactive changes?

Answer 8

• reactive squamous cells
• Anucleated keratinised squamous cells
• hyperplasia of bronchial epith.
• reactive bronchiolar cells
• artefacts or poor preservation
• Squamous metaplasia

Question 9

Cytological findings in sputum samples from asthma patients

Answer 9

• Eosinophils & Charcot Leydin crystals

- Cruschmann spirals

Question 10

What does it mean when you find cilia in cells?

Answer 10

NOT malignant (but a benign feature?)

Question 11

Features of Herpes simplex virus

Answer 11

• multinucleation
• nuclear margination (defined border around nucleus)
• Ground glass appearance in nucleus
• nuclear inclusions (e.g. eosinophilic)

Question 12

Special stains for pneumocystis

Answer 12

• methanamine silver

- Toluidine blue

Question 13

Types of pulmonary neoplasms collected in a) sputum samples & b) bronchial (Br) brush, Br lavage (BAL) & FNA

Answer 13

a) sputum: SCC & SCA

b) Brush etc.: peripheral & subpleural lesions

Question 14

what does pack a year mean?

Answer 14

packs /day x # years smoking

Question 15

3 causes to dyspnoea (SOB)

Answer 15

• lung cancer, heart failure, asthma, cystic fibrosis

Question 16

Factors contributing to SOB

Answer 16

• Emphysema
• constraction of muscles bronchiole = reduce flow
• mucous build-up / emphysema = reduce gas exchange

Question 17

changes to columnar respiratory membrane

Answer 17

metaplasia -> dysplasia -> carcinoma in situ-> invasive cancer

Question 18

differentiate b/w Lipidic adeno Ca (BAC) vs Small cell anaplastic Ca

Answer 18

• BAC: ball-like cluster of cells, single cells resemble P.macro., cytoplasmic villi may represent cilia
• SCC: associated w/ smoking, nuclear molding (stacked coins)

Question 19

Function of the respiratory system

Answer 19

• transportation of gases
• gas exchange
• moisten air
• filter air
• warming
• provide immune defence to inhaled micro-o