Cytology Flashcards
(123 cards)
1
Q
Adequacy criteria for liquid based cytology of cervix
A
5000 well visualized squamous cells
2
Q
Adequacy criteria for conventional cytology of cervix
A
8000-12000 well visualized squamous cells
3
Q
What cells can be included when counting for adequacy of cervical cytology
A
Mature nucleated squamous cells and squamous metaplastic cells
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
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
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
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
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
9
Q
Features favouring metastatic adenocarcinoma over endocervical adenocarcinoma
A
No tumor diathesis/clean background
Rare malignant cells
No AIS background
10
Q
Categories of squamous epithelial abnormalities in cervical cytology
A
ASC-US
LSIL
ASC-H
HSIL
SCC
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
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
13
Q
DDx of HSIL
A
Squamous metaplasia
Atrophy
IUD effect
LUS
follicular cervicitis
Endocervical AIS
14
Q
SCC vs HSIL
A
SCC: macronucleoli, tumor diathesis, keratinization (tadpole cells)
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
16
Q
Features of endocervical AIS
A
Crowded, columnar cells, with pseudostratification
Nuclear enlargement, nuclear hyperchromasia
Mitosis, apoptosis, rosettes
Feathering
Absent or inconspicuous nulceoli
17
Q
AdenoCA vs endocervical AIS
A
Tumor diathesis
Prominent nucleoli
Rounding of nucleus with increased cytoplasm
18
Q
Features of endometrial adenocarcinoma
A
Rounded cell clusters
Nuclear hyperchromasia
Prominent nucleoli
Vacuolated cytoplasm
Intracytoplasmic nuetrophils “poly bags”
lack of tumor diathesis
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
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)
21
Q
Adequacy criteria for sputum samples
A
Presence of easily identifiable pulmonary macrophages (no specified number)
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
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
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
25
Cytologic features of typical carcinoid
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
26
Cytologic features of well diff SCC in lung
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
27
Cytologic features of poorly diff SCC in lung
Cohesive three-dimensional groups
Elongated to spindle cells
large cells
Coarse "chunky" chromatin
Multiple prominent nucleoli usually
Single keratinized cells - rareCy
28
Cytologic features of adenocarcinoma in lung
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
29
Importance of differentiating adenocarcinoma from other NSCLC
Molecular testing allows for potential targeted therapies
30
Causes of false positive diagnoses in lung FNA
Granulomatous inflammation
Radiation/chemotherapy
Lung abscess
Organizing pneumonia
pulmonary infarct
31
Diagnostic categories in reporting respiratory cytology
Nondiagnostic
Negative for malignancy
Atypical
Neoplastic - benign vs undetermined malignant potential
Suspicious for malignancy
Malignant
32
Tumors in neoplastic, benign category of respiratory cytopathology reporting
Pulmonary hamartoma
Squamous papilloma
Granular cell tumor
Hemangioma
Sclerosing pneumocytoma
33
Tumors in neoplastic, undetermined malignant potential category of respiratory cytopathology reporting
Epithelioid hemangioendothelioma
Clear cell tumor of lung
Sclerosing pneumocytoma
Primary pulmonary meningioma
Langerhans cells histiocytosis
SFT
IMT
Myoepithelial neoplasms
34
DDx of eosinophilic pleural effusion
Pneumothorax - including repeat thoracocentesis
Drug reaction
Parasitic infection
pulmonary infarction
Vasculitis
Eosinophilic pneumonia
35
DDx lymphocytic pleural effusion
Nonspecific reaction
Postsurgical reactive changes
Malignancy - seen in background of metastatic malignancy
TB
Lymphoma
36
Most common cause of malignant pleural effusions in men and women
Men - lung CA
Women - breast CA
37
Most common cause of malignant peritoneal effusion in men and women
Men - Gastrointestinal and pancreatic CA
Women - Ovarian CA
38
Metastatic adenoCA vs reactive mesothelial cells in effusion
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)
39
Stains to differentiate adeno from mesothelial
Mesothelial: calretinin, WT1, CK5/6, D2-40
Glandular: Claudin 4, BerEP4/MOC31, CEA, CD15
40
DDx of psammoma bodies in effusions
Reactive mesothelial cells
Endosalpingiosis
Metastatic serous carcinoma
implants from serous neoplasm of low malignant potential
41
Cytomorphologic features of epithelioid mesothelioma
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
42
Causes of false positive diagnoses in effusion cytology
Infarction
Acute or chronic inflammatory process
Prior treatment (surgery, rads, chemo)
Reactive mesothelial proliferations (eg cirrhosis, dialysis)
Pericardial effusions
43
Diagnostic categories in international system for serous fluid cytopathology
Nondiagnostic
Negative for malignancy
Atypia of undetermined significance
Suspicious for malignancy
Malignant - primary vs secondary
44
Ancillary tests helpful for the diagnosis of mesothelioma
Homozygous deletion of CDKN2A (FISH or NGS)
Loss of BAP1 expression (IHC)
Loss of MTAP expression (IHC)
45
Diagnostic categories and associated risk of malignancy in reporting system for Breast FNA
Insufficient/inadequate: 3-5%
Benign: 1-2%
Atypical: 13-15%
Suspicious: 85-97%
Malignant: 99-100%
46
Management guidelines for atypical and suspicious diagnostic categories of breast FNA
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
47
Cytologic features of fibroadenoma
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
48
Can fibroadenomas be accurately differentiated from phyllodes on cytology
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
49
Can intraductal papillomas and papillary carcinoma be distinguished on FNA
Classic teaching is not to distinguish them in cytologic material
Markers of possible malignancy: complex architecture, lack of myoeps, high grade atypia
50
Characteristic cytologic features of breast ductal carcinoma in FNA`
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
Cytologic features of lobular CA of the breast
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
DDx of lymphocytes in breast FNA
intramammary lymph node
Caricnoma with medullary features
Lymphoma
Lymphocytic mastitis (not mass forming)
53
Causes of false negative diagnoses in breast FNA
Sample problem due to : poor sampling technique, necrosis, sclerosis, small size, in situ lesions
Underdiagnosis of: lobular CA, tubular CA, adenoid cystic CA
54
Causes of false positive diagnoses in breast FNA
Fibroadenoma
Fibrocystic changes
Papillary neoplasms and papillomatosis
Fat necrosis/repair
Lactational change/adenoma
Radiation atypia
55
Categories for reporting of thyroid FNA
Nondiagnostic/unsat
Benign
AUS/FLUS
Follicular neoplasm or suspicious for a follicular neoplasm
Suspicious for malignancy
Malignant
56
Adequacy criteria for thyroid FNA
At least six groups of benign follicular cells at least 10 cells
3 exceptions:
-cyst fluid only
- very abundant colloid
- abundant lymphocytes
57
Cytologic features favoring diagnosis of follicular neoplasm, hurthle cell type over hurthle cell metaplsia
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
Cytologic features of benign thyroid nodules
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
Cytologic features of lymphocytic thyroiditis
Abundant lymphocytes, typically polymorphous
Germinal centres with TBMs
Presence of at least a few Hurthle cells (can have atypia)
60
Cytologic criteria of follicular neoplasm
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
Cytologic features of PTC
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
Benign ddx of PTC
Lymphocytic thyroiditis
Cyst-lining cells
Previous FNA changes
Radiation atypia
Hyperplastic nodule and follicular neoplasm
63
Cytologic features of medullary thyroid carcinoma
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
DDx of oncocytic cells in thyroid FNA
Multinodular goitre
Lymphocytic thyroiditis
Follicular neoplasm/hurthle cell type
PTC (oncocytic or tall cell variants)
MTC
Metastatic carcinoma
65
DDx of abundant lymphocytes in thyroid FNA
Lymphocytic thyroiditis
Lymph node aspirate
Lymphoma
PTC (warthin-like, diffuse sclerosing variants)
MTC (single cell pattern can mimic lymphs)
66
IHC Medullary thyroid CA vs Follicular neoplasm hurthle cell type
MTC: TTF1+,calcitonin+, synapto/chromo+, CD56+, CEA+, thyroglobulin-
FNHCT: TTF+, thyroglobulin+, calcitonin-, chromo/synapto/CD56-, CEA-
67
Diagnostic categories of reporting salivary gland cytopathology
Nondiagnostic
Non-neoplastic
AUS
Neoplasm - benign and SUMP
Suspicious for malignancy
Malignant
68
Cytologic features of pleomorphic adenoma
Cohesive "honeycomb" epithelial cells
Myoepithelial cells (spindled, plasmacytoid, epithelioid, clear cell)
Chondromyoxoid stroma with fibrillary and frayed edges
69
Cytologic features of warthin tumor
Abundant lymphocytes
Cohesive and single oncocytes (moreso cuboidal)
Abundant granular proteinaceous debris in background
70
Cytologic features of mucoepidermoid carcinoma, low grade
Mucous cells, epidermoid cells, intermediate cells
71
What malignancy is the most common cause of false negative diagnosis on salivary gland FNA
Mucoepidermoid carcinoma, due to characteristic cystic morphology and low grade cytologic features
72
Cytologic features of adenoid cystic carcinoma
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
DDx of abundant oncocytic/oncocytoid cells on salivary gland FNA
Warthin tumor
Oncocytoma
Pleomorphic adenoma with oncocytic metaplasia
mucoepidermoid CA, oncocytic
Acinic cell carcinoma, oncocytic
Secretory carcinoma
Salivary duct carcinoma
Metastatic RCC
74
DDx of abundant lymphocytes in salivary gland FNA
Warthin tumor
Intraparotid LN
chronic sialadenitis
Lymphoepithelial sialadenitis
Lymphoepithelial cyst (HIV-associated)
Acinic cell carcinoma
Lymphoepithelial carcinoma
Mucoepidermoid carcinoma (warthin-like)
Lymphoma
75
DDx basaloid tumor on salivary gland FNA
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
Molecular surrogate IHC helpful in diagnosing salivary gland neoplasms
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
Recommended management for salivary gland FNAs diagnosed as AUS
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
Recommended management for salivary gland FNAs diagnosed as SUMP
-preoperative imaging
- nerve sparing surgical resection
- consider frozen section to determine neck dissection
79
Cytologic features of reactive hyperplasia in a LN
Polyomorphous lymphocytes with predominance of small lymphocytes
Germinal centre elements
Dendritic lymphocytic and lymphohistiocytic aggregates
Immunoblasts
80
Cytologic features of granulomatous lymphadenitis
Aggregates of epithelioid histiocytes +/- lymphocytes
Epithelioid histiocytes are elongated with spindle shaped nuclei
Possible background necrosis
81
Diagnosis of "small cell" lymphoma on FNA
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
DDx of "small cell" lymphoma
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
Can large cell lymphomas be accurately diagnosed on FNA
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
Cytologic features of DLBCL
Predominantly single, large cells (>3x size of resting lymphocytes)
Centroblast-like (multiple nucleoli) or immunoblast-like (single central nucleolus)
85
Cytologic features to differentiate large cell lymphoma from poorly differentiated nonlymphoid malignancies
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
DDx of lymphoma composed of lymphocytes of "intermediate" cell size
Burkitt
Lymphoblastic
Blastic variant of Mantle cell lymphoma
87
Cytologic features of hepatocytes in FNA
Large cells with abundant granular cytoplasm
Large centrally placed nuclei with prominent nucleolus
Binucleate cells
Cells with intranuclear cytoplasmic pseudoinclusions
Cytoplasm contains pigment
88
Benign liver nodules that can result in abundant, apparently normal hepatocytes on aspiration
Hepatocellular adenoma
FNH
Cirrhosis and dominant regenerative nodules
NRH
Normal background liver sampled when aspiration missed nodule
89
Cytologic features of HCC
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
DDx of low grade and high grade HCC
Low grade:
- HCA
- FNH
- Cirrhosis
High grade:
- cholangioCA
- metastatic adenoCA
- Metastatic renal cell or adrenocortical CA
91
Cytologic features of cholangioCA
Cohesive 3 dimensional clusters and single cells
Glandular differentiation
high NC ratio
Looks like an adenoCA
92
Cytologic features of pancreatic ductal adenoCA
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
DDx of low grade pancreatic ductal adenocarcinoma
Chronic pancreatitis
Stent associated atypia
PSC
Recent implementation
94
DDx predominantly single cell pattern on cytology for pancreatic mass
Acinar cell carcinoma
WDNET
Solid pseudopapillary neoplasm
Lymphoma
95
Cytologic features of well diff PanNET
Cellular smear
Single cell pattern
Plasmacytoid cells
Granular cytoplasm
Salt and pepper chromatin
Variable nucleoli
96
Cytologic features of pancreatic pseudocysts
Granular and inflammatory debris
Histiocytes
High amylase, low CEA on cyst fluid analysis
97
DDx mucinous epithelium on pancreatic cyst aspiration
Neoplastic - IPMN, MCN, pancreatic adenoCA with cystic degeneration
Contamination by gastric or duodenal epithelium
98
Ancillary cell block studies to help diagnose acrinary cell carcinoma on pancreas FNA
PAS/PASD
Mucicarmine
Trypsin+
BCL10+
Chymotrypsin+
99
Diagnostic categories of reporting pancreaticobiliary cytology
Nondiagnostic
Negative for malignancy
Atypical
Neoplastic - benign vs other
Suspicious for malignancy
Malignant
100
Neoplasms in the Neoplastic, benign and Neoplastic, other categories of pancreatobiliary cytopathology reporting
Neoplastic, Benign:
- serous cystadenoma
- neuroendocrine microadenoma
- lymphangioma
- cystic teratoma
- schwannoma
Neoplastic, Other:
-WDNET
- Solid pseudopapillary neoplasm
- mucinous cysts
101
Diagnostic criteria for mucinous cyst in reporting system for pancreaticobiliary cytology
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
Neoplasms under "malignant" category in reporting pancreatobiliary cytology
Adenocarcinoma
Acinar cell carcinoma
Poorly diff NEC
Pancreatoblastoma
Metastasis
Lymphoma
103
DDx of oncocytes in kidney FNA
Oncocytoma
Chromophobe RCC
Papillary RCC
CCRCC
Tubulocystic renal cell tumor
SDH def RCC
HLRCC
Epithelioid angiomyolipoma
Hepatocytes
104
Cytologic features of CCRCC
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
Cytologic features of high grade urothelial carcinoma
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
Indications of urine cytology
Hematuria
Patient being followed for treated urothelial CA or CIS
Patient at high risk for urothelial CA: occupational chemical exposure, chemotherapy
107
DDx of urothelial cell clusters
Urolithiasis
Instrumented urine
Low grade papillary urothelial tumors (papilloma, PUNLMP, LGPUC)
HGUC
108
Can low grade urothelial CA be accurately diagnosed on urine cytology
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
Diagnostic feature of low grade papillary urothelial neoplasm on cytology
Presence of true papillary fragment with fibrovascular core
110
DDx high grade urothelial carcinoma
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
Ideal time to take sample for urine cytology
3-4 hours after last urination
112
Diagnostic categories for reporting urinary cytoplathology
Negative for HGUC
Atypical urothelial cells
Suspicious for HGUC
HGUC
LGUC
Other malignancy
113
Cytologic features of atypical urothelial cells
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
Cytologic features of suspicious for high grade urothelial carcinoma
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
Causes of false positive diagnoses in urinary cytology
Reactive umbrella cells
Lithiasis
Instrumentation
Inflammation
Rads/chemo
Polyoma virus infection
Ileal conduit specimens
Cells from seminal vesicles
116
Causes of false negative diagnoses in urinary cytology
LGPUC
Obscuring marked inflammation or blood
RCC
Prostate adenoCA
117
Cytologic features of leptomeningeal metastatic adenoCA in CSF
Small clusters of cells and isolated single cells
Large cells with eccentric nuclei
Abundant cytoplasm with vacuolization, some containing mucin
118
Leukemia in CSF vs peripheral blood contamination of CSF
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
Tumors with likelihood to be diagnosed on CSF from most to least likely
Lymphoma/leukemia
Medulloblastoma
Mets
Glioma
Benign primary brain tumor
120
Features of a good screening test
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
Examples of cervical cytology quality assurance practices
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
Possible causes of discrepancy during cervical cytology-histology correlation
Sampling error on cervical biopsy
Resolution/healing of lesion in interum between cervical smear and biopsy
Cytology interpretation error
Histology interpretation error
123
Breakdown of the ASC category in cervical cytology
90% ASC-US
10% ASC-H
