Cytology Sample Collection - Ex 6

Question 1

Sample Collection - Solid Mass

Answer 1

1. Aspiration 2. Fenestration 3. Impression smear

Question 2

Sample Collection - Fluid-filled Mass

Answer 2

1. Aspiration - direct smear - concentration preparation

Question 3

Sample Collection - Excised Tissue

Answer 3

1. Imprint - blot tissue thoroughly - roll 2. Swab

Question 4

Sample Collection Guidelines

Answer 4

1. Sample multiple areas 2. Aspirate edges of large lesions 3. Do NOT heat fix!! 4. Do NOT expose to formalin!

Question 5

Aspiration/Fenestration

Answer 5

• Sterile 22G needle - 6 or 12 cc syringes - Stains - Scope

Question 6

FNA - steps

Answer 6

1. attach needle to syringe and position needle in the mass 2. rapidly pull back several times 3. release pressure and withdraw lesion 4. take needle off –> pull air into syringe 5. reattach needle to syringe and expel air through to push cells onto slide 6. use additional glass slides to smear sample 7. air dry and stain

Question 7

FNF - steps *good for firm, nodular lesions

Answer 7

1. 18 to 20 G needle 2. repeatedly reposition the needle in the mass without withdrawing needle from skin 3. expel cells in the needle hub onto a slide using air-filled syringe 4. use additional slide to smear 5. air dry & stain

Question 8

Impression Smear - steps

Answer 8

1. gently press clean glass slide onto the surface of the lesion 2. air dry and stain **good for ulcerated lesion

Question 9

Fluid-filled lesions

Answer 9

1. perform FNA 2. place portion of fluid into sterile tube for bacti or fungal culture 3. place additional fluid in an EDTA or heparinized tube 4. make direct smear *if cellularity is low - centrifuge and remove the supernatant and smear the cell pellet

Question 10

Imprint - steps

Answer 10

1. cut section 2. blot vigorously to minimize blood contamination 3. press onto the slide multiple times

Question 11

Artifacts

Answer 11

1. US/lubricant gel - eosinophilic material obscures cells - AVOID at all costs 2. glove powder 3. pollen 4. anucleated squamous epithelial cells - skin surface contaminants - finger prints on slides

Question 12

What can damage cells?

Answer 12

• heat fixation - formalin fixation - poor sample handling *cell lysis, samples too thick, or poor staining technique

Question 13

Staining - Cytology

Answer 13

1. Romanowski-type stain - diff-quick - extra time in fix for thick samples - send through stains twice if needed 2. Gram stain - only useful to determine if bacteria are Gram-+/- - NOT a ‘cytological’ stain

Question 14

Slide Examination

Answer 14

* Cellularity - high vs low * Cellular components - inflammation - hyperplasia - neoplasia * Background - blood - protein - broken cells

Question 15

Cytologic Interpretation - Cysts

Answer 15

poorly cellular fluid-filled

Question 16

Cytologic Interpretation - Hemorrhage

Answer 16

blood erythrophagia

Question 17

Cytologic Interpretation - Inflammation

Answer 17

purulent pyogranulomatous lymphocytic eosinophilic

Question 18

Cytologic Interpretation - Mixed

Answer 18

inflammatory & non-inflammatory cells

Question 19

If a cytologic description does not make your clinical findings…

Answer 19

… question it! *small sample, may not represent lesion *consider re-aspiration or biopsy with histopathology

Question 20

Answer 20

Gel

Question 21

Answer 21

More Gel

Question 22

Answer 22

Glove Powder

Question 23

Answer 23

Pine Pollen

Question 24

Answer 24

Surface Epithelium