Cytology Flashcards
(101 cards)
1
Q
What is a laboratory diagnosting test dependant on
A
Good history
Quality of sample
Proper identification of sample
2
Q
How do you choose what sampling technique to use for histology
A
Anatomic location
Patient’s overall health
Suspected tumor type
Clinician’s preference
3
Q
What are the pretreatment biopsy types
A
Needle core biopsy
Punch biopsy
Wedge biopsy
4
Q
How do you obtain additional information about a tumor
A
treatment planning (surgical, medical)
5
Q
What is excisional biopsy
A
Surgical removal of the tumor
6
Q
what is a post treatment biopsy method
A
excisional biopsy
7
Q
How do you obtain a more complete picture about a growth
A
Grading
Lymphatic/vascular invasion
Margins
8
Q
Is a biopsy a good first step?
A
No
9
Q
What is the disadvantage to not doing a biopsy first when a lump is removed
A
can result in incomplete removal, more morbidity and costs
10
Q
What are the advantages to pre-treatment biopsies
A
Can help clients make an informed decision
Can consult with oncologist and surgeon
Can plan treatment sooner after surgery
11
Q
When are pre-treatment biopsies not indicated
A
Treatment or Sx would not change (spleen, testicle)
As risky as removal (spinal cord)
12
Q
What are needle core biopsies done on
A
external palpable masses (no highly inflamed or necrotic)
deep (kidney, liver)
13
Q
Describe the needle core biopsy punch
A
manual or spring/pneumatic powered
Small sample size still enough for pathologic exam
14
Q
what is the size of the needle core biopsies needle
A
1 mm wide biopsy
1.0 – 1.5 cm long
15
Q
What does a needle core biopsy require
A
local anesthesia and sedation
sterile preparation
16
Q
Why do you use a small scalpel incison for the needle core biopsy
A
Prevents dulling
Facilitates tru-cut mechanism
Can be sutured
17
Q
How do you handle the tissue from the needle core biopsy
A
Tissue can be removed with blade, needle or saline
Can be rolled on glass slide for cytology
Place in formalin (in cassette)
18
Q
What is a possible risk when you do a needle core biopsy
A
minimal risk of seeding but you should plan ahead and remove original incision tract
consider hemorrhage and fluid leakage
19
Q
Why do you use a punch biopsy
A
Typically for skin
Skin, oral, perianal
Direct access with laparoscopy
Liver, GIT, etc.
20
Q
What is the size of a punch biopsy
A
2-8mm
21
Q
What is required for punch biopsy
A
local anesthesia and sedation
usually no sterile preparation
22
Q
what is the ideal size of a punch biopsy
A
6mm
4 mm only for nose, footpad
8 mm slight more chances of infection
23
Q
What can cause tissue compression and artifacts when doing a punch biopsy
A
dull punches
24
Q
how do you handle a tissue sample from a punch biopsy
A
handle sample very gently
place in formalin, no cassette
25
what is important for punch biopsies if you're doing dermatology
draw line in direction of hair
26
When do you do an incisional biopsy
When cytology and/or biopsy is unsuccessful
| For ulcerated and necrotic lesions (larger sample)
27
What do you need to do for an incisional biopsy
Surgical preparation + drapes
Local anesthesia
Tumors are usually POORLY innervated
Skin is incised and tumor wedge removed
28
Is it necessary to remove intact skin with the incisional biopsy?
NOT necessary to remove intact skin (next or over)
Margins evaluated with removal of tumor
Can compromise
Careful not to sample just the reactive tissue surrounding the tumor
Imprint cytology can be done
29
Describe endoscopic biopsy
Convenient, cost-effective, safe
| Limited sample, inadequate visualization
30
Describe laparoscopy, thoracoscopy
Very good, can always convert to laparotomy
| Needs specialized tools & skills
31
How do you properly identify margins
tissue ink is preferred but sutures can also be used.
| need to write: color = which margin.
32
when should tissue ink be done
before fixation, to orient the sample and identify areas of concern
33
describe the tissue inking process
Tissue should be blotted with paper towel before
Ink can be applied with gauze on surface or cotton swab for precision
Allow to dry 20 min before formalin
34
describe proper tissue fixation
10% buffered neutral formalin
Special fixative for eyes, testicles
1 part tissue to 10 part fixative
Ideally 1 container per lesion
done within 30 minutes
35
describe containers for fixation
```
Wide container, secure lid
No glass
No more than 1L
In secure plastic bag (ziploc)
With absorbent packing material
Insulated (avoid freezing)
```
36
Descriibe large unusual specimen fixation
Amputated limbs, spleen
Can overnight on ice
Can pre-fix 48-72h with partial parallel incisions approximately 1 cm apart (‘‘bread loafing’’)
Then shipped without formalin (double-bag) or in 1:1 formalin
Can section and fix/send in individual containers
An annotated digital image or sketch of the original specimen to depict sectioning and orientation should accompany the samples
37
describe very small unusual specimen fixation
Labeled cassettes
| Do not use gauze sponges or cardboard because tissue may become compromised upon retrieval
38
describe luminal organs unusual specimen fixation
Flush the intact lumen with formalin
Partial longitudinal incision
3 labeled sections (cranial/proximal, mass and caudal/distal) can be submitted
39
describe thin flat sample fixation
Small: placed in a tissue cassette with a foam pad to minimize tissue curling
Larger samples can be tacked onto a flat piece of cardboard presoaked in formalin or water with suture through edges of tissue not needed for examination
40
What do you need to write about the lesion in the mass submission form
Lesion-specific clinical history (eg, anatomic site, date first noticed, rate of growth)
Potentially lesion-associated clinical signs (eg, lameness, vomiting)
Type of lesion (eg, new lesion, recut following incomplete excision, excisional biopsy following previous incisional biopsy, local recurrence)
Results of prior lesion-associated diagnostic tests - cytology, prior biopsy reports, imaging (radiographs, ultrasound, MRI, CT); access to radiographs may be especially important for bone and gingival tumors.
41
What general information do you need to put on the mass submission form
General clinical history—previous neoplastic diseases, previous or current nonneoplastic conditions of relevance
Treatment history—local and systemic, current and previous (eg, chemotherapy, radiation, corticosteroids)
Previous unrelated treatments or potential tumor-inducing historical events at tumor site (eg, previous radiation, vaccination, implants)
42
What other abnormalities should you include on the mass submission form
CBC, biochemical, and hormonal (eg, hyperinsulinemia) abnormalities
43
What else should be on the submission form
Working clinical diagnosis and/or list of differentials
Thorough gross lesion description.
Indication whether the submitted sample is an incisional or excisional biopsy.
Excisional biopsy indicates assessment of surgical margins is necessary, whereas for incisional biopsies the margin evaluation is null.
Anatomic site should be thoroughly described
Features appreciated during diagnostic imaging or perioperatively should be described
tissues involved or associated with the mass (eg, thyroid mass invading subjacent skeletal muscle).
44
What is cytology
examination of cells having exfoliated from tissue or having accumulated in body fluid
45
what can cytology provide
May provide definitive diagnosis
| Very dependent on sample quality!
46
is cytology invasive?
Not invasive
47
How quickly does cytology need to be processed
rapidly
48
What should be in the cytology kit
Clippers
Cleansing & disinfectant wipes
Syringes: 6 – 12 ml, up to 20 ml
Needles: 1 – 1.5 in (20g to 22g), 2.5 – 3.5 in spinal needle with stylet
Bone Marrow aspiration needle & core biopsy material
Scalpel blades
Culture swabs & applicator sticks for slide preparation
Box of slides (frosted)
EDTA and red top tubes
Rigid, flat surface for 6 -10 slides (foam tray)
Butterfly catheter, IV extension tubing
Pencil or slide marker
Sterile EDTA
49
What is the skin prep for a FNA
Minimal for cutaneous, subcutaneous
| Shave, clean & disinfect for internal
50
Where can you do an FNA
Cutaneous, subcutaneous, internal organs
51
What are the benefits of going needle only, vs aspiration
Should start with no aspiration
| Less blood contamination
52
What is the best FNA size needle
22g
53
What do you do if a FNA sample is liquid
place in edta
54
what do you do if an FNA sample is solid
prepare slides immediately
55
Describe imaging guided aspiration
typically ultrasound guided
complications are rare
thoracic samples can be taken.
56
Should ascites and pleural effusion be sampled via US
yes
57
Describe the squash preparation
Most common
For semi-solid, mucus-like, or pelleted (via centrifugation)
Place sample close to frosted edge and use second slide to spread sample
58
What do you do with fluid cytology samples
```
Keep in EDTA
Prevents clotting (fibrin)
Preserves cellular morphology
Facilitates cell count
Refrigerated
Up to 24h in general
CSF needs special measures
```
Make slide as soon as possible
Send unstained slide with EDTA tube
59
How do you prepare a fluid slide if the sample is cloudy
```
direct smear (like blood smear)
squash
```
60
how do you prepare a fluid slide if the sample is clear
```
If lower cellularity
Need to concentrate
Similar to urine sediment
Via special centrifuge (CSF, BAL)
Buffy Coat
Still do a direct smear
```
61
What hematology methods can you use with cytology fluid
```
Cell counts
Can be automated (hematology machine)
Flush with saline after
Manually
Total proteins
Refractometer
Conversion tables for low TP
```
62
Describe the touch imprint
Permits evaluation of a biopsy
With surface lesions is often of poor diagnostic utility
Superficial inflammation, secondary bacterial infection
Exception for fungal diseases
```
Need to blot aggressively the sample
Until tacky
Then imprint on slide
Fibrous lesions can be scraped
Scalpel blade
```
63
How do you prepare joint-synovial fluid cytology
Surgical preparation
Normally viscous
```
Ideally small EDTA tube
To get cell count
To be able to use hyaluronidaze
Direct smear (like seen previously)
Culturette for microbiology
```
64
What are miscellaneous types for doing cytology
```
Always air dry – do not use flame
Do not freeze
Do not expose to formalin
Label properly all tubes & slides
Always submit an unstained smear with a tube (also for hematology)
```
65
When do you do bone marrow evaluation
Bone marrow evaluation is indicated when peripheral blood abnormalities are detected
persistent neutropenia, unexplained thrombocytopenia, poorly regenerative anemia
To stage neoplasia
Lymphoma, plasma cell tumor, mast cell tumors, other
66
What is the difference between aspiration and core biopsy
Aspirates are easier, faster, and less expensive to perform than are core biopsies.
Bone marrow core biopsies require special needles.
Core biopsy sections provide a more accurate way of evaluating marrow cellularity and examining for metastatic neoplasia than do aspirate smears, but cell morphology is more diffcult to assess.
67
How can you classify inflammation
```
purulent
pyogranulomatous
macrophagic
eosinophilic
lymphocytic
```
68
Describe purulent inflammation
predominance of neutrophils (>85%)
| Try to say if degenerated or not
69
Describe pyogranulomatous inflammation
mix of neutrophils and macrophages
70
Describe macrophagic inflammation
predominance of macrophages (>50%)
71
Describe eosinophilic inflammation
important component of eosinophils (>10 – 30%)
72
describe lymphocytic inflammation
need to rule out lymphoma
73
What does it mean if you have degenerate neutrophils in your purulent inflammation
Degenerate neutrophils:
Bacterial infections
Need to see to call septic
74
What are the causes of degenerate neutrophils in purulent inflammation
Degenerate neutrophils:
Immune-mediated
Neoplastic
Sterile irritants (bile, urine)
75
What are granulomatous lymphocytes associated with
```
Foreign body
Fungal infection
Mycobacterial infection
Panniculitis
Lick granuloma
Other chronic lesions
```
76
what is eosinophilic inflammation due to
```
Eosinophilic granulomas
Hypersensitivity
Parasites
Fungal
Mast cell tumors
Some neoplasms
```
77
what is lymphocytic inflammation due to
Rare
Immune reaction
Viral
Chronic lesion
78
What is the infectious agent blastomycosis associated with
```
Pyogranulomatous or granulomatous
Dogs mostly
“hunting”
Nose, legs
Found in the environment
```
79
What is the infectious agent cryptococcus associated with
Granulomatous
Dogs & Cats
Nose
80
where is the aspergillus fungi found
Opportunistic
Dog: nose
Horse: cornea
81
Describe mycobacterium
Fairly rare
Granulomatous
Very slow to grow in microbiology
82
How do you classify a neoplasm
need to say the cell type
| if it is benign or malignant
83
what are the 4 cell types of neoplasms
epithelial cells
mesenchymal cells
round cells
neuroendocrine cells
84
how do you classify if a cell is benign or malignant
Set of criterias
Cytoplasmic
Nuclear
85
what are the cellular features of malignancy
```
Cellular
Crowding
Pleomorphism
Different shapes
Anisocytosis
Different cell size
Giant cells
Basophilia
```
High N/C ratio (nuclear/cytoplasmic)
Not always
86
what are the nuclear features of malignancy
```
Nuclear
Nuclear molding
More than 1
Pleomorphisme
Anisocaryosis
Within a cell also
Mitotic figure
Number and shape
```
87
what are the nucleolus features of malignancy
multiple
varied within one nucleus
may be normal
88
Describe the organization of mesenchymal cells
Weak cohesion, loosely arranged
| Often extra-cellular matrix
89
describe the cellular types of mesenchymal cells
Cellular types
| Eg. fibroblasts, osteoblasts, chondroblasts…
90
describe the morphology of mesenchymal cells
Morphology
Spindled, stellate, oval
Poorly defined cytoplasmic margins
91
describe the exfoliation for mesenchymal cells
Exfoliation
| Moderate to weak
92
describe the organization of epithelial tumors
Cohesive clusters
93
describe the cell types of epithelial tumors
Glandular and parenchymal tissue
Surface lining
Eg. Basal cells, squamous cells, hepatocytes, tubular cells, renal cells
94
describe the morphology of epithelial tumors
Variable: round to polygonal +/- elongated
| Distinct cytoplasmic borders
95
describe the exfoliation of epithelial tumors
very easy
96
What are all the round cell types
Lymphome
Plasmocytome
Mastocytome
Histiocyte
Sarcome histiocytaire
Transmissible veneral tumor
97
What does it mean when you see lymphoglandular bodies
Cytoplasm fragment
Mostly seen with lymphocytes
lymphoma
98
what does it mean when you see collagen breakdown
Mostly seen in mast cell tumors
| Some soft tissue sarcoma
99
what does it mean when you see a hematoidin crystal
Hematoidin crystal
Hemoglobin breakdown
Indicates chronic bleeding
100
what does it mean when you see cholesterol crystals
Cholesterol crystals
Cell membrane damage
Frequent in
Follicular cysts
101
what does it mean when you see skeletal muscle
Skeletal muscle
Normal
Incidental finding
