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Cytology Flashcards

1
Q

Adequacy criteria for liquid based cytology of cervix

A

5000 well visualized squamous cells

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2
Q

Adequacy criteria for conventional cytology of cervix

A

8000-12000 well visualized squamous cells

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3
Q

What cells can be included when counting for adequacy of cervical cytology

A

Mature nucleated squamous cells and squamous metaplastic cells

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4
Q

Types of squamous cells present in 30F NILM cervical sample

A

Superficial, intermediate, metaplastic
Parabasal and basal cells exceptionally rare in this population

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5
Q

Impact of endocervical/squamous metaplastic cells for adequacy

A

No impact - transition zone is not an adequacy requirement
Presence/absence can be recorded as a quality indicator

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6
Q

Classic features of herpesvirus infection of vagina/cervix

A

Multinucleation, margination, molding
Intranuclear inclusions (Eosinophilic) - cowdry A
Intranuclear clearing (ground-glass) - cowdry B

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7
Q

DDx of multinucleated cells in cervical smear

A

Reactive endocervical changes (most common)
Conditions associated with multinucleated histiocytes
HPV changes
Radiation effect
HSV infection
Syncytiotrophoblast in pregnancy

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8
Q

Features of reactive/reparative squamous changes

A

Nuclear enlargement (up to 2x size of intermediate nucleus)
Nonspecific, ill-defined small, perinuclear halos
Cohesive flat sheets with smearing cells

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9
Q

Features favouring metastatic adenocarcinoma over endocervical adenocarcinoma

A

No tumor diathesis/clean background
Rare malignant cells
No AIS background

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10
Q

Categories of squamous epithelial abnormalities in cervical cytology

A

ASC-US
LSIL
ASC-H
HSIL
SCC

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11
Q

Categories of glandular epithelial abnormalities in cervical cytology

A

Atypical endocervical cells, NOS
Atypical endometrial cells, NOS
Endocervical AIS
Endocervical AdenoCA
Endometrial adenoCA
Extrauterine adenoCA

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12
Q

DDx of LSIL

A

Reactive changes
Small perinuclear halos in infections - trich, candida
Nuclear enlargement in perimenopausal patients
Multinucleation in reactive endocerivcal cells, HSV, histiocytes, syncytiotrophoblasts

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13
Q

DDx of HSIL

A

Squamous metaplasia
Atrophy
IUD effect
LUS
follicular cervicitis
Endocervical AIS

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14
Q

SCC vs HSIL

A

SCC: macronucleoli, tumor diathesis, keratinization (tadpole cells)

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15
Q

DDx glandular cells in posthysterectomy patient pap

A

Recurrent adenocarcinoma of cervix or endometrium
Metastatic adenoCA
Glandular metaplasia - consider radiation induced
Vaginal adenosis
Supracervical hysterectomy
Fallopian tube prolapse
Endometriosis/endosalpingiosis
Primary adenoCA of vagina - rare

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16
Q

Features of endocervical AIS

A

Crowded, columnar cells, with pseudostratification
Nuclear enlargement, nuclear hyperchromasia
Mitosis, apoptosis, rosettes
Feathering
Absent or inconspicuous nulceoli

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17
Q

AdenoCA vs endocervical AIS

A

Tumor diathesis
Prominent nucleoli
Rounding of nucleus with increased cytoplasm

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18
Q

Features of endometrial adenocarcinoma

A

Rounded cell clusters
Nuclear hyperchromasia
Prominent nucleoli
Vacuolated cytoplasm
Intracytoplasmic nuetrophils “poly bags”
lack of tumor diathesis

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19
Q

Cytologic features of lower uterine segment sampling

A

Large, cellular hyperchromatic crowded groups composed of 2 cell types - glandular and stromal cells
Branching glands and “tubules” can be seen within the large sheets
Glandular cells may be columnar and may mimic AGC or AIS

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20
Q

Sampling techniques for acquiring cytology specimens from lower respiratory tract

A

Sputum
Bronchial brushing
bronchial washing
BAL
Percutaneous FNA biopsy (CT or US-guided)
Endobronchial biopsy (EBUS)
Endoscopic ultrasound biopsy fort mediastinal LNs (EUS)

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21
Q

Adequacy criteria for sputum samples

A

Presence of easily identifiable pulmonary macrophages (no specified number)

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22
Q

Cytologic features of PJP pneumonia

A

Foamy proteinaceous material on pap stain, shaped as alveolar casts
Cup and crescent shaped organisms on grocott silver stain
Dots within cysts

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23
Q

Cytologic features of small cell carcinoma

A

Cells 2-3x the size of a lymphocyte
Predominantly single cells with small, loosely cohesive aggregates
Hyperchromatic evenly dispersed finely granular chromatin
Very high NC ratio
Nuclear molding
Indistinct nucleoli
Abundant mitosis, apoptosis, necrosis, nuclear debris and crush artifact
Paranuclear blue bodies on wright-giemsa stain

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24
Q

DDx of small cell carcinoma in lung sampling

A

Reserve cell hyperplasia (smaller, cohesive, no pyknosis/necrosis)
Variants of NSCLC (basaloid SCC, some adenoCAs)
Lymphocytes/lymphoma
Atypical carcinoid tumor
NUT carcinoma
Small round blue cell tumors
Pulmonary blastoma

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25
Q

Cytologic features of typical carcinoid

A

Predominantly single cells with small, loosely cohesive aggregates (may have rosettes)
Epithelioid, plasmacytoid, spindle cells
Coarsely granular chromatin
Evenly dispersed granular chromatin (salt and pepper chromatin)
inconspicuous nucleoli
Rare mitoses
No necrosis

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26
Q

Cytologic features of well diff SCC in lung

A

Large, round, or elongated “tadpole cells”
Herxheimer spiral (tails of spiraling cytoplasm)
Dense, waxy organgopilic cytoplasm on pap stain
dense blue cytoplasm (robin’s egg) on Wright-Giemsa stain
Pyknotic hyperchromatic nuclei with absent or inconspicuous nucleoli
Abundant keratin and anucleate keratinocytes
Squamous pearl formation

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27
Q

Cytologic features of poorly diff SCC in lung

A

Cohesive three-dimensional groups
Elongated to spindle cells
large cells
Coarse “chunky” chromatin
Multiple prominent nucleoli usually
Single keratinized cells - rareCy

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28
Q

Cytologic features of adenocarcinoma in lung

A

Cells arranged on honeycomb sheets, acini, papillae, and/or three-dimensional clusters
Eccentric or polarized nuclei
Very fine or vesicular light chromatin (when well diff)
large prominent single nucleolus (when well diff)
vacuolated cytoplasm
Mucin vacuoles

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29
Q

Importance of differentiating adenocarcinoma from other NSCLC

A

Molecular testing allows for potential targeted therapies

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30
Q

Causes of false positive diagnoses in lung FNA

A

Granulomatous inflammation
Radiation/chemotherapy
Lung abscess
Organizing pneumonia
pulmonary infarct

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31
Q

Diagnostic categories in reporting respiratory cytology

A

Nondiagnostic
Negative for malignancy
Atypical
Neoplastic - benign vs undetermined malignant potential
Suspicious for malignancy
Malignant

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32
Q

Tumors in neoplastic, benign category of respiratory cytopathology reporting

A

Pulmonary hamartoma
Squamous papilloma
Granular cell tumor
Hemangioma
Sclerosing pneumocytoma

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33
Q

Tumors in neoplastic, undetermined malignant potential category of respiratory cytopathology reporting

A

Epithelioid hemangioendothelioma
Clear cell tumor of lung
Sclerosing pneumocytoma
Primary pulmonary meningioma
Langerhans cells histiocytosis
SFT
IMT
Myoepithelial neoplasms

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34
Q

DDx of eosinophilic pleural effusion

A

Pneumothorax - including repeat thoracocentesis
Drug reaction
Parasitic infection
pulmonary infarction
Vasculitis
Eosinophilic pneumonia

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35
Q

DDx lymphocytic pleural effusion

A

Nonspecific reaction
Postsurgical reactive changes
Malignancy - seen in background of metastatic malignancy
TB
Lymphoma

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36
Q

Most common cause of malignant pleural effusions in men and women

A

Men - lung CA
Women - breast CA

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37
Q

Most common cause of malignant peritoneal effusion in men and women

A

Men - Gastrointestinal and pancreatic CA
Women - Ovarian CA

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38
Q

Metastatic adenoCA vs reactive mesothelial cells in effusion

A

Two cell populations
Large clusters vs single cells
smooth peripheral edges (communal border) in adenoCA
scalloped borders in reactive mesothelial cells
Vacuolated cytoplasm, esp if containing mucin (though degenerative vacuo9les can be seen in reactive mesothelial cells of longstanding effusions)

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39
Q

Stains to differentiate adeno from mesothelial

A

Mesothelial: calretinin, WT1, CK5/6, D2-40
Glandular: Claudin 4, BerEP4/MOC31, CEA, CD15

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40
Q

DDx of psammoma bodies in effusions

A

Reactive mesothelial cells
Endosalpingiosis
Metastatic serous carcinoma
implants from serous neoplasm of low malignant potential

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41
Q

Cytomorphologic features of epithelioid mesothelioma

A

Large clusters of cells or numerous smaller clusters (more than reactive) with scalloped contours
Single cell population
Larger cells than benign mesothelial cells
Abundant cytoplasm with dense perinuclear cytoplasm and peripheral microvillous skirt
Intercellular windows

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42
Q

Causes of false positive diagnoses in effusion cytology

A

Infarction
Acute or chronic inflammatory process
Prior treatment (surgery, rads, chemo)
Reactive mesothelial proliferations (eg cirrhosis, dialysis)
Pericardial effusions

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43
Q

Diagnostic categories in international system for serous fluid cytopathology

A

Nondiagnostic
Negative for malignancy
Atypia of undetermined significance
Suspicious for malignancy
Malignant - primary vs secondary

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44
Q

Ancillary tests helpful for the diagnosis of mesothelioma

A

Homozygous deletion of CDKN2A (FISH or NGS)
Loss of BAP1 expression (IHC)
Loss of MTAP expression (IHC)

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45
Q

Diagnostic categories and associated risk of malignancy in reporting system for Breast FNA

A

Insufficient/inadequate: 3-5%
Benign: 1-2%
Atypical: 13-15%
Suspicious: 85-97%
Malignant: 99-100%

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46
Q

Management guidelines for atypical and suspicious diagnostic categories of breast FNA

A

Need triple test approach
Atypical - review clinical and imaging findings - if indeterminate or suspicious, core needle biopsy (if unavailable then repeat FNA), if benign repeat FNA
Suspicious - follow up mandatory regardless of clinical and imaging findings - repeat sampling with core biopsy ideal, if not available then repeat FNA or excisional biopsy

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47
Q

Cytologic features of fibroadenoma

A

Hypercellular smear
Three-dimensional epithelial cell clusters with branching staghorn-like structures
Many bipolar spindled and naked nuclei of myoepithelial cells in the background
Myxoid to fibrous stromal fragments
Mild atypia possible but epithelial cells maintaing regular spacing, fine chromatin, small nucleoli

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48
Q

Can fibroadenomas be accurately differentiated from phyllodes on cytology

A

Benign phyllodes cannot
Malignant phyllode can be differentiated from FAs due to sarcomatous features - but can be mistaken for metaplastic CA or true sarcoma of breast

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49
Q

Can intraductal papillomas and papillary carcinoma be distinguished on FNA

A

Classic teaching is not to distinguish them in cytologic material
Markers of possible malignancy: complex architecture, lack of myoeps, high grade atypia

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50
Q

Characteristic cytologic features of breast ductal carcinoma in FNA`

A

High cellularity
Single population of cells
Poorly cohesive/single epithelial cells with prominent single cell population
Atypical cells with enlarged irregular nuclei
Lack of myoeps

51
Q

Cytologic features of lobular CA of the breast

A

Variable cellularity (common cause of false neg)
Single cells and cells arranged in small groups
Small nuclei with mild nuclear irregularit
Minute nucleoli
Plasmacytoid cells
Cells with single intracytoplasmic vacuole containing mucin

52
Q

DDx of lymphocytes in breast FNA

A

intramammary lymph node
Caricnoma with medullary features
Lymphoma
Lymphocytic mastitis (not mass forming)

53
Q

Causes of false negative diagnoses in breast FNA

A

Sample problem due to : poor sampling technique, necrosis, sclerosis, small size, in situ lesions
Underdiagnosis of: lobular CA, tubular CA, adenoid cystic CA

54
Q

Causes of false positive diagnoses in breast FNA

A

Fibroadenoma
Fibrocystic changes
Papillary neoplasms and papillomatosis
Fat necrosis/repair
Lactational change/adenoma
Radiation atypia

55
Q

Categories for reporting of thyroid FNA

A

Nondiagnostic/unsat
Benign
AUS/FLUS
Follicular neoplasm or suspicious for a follicular neoplasm
Suspicious for malignancy
Malignant

56
Q

Adequacy criteria for thyroid FNA

A

At least six groups of benign follicular cells at least 10 cells
3 exceptions:
-cyst fluid only
- very abundant colloid
- abundant lymphocytes

57
Q

Cytologic features favoring diagnosis of follicular neoplasm, hurthle cell type over hurthle cell metaplsia

A

Predominant syncytial or microfollicular pattern and/or trabeculae
Hypercellularity with a pure population of hurthle cells
scant colloid
absence of lymphocytes
Transgressing blood vessels

58
Q

Cytologic features of benign thyroid nodules

A

Predominantly flat sheets of follicular cells
Follicular cells with evenly spaced nuclei (honeycomb)
Small nuclei with coarse chromatin (without PTC features)
Abundant colloid in background
Oncocytes in background
Cyst contents and cyst lining cells

59
Q

Cytologic features of lymphocytic thyroiditis

A

Abundant lymphocytes, typically polymorphous
Germinal centres with TBMs
Presence of at least a few Hurthle cells (can have atypia)

60
Q

Cytologic criteria of follicular neoplasm

A

Cellular smear
Predominantly microfollicles or syncytial architecture
Usually few single cells
Nuclei possible enlarged/crowded (without PTC features)
Colloid possibly present in microfollicles but none/little background

61
Q

Cytologic features of PTC

A

Cellular smear
Cells arranged in syncytia/papillae/sheets
Nuclear PTC features - enlargement, irregularity {grooves}, powdery chromatin, peripheral micronucleoli, intranuclear pseudoinclusions
Nuclear crowding/molding
Squamoid cytoplasm
Psammomatous calcs
Thick, “bubble gum colloid”
Multinucleate giant cells

62
Q

Benign ddx of PTC

A

Lymphocytic thyroiditis
Cyst-lining cells
Previous FNA changes
Radiation atypia
Hyperplastic nodule and follicular neoplasm

63
Q

Cytologic features of medullary thyroid carcinoma

A

Cellular smear
Cells arranged in loosely cohesive groups with abundant single cells
Nuclei eccentrically placed/plasmacytoid
Coarse granular chromatin without nucleoli (salt and pepper)
Acellular fragments of amyloid possible

64
Q

DDx of oncocytic cells in thyroid FNA

A

Multinodular goitre
Lymphocytic thyroiditis
Follicular neoplasm/hurthle cell type
PTC (oncocytic or tall cell variants)
MTC
Metastatic carcinoma

65
Q

DDx of abundant lymphocytes in thyroid FNA

A

Lymphocytic thyroiditis
Lymph node aspirate
Lymphoma
PTC (warthin-like, diffuse sclerosing variants)
MTC (single cell pattern can mimic lymphs)

66
Q

IHC Medullary thyroid CA vs Follicular neoplasm hurthle cell type

A

MTC: TTF1+,calcitonin+, synapto/chromo+, CD56+, CEA+, thyroglobulin-
FNHCT: TTF+, thyroglobulin+, calcitonin-, chromo/synapto/CD56-, CEA-

67
Q

Diagnostic categories of reporting salivary gland cytopathology

A

Nondiagnostic
Non-neoplastic
AUS
Neoplasm - benign and SUMP
Suspicious for malignancy
Malignant

68
Q

Cytologic features of pleomorphic adenoma

A

Cohesive “honeycomb” epithelial cells
Myoepithelial cells (spindled, plasmacytoid, epithelioid, clear cell)
Chondromyoxoid stroma with fibrillary and frayed edges

69
Q

Cytologic features of warthin tumor

A

Abundant lymphocytes
Cohesive and single oncocytes (moreso cuboidal)
Abundant granular proteinaceous debris in background

70
Q

Cytologic features of mucoepidermoid carcinoma, low grade

A

Mucous cells, epidermoid cells, intermediate cells

71
Q

What malignancy is the most common cause of false negative diagnosis on salivary gland FNA

A

Mucoepidermoid carcinoma, due to characteristic cystic morphology and low grade cytologic features

72
Q

Cytologic features of adenoid cystic carcinoma

A

cohesive groups of basaloid cells
Characteristic cluster of cells around distinct globules of acellular matrix
Acellular, amorphous matric (metachromic on wright-giemsa, colourless on pap stain)

73
Q

DDx of abundant oncocytic/oncocytoid cells on salivary gland FNA

A

Warthin tumor
Oncocytoma
Pleomorphic adenoma with oncocytic metaplasia
mucoepidermoid CA, oncocytic
Acinic cell carcinoma, oncocytic
Secretory carcinoma
Salivary duct carcinoma
Metastatic RCC

74
Q

DDx of abundant lymphocytes in salivary gland FNA

A

Warthin tumor
Intraparotid LN
chronic sialadenitis
Lymphoepithelial sialadenitis
Lymphoepithelial cyst (HIV-associated)
Acinic cell carcinoma
Lymphoepithelial carcinoma
Mucoepidermoid carcinoma (warthin-like)
Lymphoma

75
Q

DDx basaloid tumor on salivary gland FNA

A

Cellular PA
Basal cell adenoma/adenoCA
Adenoid cystic CA
Epi-myoepi CA
Myoepithelioma/myoepithelial CA
Polymorphous adenoCA
Basaloid CA/basaloid SCC
Basal cell CA of skin

76
Q

Molecular surrogate IHC helpful in diagnosing salivary gland neoplasms

A

PA and CA ex-PA: PLAG1+, HMGA2+
Basal cell adenoma/adenoCA: nuclear B-catenin, LEF1+
Adenoid cystic CA: MYB+
Acinic cell carcinoma: NR4A3+
Secretory CA: pan-TRK+

77
Q

Recommended management for salivary gland FNAs diagnosed as AUS

A

Repeat FNA (consider US-guided, if not already done)
Clinical follow up q3-6m
MRI or CT
Biopsy or resection if concerning for malignancy

78
Q

Recommended management for salivary gland FNAs diagnosed as SUMP

A

-preoperative imaging
- nerve sparing surgical resection
- consider frozen section to determine neck dissection

79
Q

Cytologic features of reactive hyperplasia in a LN

A

Polyomorphous lymphocytes with predominance of small lymphocytes
Germinal centre elements
Dendritic lymphocytic and lymphohistiocytic aggregates
Immunoblasts

80
Q

Cytologic features of granulomatous lymphadenitis

A

Aggregates of epithelioid histiocytes +/- lymphocytes
Epithelioid histiocytes are elongated with spindle shaped nuclei
Possible background necrosis

81
Q

Diagnosis of “small cell” lymphoma on FNA

A

Controversial: FNA with cell block IHC and flow cytometry can subtype small cell lymphomas based on appropriate sampling
Challenges: MALT lymphoma, SLL/CLL
Cytology limited by complex histologic, IHC and molecular for grading, staging and prognostication

82
Q

DDx of “small cell” lymphoma

A

Reactive lymph node
Small cell carcinoma
Partial involvement of lymph node by lymphoma or metastasis
Hodgkin lymphoma with abundant reactive background
T cell rich, diffuse large B-cell lymphoma

83
Q

Can large cell lymphomas be accurately diagnosed on FNA

A

FNA more accurate for large cell lymphomas than for “small cell” lymphoma
FNA with cell block IHC can accurately subtype large cell and Hodgkin lymphomas
DDx large cell lymphoma vs nonlymphoid malignancy can be done on cytomorphology
Limitations include sampling error, low number of malignant cells, or large population of reactive lymphocytes

84
Q

Cytologic features of DLBCL

A

Predominantly single, large cells (>3x size of resting lymphocytes)
Centroblast-like (multiple nucleoli) or immunoblast-like (single central nucleolus)

85
Q

Cytologic features to differentiate large cell lymphoma from poorly differentiated nonlymphoid malignancies

A

Lymphoglandular bodies
Single cell population, usually without cohesion
Monomorphous population of malignant cells
Very high NC ratio
Pertinent negs - lack of cytoplasm, mucin vacuoles, melanin pigment

86
Q

DDx of lymphoma composed of lymphocytes of “intermediate” cell size

A

Burkitt
Lymphoblastic
Blastic variant of Mantle cell lymphoma

87
Q

Cytologic features of hepatocytes in FNA

A

Large cells with abundant granular cytoplasm
Large centrally placed nuclei with prominent nucleolus
Binucleate cells
Cells with intranuclear cytoplasmic pseudoinclusions
Cytoplasm contains pigment

88
Q

Benign liver nodules that can result in abundant, apparently normal hepatocytes on aspiration

A

Hepatocellular adenoma
FNH
Cirrhosis and dominant regenerative nodules
NRH
Normal background liver sampled when aspiration missed nodule

89
Q

Cytologic features of HCC

A

Hepatocytes arranged in thick trabeculae, clusters, nests, or sheets
Hepatocytes wrapped in flattened endothelial cells
Higher NC ratio than normal hepatocytes
Possible mild nuclear atypia to high grade pleomorphism

90
Q

DDx of low grade and high grade HCC

A

Low grade:
- HCA
- FNH
- Cirrhosis

High grade:
- cholangioCA
- metastatic adenoCA
- Metastatic renal cell or adrenocortical CA

91
Q

Cytologic features of cholangioCA

A

Cohesive 3 dimensional clusters and single cells
Glandular differentiation
high NC ratio
Looks like an adenoCA

92
Q

Cytologic features of pancreatic ductal adenoCA

A

Cellular aspirate
Single cells (more common in higher grade) and cells arranged in sheets
Drunken honeycomb cellular arrangement
Nuclear irregularities - low grade may have irregular contours and pale chromatin, high grade has severe nuclear atypia
Single malignant cells

93
Q

DDx of low grade pancreatic ductal adenocarcinoma

A

Chronic pancreatitis
Stent associated atypia
PSC
Recent implementation

94
Q

DDx predominantly single cell pattern on cytology for pancreatic mass

A

Acinar cell carcinoma
WDNET
Solid pseudopapillary neoplasm
Lymphoma

95
Q

Cytologic features of well diff PanNET

A

Cellular smear
Single cell pattern
Plasmacytoid cells
Granular cytoplasm
Salt and pepper chromatin
Variable nucleoli

96
Q

Cytologic features of pancreatic pseudocysts

A

Granular and inflammatory debris
Histiocytes
High amylase, low CEA on cyst fluid analysis

97
Q

DDx mucinous epithelium on pancreatic cyst aspiration

A

Neoplastic - IPMN, MCN, pancreatic adenoCA with cystic degeneration
Contamination by gastric or duodenal epithelium

98
Q

Ancillary cell block studies to help diagnose acrinary cell carcinoma on pancreas FNA

A

PAS/PASD
Mucicarmine
Trypsin+
BCL10+
Chymotrypsin+

99
Q

Diagnostic categories of reporting pancreaticobiliary cytology

A

Nondiagnostic
Negative for malignancy
Atypical
Neoplastic - benign vs other
Suspicious for malignancy
Malignant

100
Q

Neoplasms in the Neoplastic, benign and Neoplastic, other categories of pancreatobiliary cytopathology reporting

A

Neoplastic, Benign:
- serous cystadenoma
- neuroendocrine microadenoma
- lymphangioma
- cystic teratoma
- schwannoma

Neoplastic, Other:
-WDNET
- Solid pseudopapillary neoplasm
- mucinous cysts

101
Q

Diagnostic criteria for mucinous cyst in reporting system for pancreaticobiliary cytology

A

Presence of mucin production
Elevated cyst fluid CEA levels
Presence of KRAS, GNAS, RNF43 mutations
Presence of neoplastic cells - low grade or high grade

102
Q

Neoplasms under “malignant” category in reporting pancreatobiliary cytology

A

Adenocarcinoma
Acinar cell carcinoma
Poorly diff NEC
Pancreatoblastoma
Metastasis
Lymphoma

103
Q

DDx of oncocytes in kidney FNA

A

Oncocytoma
Chromophobe RCC
Papillary RCC
CCRCC
Tubulocystic renal cell tumor
SDH def RCC
HLRCC
Epithelioid angiomyolipoma
Hepatocytes

104
Q

Cytologic features of CCRCC

A

Cohesive groups of large cells with abundant vacuolated thin cytoplasm
Round nuclei with prominent nucleoli (higher grade)
Prominent thin-walled transgressing capillary network
Intermixed inflammatory cells
Thin strands on Giemsa-Wright

105
Q

Cytologic features of high grade urothelial carcinoma

A

Single and small clusters of abnormal urothelial cells
At least ten abnormal cells
Nondegenerated, nonsuperficial urothelial cells with increased NC ratio and moderately to severely hyperchromatic nuclei with clumpy chromatin and irregular nuclear membranes
Possible presence of cercariform cells - cells with elongated, nontapering cytoplasm process that ends with flat cytoplasmic edge

106
Q

Indications of urine cytology

A

Hematuria
Patient being followed for treated urothelial CA or CIS
Patient at high risk for urothelial CA: occupational chemical exposure, chemotherapy

107
Q

DDx of urothelial cell clusters

A

Urolithiasis
Instrumented urine
Low grade papillary urothelial tumors (papilloma, PUNLMP, LGPUC)
HGUC

108
Q

Can low grade urothelial CA be accurately diagnosed on urine cytology

A

No - too much overlap with reactive changes
Only scenario when diagnosis can be made is when true fibrovascular core present
Aim of urine cytology is recognition of high grade urothelial carcinoma

109
Q

Diagnostic feature of low grade papillary urothelial neoplasm on cytology

A

Presence of true papillary fragment with fibrovascular core

110
Q

DDx high grade urothelial carcinoma

A

Polyoma virus
Atypia in urolithiasis
Ureter washing/brushing specimen
Chemo/rads atypia
Cervical or rectal CA with bladder involvement
Prostate adenoCA or RCC - rare

111
Q

Ideal time to take sample for urine cytology

A

3-4 hours after last urination

112
Q

Diagnostic categories for reporting urinary cytoplathology

A

Negative for HGUC
Atypical urothelial cells
Suspicious for HGUC
HGUC
LGUC
Other malignancy

113
Q

Cytologic features of atypical urothelial cells

A

Both: nonsuperficial urothelial cells and increased NC ratio
One of the following (or more than one in degenerated cells): hyperchromasia, irregular clumpy chromatin, irregular nuclear membranes

114
Q

Cytologic features of suspicious for high grade urothelial carcinoma

A

All of the following:
- nonsuperficial and nondegenerated cells
- increased NC ratio
- hyperchromasia, moderate to severe
- 5-10 cells
AND
at least one of: irregular clumpy chromatin, irregular nuclear membranes

115
Q

Causes of false positive diagnoses in urinary cytology

A

Reactive umbrella cells
Lithiasis
Instrumentation
Inflammation
Rads/chemo
Polyoma virus infection
Ileal conduit specimens
Cells from seminal vesicles

116
Q

Causes of false negative diagnoses in urinary cytology

A

LGPUC
Obscuring marked inflammation or blood
RCC
Prostate adenoCA

117
Q

Cytologic features of leptomeningeal metastatic adenoCA in CSF

A

Small clusters of cells and isolated single cells
Large cells with eccentric nuclei
Abundant cytoplasm with vacuolization, some containing mucin

118
Q

Leukemia in CSF vs peripheral blood contamination of CSF

A

CSF: contamination includes RBC
Clinical: patients in remission have peripheral blood negative for blasts
Differential cell count: Calculated value comparing CSF and blood to predict contamination or involvement

119
Q

Tumors with likelihood to be diagnosed on CSF from most to least likely

A

Lymphoma/leukemia
Medulloblastoma
Mets
Glioma
Benign primary brain tumor

120
Q

Features of a good screening test

A

Identification of asymptomatic disease or risk factors
High sensitivity and preferably high specificity
Effective treatment available
Relatively simple
Low cost
Safe and acceptable to patients

121
Q

Examples of cervical cytology quality assurance practices

A

Rescreening a subpopulation of NILM cervical smears - randomly selected low and high risk 10% of patients
Rapid prescreening or postscreening
Retrospective rescreening - reviewing all patient’s cervical smears interpreted as NILM when pt diagnosed with HSIL, AIS, or CA
Correlation cytology and histology for biopsies with discrepant results
Reviewing cytotechnologist-cytopathologist discrepant results
Assessing lab performance: ASC:SIL ratio (3:1 upper limit), correlating high risk HPV results in ASCUS

122
Q

Possible causes of discrepancy during cervical cytology-histology correlation

A

Sampling error on cervical biopsy
Resolution/healing of lesion in interum between cervical smear and biopsy
Cytology interpretation error
Histology interpretation error

123
Q

Breakdown of the ASC category in cervical cytology

A

90% ASC-US
10% ASC-H

RC (20 decks)

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