Cytology Flashcards
Ciliocytophthoria is classically seen in what infection?
Adenovirus infection in the respiratory system. Ciliocytophthoria are decapitated ciliated columnar cells, where only the terminal bar and cilia are seen.
In the 2001 Bethesda system for Paps, are smears without endocervical cells considered unsatisfactory? When is an endocervical component considered to be present?
No, but the absence of an endocervical or transformation zone component is mentioned as a quality indicator. The absence does not imply that a repeat Pap is necessary, but that physicians are expected to use their judgement and to consider repeating the Pap is the patient is at high risk for cervical cancer. An endocervical component is considered to be present if 10 or more endocervical or squamous metaplastic cells, either isolated or in groups, are present.
In the Bethesda system for reporting thyroid FNA interpretations, list the diagnostic categories and corresponding % risk of malignancy and usual management.
-Insufficient for diagnosis (nondiagnostic, unsatisfactory), 1-4%, repeat FNA with US guidance. -Benign, 0-3%, follow clinically. -Atypical cells of undetermined significance, 5-15%, repeat FNA. -Suspicious for a follicular neoplasm, 15-30%, lobectomy. -Suspicious for a Hurthle cell neoplasm, 15-45%, lobectomy. -Suspicious for malignancy (suspicious for… papillary carcinoma, medullary carcinoma, lymphoma, metastatic tumor, or other), 60-75%, lobectomy or thyroidectomy. -Malignant, 97-99%, thyroidectomy.
What are the 2001 Bethesda criteria for ASC-H?
There are 2 patterns seen and different criteria for each. “Atypical (Immature) Metaplasia” (small cells with high N/C): Cells usually occur singly or in small fragments of less than 10 cells; occasionally, in conventional smears, cells may “stream” in mucus. Cells are the size of metaplastic cells with nuclei that are about 1.5 to 2.5 times larger than normal. N/C may approximate that of HSIL. In considering a possible interpretation of ASC-H or HSIL, nuclear abnormalities such as hyperchromasia, chromatin irregularity, and abnormal nuclear shapes with focal irregularity favor an interpretation of HSIL. “Crowded Sheet Pattern”: A microbiopsy of crowded cells containing nuclei that may show loss of polarity or are difficult to visualize. Dense cytoplasm, polygonal cell shape, and fragments with sharp linear edges generally favor squamous over glandular (endocervical) differentiation.
What are the 2001 Bethesda criteria for HSIL?
Cytologic changes affect cells that are smaller and less “mature” than the cells in LSIL. Cells occur singly, in sheets, or in syncytial-like aggregates. Hyperchromatic clusters should be carefully assessed. Overall cell size is variable, and ranges from cells that are similar in size to those observed in LSIL to quite small basal-type cells. Nuclear hyperchromasia is accompanied by variations in nuclear size and shape. Degree of nuclear enlargement is more variable than that seen in LSIL (Some HSIL cells have the same degree of nuclear enlargement as in LSIL, but the cytoplasmic area is decreased, leading to a marked increase in the N/C. Other cells have very high N/C, but the actual size of the nuclei may be considerably smaller than that of LSIL). Chromatin may be fine or coarsely granular and evenly distributed. Contour of the nuclear membrane is quite irregular and frequently demonstrates prominent indentations or grooves. Nucleoli are generally absent, but may occasionally be seen, particularly when HSIL extends into endocervical gland spaces. Appearance of cytoplasm is variable; it can appear “immature,” lacy, and delicate or densely metaplastic; occasionally the cytoplasm is “mature” and densely keratinized (keratinizing HSIL).
What are the 2001 Bethesda criteria for ASC-US?
Nuclei are approximately 2.5 to 3 times the area of the nucleus of a normal intermediate squamous cell (approximately 35 square micrometers). Slightly increased N/C. Minimal nuclear hyperchromasia and irregularity in chromatin distribution or nuclear shape. Nuclear abnormalities associated with dense orangeophilic cytoplasm (“atypical parakeratosis”).
What are the 2001 Bethesda criteria for LSIL?
Cells occur singly and in sheets. Cytologic changes are usually confined to cells with “mature” or superficial-type cytoplasm. Overall cell size is large, with fairly abundant “mature” well-defined cytoplasm. Nuclear enlargement more than three times the area of normal intermediate nuclei results in a slightly increased N/C. Variable degrees of nuclear hyperchromasia are accompanied by variations in nuclear size, number, and shape. Binucleation and multinucleation are common. Chromatin is often uniformly distributed, but coarsely granular; alternatively, the chromatin may appear smudged or densely opaque. Nucleoli are generally absent or inconspicuous if present. Contour of nuclear membranes is often slightly irregular, but may be smooth. Cells have distinct cytoplasmic borders. Perinuclear cavitation (“koilocytosis”), consisting of a sharply delineated clear perinuclear zone and a peripheral rim of densely stained cytoplasm, is a characteristic feature but is not required for the interpretation of LSIL; alternatively, the cytoplasm may appear dense and orangeophilic (keratinized). Cells with cytoplasmic perinuclear cavitation or dense orangeophilia must also show nuclear abnormalities to be diagnostic of LSIL; perinuclear halos in the absence of nuclear abnormalities do not qualify for the interpretation of LSIL.
What are the past and current categories of specimen adequacy for Paps in the Bethesda system?
1988: satisfactory, less than optimal, unsatisfactory
1991: satisfactory, satisfactory but limited by…, unsatisfactory
2001: satisfactory, unsatisfactory
What are the past and current requirements for an adequate squamous component in Paps in the Bethesda system?
1988 and 1991: well-preserved and well-visualized squamous epithelial cells should cover more than 10% of the slide surface.
2001: minimum estimated number of squamous cells of 5000 for liquid-based and 8000-12,000 for conventional preparation method.
Mediastinal germinoma/seminoma. What does it look like on FNA?
Germinomas occur exclusively in males. The typical aspirate from a geminoma grossly appears slimy or viscous. Microscopically, smears are usually fairly cellular, containing large, round or polygonal, poorly cohesive cells with a moderate amount of pale cytoplasm with distinct cell membranes. The cells have relatively round nuclei and prominent nucleoli. The background typically has a characteristic “tigroid” appearance on Diff-Quik-stained smears that corresponds to the viscous appearance of the aspirate. The granular background is likely composed of cytoplasmic remnants. Lymphocytes are usually present, and granulomas and syncytiotrophoblast-like multinucleated giant cells may also be observed.
How does medullary thyroid carcinoma appear on FNA?
FNA biopsy yields neoplastic neuroendocrine cells and amyloid in variable proportions. The cellularity of the smears is usually inversely proportional to the amount of amyloid produced by the tumor. The neoplastic cells are dispersed or form loose clusters, rarely forming microfollicles or papillae. MTC is a great mimicker. The tumor cells may have spindly, plasmacytoid, polygonal, hurthloid or giant cells appearances; may demonstrate mild pleomorphism; and may be bi- or multinucleated. The nuclei often have a “salt-and-pepper” or “speckled” chromatin pattern on Pap stain. Nucleoli may be seen, but are usually inconspicuous. Intranuclear cytoplasmic inclusions are frequently identified, and are morphologically identical to those seen in papillary thryoid cancer. Mitotic figures are present in 15% of cases. On Diff-Quik staining, red cytoplasmic granules, corresponding to neurosecretory granules containing calcitonin, may be seen.
What is seen on FNAs in Hashimoto thyroiditis?
Smears from Hashimoto’s thyroiditis show a polymorphous lymphoplasmacytic infiltrate with germinal center formation. Lymphoid tangles, lymphohistiocytic aggregates, tingible body macrophages, and background lymphoglandular bodies may be the overwhelming findings on the smears. Multinucleated histiocytes may be seen. Oncocytic (Hurthle cell) metaplasia is usually prominent. Hurthle cells are epithelial cells with abundant, finely granular cytoplasm and enlarged, variably sized, typically round nuclei that may display prominent nucleoli.
How does Warthin’s tumor appear on FNA?
Most of them are cystic, feel “doughy” upon palpation, and yield cloudy fluid on FNA. Smears are hypocellular, but scattered flat sheets of oncocytic cells and lymphocytes are likely to be found. Corpora amylacea and mast cells may be seen. Aspiration of more peripheral solid regions of the lesion may yield more cells. Oncocytic metaplasia is common in elderly males. Therefore, identification of all three components - oncocytic cells, lymphocytes, and cyst contents - is important for diagnosis.
How does pleomorphic adenoma/benign mixed tumor appear on FNA?
BMTs present as painless, slowly growing masses, and are the most common type of salivary gland tumor, especially in the parotid. Aspirates of BMT contain a combination of myxoid matrix, sheets and clusters of epithelial cells, and mesenchymal cells. The mesenchymal cells are of myoepithelial origin and are spindle shaped. “Hyaline cells” are modified myoepithelial cells which appear plasmacytoid with dense, glassy cytoplasm. They tend to present singly and may also be embedded within the fibrillary chondromyxoid stroma. Their presence is quite characteristic of BMT. Electron microscopy demonstrates that intermediate prekeratin filaments account for the dense, glassy appearance of the cytoplasm of hyaline cells. The chondromyxoid stroma is believed to be produced by myoepithelial cells. Tyrosine-rich crystals with radiating, flower-shaped or “daisy head” appearances stain orangeophilic on Pap stain and are not pathognomonic but, when present, support the diagnosis of BMT. They are detectable in less than 10% of BMTs. BMTs may show considerable epithelial atypia, but the atypia is limited and focal. If an aspirate contains features of BMT, but with readily identifiable, highly atypical epithelial cells, high mitotic activity, atypical mitotic figures and necrosis, malignant transformation should be suspected.
Breast carcinoma has a few characteristic patterns in fluid cytology, one of which is the presence of large morules (also called proliferation spheres or “cannonballs”). Describe.
“Cannonballs” are large, tightly cohesive balls of relatively uniform, neoplastic epithelial cells. Very few single malignant epithelial cells may be present. The borders of the cell groups are smooth - so-called “community” borders. In contrast, malignant cell clusters in mesothelioma are more commonly “knobby.” Although cannonballs are suggestive of breast origin, they may also be seen in carcinomas from other sites (e.g., ovary, lung, GI tract).
How do you distinguish fibroadenoma from phyllodes tumor on breast FNA?
FAs characteristically appear at age 20-30, while phyllodes tumors appear at age 40-50. Aspirates of phyllodes tumors typically contain the same triad of features as FAs, and the epithelial component is usually indistinguishable from FA. The main differentiating diagnostic feature is the stromal component: large, highly cellular, stromal fragments; single, intact mesenchymal cells; stromal cell atypia; and mitotic activity in stromal cells favors phyllodes tumor.
How do you distinguish fibroadenoma from papillary neoplasms in the breast on FNA?
Papillary neoplasms, including benign papillomas and invasive and noninvasive papillary carcinomas, may clinically mimic FAs. A subareolar location and nipple discharge favor a papillary neoplasm. FNAs from papillary neoplasms may be similar to those of FAs. However, 3D clusters containing fibrovascular cores are a feature of papillary neoplasms and not of FAs. In addition, the stromal component is usually sparse or absent in papillary neoplasms. Tall, columnar, epithelial cells are characteristic of papillary neoplasms, but may be seen in FAs as well.
Candida ___ consists of small, uniform, round budding yeast forms surrounded by clear halos on Pap stain. Unlike other Candida species, it does not form pseudohyphae in vivo or in culture.
Candida (previously Torulopsis) glabrata consists of small, uniform, round budding yeast forms surrounded by clear halos on Pap stain. Unlike other Candida species, it does not form pseudohyphae in vivo or in culture.
