UNIT 10 Flashcards
1
Q
Due to the enlargement of nuclei and the most important criteria of malignancy.
A
ALTERED NUCLEAR-CYTOPLASMIC RATIOS
2
Q
Benign in certain tissues, e.g. endocervical and renal pelvic cells.
A
ALTERED NUCLEAR-CYTOPLASMIC RATIOS
3
Q
Frequently seen in reactive pleural and peritoneal
mesothelial cells, in histiocytes and in any tissue
undergoing active repair and benign growths.
A
increased mitotic activity
4
Q
Triple or quantiple spindles are highly
suspicious and important signs of
malignancy.
A
atypical mitoses
5
Q
Irregular hyperchromatic or bizarre nuclei
A
multinucleated giant cells
6
Q
Considerable variation in nuclear size and
shape is common in malignant.
A
anisokaryosis
7
Q
common in malignant (especially in
thyroids of older women and less in the
adrenal cortex and hyperactive islets of
Langerhans.)
A
polyploidy
8
Q
In vaginal smears, they may result from
pregnancy as well as malignancy.
A
polyploidy
9
Q
nuclear changes
A
ALTERED NUCLEAR-CYTOPLASMIC RATIOS
HYPERCHROMASIA
INCREASED MITOTIC ACTIVITY
ATYPICAL MITOSES
MULTINUCLEATED GIANT CELLS
ANISOKARYOSIS
POLYPLOIDY
10
Q
Cells of epidermoid carcinomas frequently show a tendency to cytoplasmic _______
A
eosinophilia
11
Q
cells may enclose PMNs, (eg. endometrial andcolonic cancers)
A
adenocarcinoma
12
Q
_____ is common in adenocarcinoma cells, but may be also be seen in endometrial cells following cutterage.
A
cytoplasmic vacuolation
13
Q
Examine for the small groups or clusters of cells:
● Obvious growth patterns.
A
cell pattern
14
Q
cell pattern in adenocarcinoma arising in glandular tissues.
A
acini
15
Q
cell pattern in neuroblastomas and ependymoma
A
rosettes
16
Q
cell pattern in squamous epithelial growths.
A
stratification
17
Q
responsive to sex steroids, particularly _______, and undergoes predictable changes through the cycle in response to changes in blood concentrations
A
vaginal epithelium ; estrogen
18
Q
Rising levels of estrogen cause the vaginal epithelium to become ________
- the surface cells become large and flattened, with small (pyknotic) or absent
nuclei.
A
cornified
19
Q
vaginal cytology is a type of
A
endocrine assay
20
Q
Tracking changes in the morphology of desquamated vaginal epithelial cells provides a convenient means of assaying
changes in estrogen levels.
A
TRUE
21
Q
Vaginal smears may be taken regularly and often
A
TRUE
22
Q
Hormonal changes are best mirrored in the
A
upper third of the vagina.
23
Q
Can also be taken from the _________ because this is more accessible and less likely to be contaminated by cellular debris or discharge
A
lateral walls
24
Q
Large(30-60u)
A
superficial cells
25
Medium-sized
(20-30u)
INTERMEDIATE CELLS
26
Smaller than
intermediates
(15-25u)
PARABASAL CELLS
27
Polyhedral flat cells
predominant in estrogen
effect
superficial cells
28
Polyhedral or elongated
intermediate
29
Round or oval to oval
“boat” shaped cells
(navicular cells,
“pregnancy cells)
glycogen rich in intermediate cells
30
Occurs in groups “picket
fence” enface view,
mosaic, monolayered
sheet
intermediate
31
Boat-shaped
intermediate cells with a
strong tendency to fold
and curl at the edges.
intermediate
32
Round to oval cells
parabasal cells
33
Tall columnar cylindrical
cells, basal oriented
nuclei
Occurs in groups “picket
fence” enface view,
mosaic, monolayered
sheets
endocervical cells
34
Glandular cells: slightly
larger forms acini.
Nucleus: small and
Basophilic and maybe
vacuolated -
endometrial cells
35
Acidophilic or may be
basophilic.
superficial cells
36
Basophilic with vacuoles.
Elongated cytoplasm
intermediate cells
37
Translucent basophilic
cytoplasm (due to
glycogen accumulation).
glycogen rich in intermediate cells
38
Cytoplasm stains deep
blue or blue green + cell membrane = a “double
cell wall” appearance
glycogen rich in intermediate cells
39
Thick cytoplasm,
“sunny-side up fried
egg” appearance;
monolayer sheets.
parabasal cells
40
Strong basophilic
cytoplasm
parabasal
41
Pale basophilia,
vacuolated
endocervical
42
Basophilic and maybe
vacuolated
endometrial cells
43
Vesicular: 6-9u
intermediate and parabasal
44
Pyknotic:
● Presence of
small dark
pyknotic
nuclei (less
than 6u).
superficial only
45
● Expression of the combined exaggerated
progesterone effect.
● Found in the latter half of menstrual cycle, during
pregnancy, perimenopause.
● May also be found as a result of abnormal
androgen stimulation, either endogenous or
exogenous
intermediate
46
Anucleate cells are abnormal (may be derived from):
● Smear contamination by the cells from the vulva.
● Epidermization of the vagina or cervix resulting
from prolapse.
● Leukoplakia of the cervix.
● Ruptured membranes in pregnant women.
● Marked hyper-estrinism.
superficial
47
Found from 2 weeks of age to puberty, after
childbirth, abortion or miscarriages, and after
menopause (atrophy).
parabasal
48
Found during menstruation period (in groups) and
4-10 days after LMP, endometrial hyperplasia,
endometrial adenocarcinoma.
endometrial
49
Percentage of cells that stain
pink-orange to red with Pap’s
and red in Shorr method.
● Refers to Acidophilic cytoplasm.
AI
50
“Karyo-pyknotic index”; percentage of
cells having shrunken, dark, small (less than
6μ) structures nuclei
○ Refers to the pyknotic nuclei.
PI
51
Percentage proportion of cells from the three layers of the vaginal epithelium
MATURATION INDEX CHMI
52
○ Percentage between Parabasal cells (left Value), Intermediate
(Midzone), Superficial (right)
CHMI = CytoHormonal Maturation Index
53
0 / 5/ 95
estrogen effect
54
0 / 80 / 20
progesterone effect
55
100 / 0 / 0
atrophy
56
30/50/20
unfit
57
specimens that require adhesive agent
urinary sediment
bronchial lavage specimen
specimen that utilize proteolytic enzymes
58
CHARACTERISTICS OF A GOOD ADHESIVE
must be permeable to both fixative and the stain
must not retain the stain
59
GOOD ADHESIVES FOR CYTOLOGIC METHOD
pooled human serum or plasma
celloidin ether alcohol
leukonostoc culture
60
methods of smear preparation
streaking
spreading
pull apart
touch or impression smear
61
A histologic preparation that is a sediment that would be processed just like a tissue
and will be used as a complement to the smears
cellblock preparation
62
Used for preparing mucoid secretions , vaginal
secretions/pap smear preparation , sputum , and
gastric contents
streaking
63
materials need in streaking
spatula
dissecting needle
applicator stick
64
Used for thick mucoid secretions (smears of fresh
sputum and bronchial aspirates
spreading
65
The material is placed at the______ of the slide and
gently spread out in a centrifugal fashion where it is
thin and evenly distributed
center
66
another spreading technique that may
also be done wherein the material is gently teased in a
centrifugal fashion forming a star-like pattern.
star pattern
67
We have two slides
wherein the material is
sandwiched and
macerated in between and
gently pressed/squashed
in opposite directions
using both fingers.
pull apart
68
Thinner material = preferred = better cytologic
evaluation
TRUE
69
For preparation of direct impression from the cut
surface of tissue like the lymph nodes , mucosa , and
other surgical /autopsy material
touch or impression slide
70
Exception: CSF
–considered as stab material ,
meaning should be collected and processed
immediate
TRUE
71
Fluid that accumulates in the lungs and is aspirated
using the aspiration technique
thoracentesis
72
The liquid material collected in thoracentesis is called
pleural fluid/effusion
73
The fluid can be smeared onto the slide using the
pull apart method
cell block technique
74
Another method of collecting specimens that are abnormally seen/accumulates in the peritoneal cavity.
paracentesis
75
Fluid in paracentesis is referred to as
Ascitic fluid/Peritoneal fluid
76
Fluid that is found on the pericardial sac/pericardium .
pericardial effusion
77
technique of aspirating pericardial effusion
pericardiocentesis
78
Fluid can be directly placed onto the slide and processed to form a cell block
pericardiocentesis
79
Should be collected and processed immediately
CSF:LUMBAR TAP
80
Help diagnose breast cancer early in the disease
process.
Used to aspirate material from palpable masses as seen
in the image.
Used to diagnose breast cancer in the early phase of its
developmen
fine needle aspiration biopsy
81
a _______ syringe is used, and the fine needle
gauge is between
hypodermic ; 22-25
82
The aspirated material is gently placed onto a slide and
a smear is prepared
fnab
83
Immediately immerse the slide into a bottle of _______
95% Ethyl or Isopropyl ROH or use a spray fixative .
84
Bronchial aspirate;
● Bronchial brushings;
● Bronchial lavage (BAL)
bronchospy
85
Specimen:
○ Bronchoscopically
- directed brushing of the
bronchial brushings
86
Gently apply the sample on to glass slide and immediately immerse slide into _______
3% glacial acetic acid alcohol fixative
87
Obtained at three
consecutive morning
sputum specimens by
deep cough method
NORMAL SPUTUM CYTOLOGY
88
Collect the sample in a
wide-mouth container
containing _______
Saccomano fluid (50% EtOH and 2% carbowax)
89
Inhalation of aerosol
solution for 20 mins to
produce a deep cough
sample .
INDUCED SPUTUM CYTOLOGY
90
method of preparing cytologic
material so that it can be processed , sectioned ,
stained , and viewed as a histology section
cell block
91
can provide diagnostic information in addition to
that obtained from cytology slides.
Advantage: complements the smears.
● It is easier to do special stains, and immunohistochemistry on cell block slides rather than
on regular cytology slides because the slides often
require adaptations of the staining protocols and
different controls.
CELL BLOCK
92
but refers to the technique of
'blocking'
something to hold it together and maintain
its shape .
block
93
micro biopsies embedded in paraffin
that broaden the diagnostic value of cytology
specimens and are complementary to cytology
preparations.
cell blocks
94
Cell block is fixed in a ______
10% neutral buffered
formalin
95
It employs retrieval of small tissue fragments from
FNA specimens which are processed to form a
paraffin block
cell block
96
The supernatant is decanted and the sediment is
directly placed on the slide and uses proper
methods such as pull-apart or streaking.
cell block technique
97
can also be used wherein the plasma + thrombin is added until the preparation forms a semi-solid clot fixed in formalin.
plasma thrombin method
98
Another option: Adding agar to the sediment and is
fixed with formalin and embedded in paraffin,
hence, cell block
cell block technique
99
used wherein the material is mixed with
a special gel material and similarly prepared into a
block.
histogel
100
is collected into a conical tube .
● A ______processin g step is performed
as well.
colloidin ; double embedding
101
A branch of General Cytology which deals with the
microscopic study of cells that have been
desquamated from the epithelial surfaces
basic exfoliative cytology of the female genital tract
102
Recommended for:
○ Cytologic detection of malignant cells or
precancerous lesions in the body.
○ Detection of asymptomatic or precancerous cervical lesions in women.
○ Assessment of female hormonal status in
case of sterility and endocrine disorders .
○Determination of genetic ( phenotypic ) sex .
○ Detection of the presence of infectious microor
basic exfoliative cytology of the female genital tract
103
Use an unlubricated speculum
saline or water
pap
104
After visualization of the cervix is accomplished, insert the sampling device
(e.g. cytobrush®) into the endocervical
canal and rotate one complete turn .
TRUE
105
Using the _______
scrape material with the spatula from the whole
circumference of the cervix.
extended-tip spatula (e.g. Ayerst®),
106
Fix Immediately (drop slide into fixative or spray
with fixative, holding the spray bottle approximately
_______ from the slide).
○
________(fixative of choice)
8 to 12 inches
95% ethyl alcoho l
107
Pap smear has two sites:
cervix
vaginal mucosa
108
Cervix viewed through _______ with
patient in_____ position
speculum; lithotomy
109
Opening of the endocervix containing
endocervical glands and mucus
orifice
110
Transition point between
ectocervix and ectocervix.
transition zone
111
Stratified squamous
epithelium
ecto
112
Simple columnar/glandular
epithelium.
Endocervix
113
Dynamic location where pathologic processes occur
hyperplasia,
metaplasia, dysplasia, and cancer
114
Special wooden fish-tail spatula
○ Used to collect material from the ectocervix.
ayres spatula
115
Suspending cells in a fixative solution and
centrifuged in the machine.
Sediment is prepared onto the slide.
LBC SREENING
116
Removes non-essential debris (e.g. rbc,
bacteria).
○ Suspension of cells which can be preserved in a fixative solution.
○ Small aliquot only is used
LBC
117
spread onto slide
○ Disadvantage: Required to examine the
whole slide.
conventional smear
118
Advantage: clean smear.
○ Disadvantage: more expensive
liquid based preparation
119
Transparent blue or pink
staining of cytoplasm is
observed.
● Excellent nuclear
staining .
● Color range is
predictable and of great
value in identification of
cells.
PAPANICOLAOU OR PAPS STAIN
120
STAINS FOR PAP’S SMEAR
1. harris
2. OG 6 STAIN
3. EA 50 AND EA 65
121
Demonstrates keratin
in cytoplasm.
og 6 stain
122
polychromatic
cytoplasmic stain comparable
to EA 36. It differentiates
cellular components with pink,
green and blue-green h
EA 50
123
has a lower
concentration of light green
that improves expression of
eosin-stained components.
● Brings out more of
the orange color of
the cytoplas
EA 65
124
Purpose: improve cell clarity by removing
excess hematoxylin
Pass thru 0.25% HCl in 50% ROH(Acid alcohol)*
differentiation step
125
Either bright red/pink or
greenish to blue-gray
cytoplasm
126
Blue
vesicular nucleus
127
Dark blue to black
pyknotic nucleus
128
dark blue
bacteria
129
Violet
mycelia
130
Pale greenish blue blob of
cytoplasm
trichomonas vaginalis
131
intermediate
Younger cells
○Granular nucleus
blue cytoplasmic
132
Superficial cells
○ Older variants/more mature cells
○Pyknotic nucleus
pink- superficial
133
STEPS IN CYTOPREPARATORY TECHNIQUES
1. Evaluation of specimens
2. Preparation of smears
3. Fixation
4. Staining and coverslipping
134
Does not pass through difficult processes (e.g.
sectioning/blocking.
● Quick and expedited within the day.
● Smears may be read immediately shortly after
preparation
cytopreparatory
135
Problem: Red nuclei
Remove time in bluing reagent
136
Nuclear staining too weak
Increase staining time. Use
higher strength Haematoxylin .
Reduce concentration (not
time) of acid alcoho
137
Background Hematoxylin
staining
increase time in acid alcohol
138
Overall color too blue
increase time in acid alcohol
139
Cytoplasm too pink
increase time in OG 6
140
Cytoplasm too orange
Increase time in alcohol after
OG 6
141
Cytoplasm too blue
Increase time in EA-50
142
Cytoplasm too green
Increase time in alcohol after
EA-50
