Cytology

Question 1

When Evaluating Cytology Slides principally the Nucleus indicates what? And the Cytoplasm indicates what?

Answer 1

• Nuecleus - Indicates state of growth activity of a cell (euplasia, Proplasia, retroplasia, neoplasia)
• Cytoplasm - Indicates functional differentiation (lineage of cell)

Question 2

What type of tumor is this?

Answer 2

Round Cell Tumour

Lymphoma

Note the Blue arrow pointing at a normal Lymphocyte

Question 3

What should you look for within a cytology smear?

Answer 3

1. Cell Populations
   
   • List and define proportions of cell types (%diff. count) [Inflammatory of Monomorphic?]
2. Sub-Cellular Morphology
   
   • Nucleus and cytoplasm
3. Background
   
   • Protein, RBC’s, Foreign Organisms, Crystals, etc

Question 4

What Features or Malignancy do you see here?

Answer 4

• High Nuclear/cytoplasmic ratio
• Anisokaryosis
• Nuclear molding (deformation by other nuclei)

Question 5

When diagnosing Neoplasia from a cytology slide, what is used to :-

• Differente the type of tumour
• Diagnose the malignancy?

Answer 5

• Cytoplasmic appearance of cells is used to evaluate the degree of differentiation and the type of tumor
• Diagnosis of malignancy is based primarily on the nuclear criteria

Question 6

What is Cytology?

Answer 6

The analysis of fresh cells collected from lumps, swellings, fluid and Urine.

Question 7

When looking at cytology what do you look for to determine if it is inflammatory or not.

Answer 7

Presence of Neutrophils

Question 8

By looking at these cytology pictures what can you tell me about them?

Answer 8

• They are both inflammatory reactions
• The second is acute inflammation as it consists of mainly neutrophils with maybe a monocyte and possibly an occasional lymphocyte but rarely a plasma cell

Question 9

When looking at the background of a cytology slide what are we looking for?

Answer 9

• Cholesterol Crystals
• RBC’s
• Protein

Question 10

WHat features or Malignancy do you see here?

Answer 10

• Marked variation in size, shape and number
• Irregular shapes with sharp angularity
• Enlarged Nucleoli

Question 11

Describe how you would prepare a FNA slide?

Answer 11

Using the Squash Preparation technique

Question 12

What 2 factors do we take into consideration when looking at cytology and trying to make a diagnosis?

Answer 12

• Tissue Type
• Type of Lesion Present

Question 13

What are the Nuclear criteria of malignancy?

Answer 13

Must have at least four of these to be classed malignant

• Increased Nuclear-Cytoplasmic ratio
• Variation in nuclear size - anisokaryosis
• Increased mitotic figures
• Chromatin pattern - Clumping
• Multi-Nucleation
• Abnormal mitosis
• Nuclear Molding

Question 14

What do the cells in the lymphnodes look like?

Answer 14

• Normal lymph nodes contain 75-90% small well differeentiated lymphocytes.
• THey contain a thin rim of cytoplasm and the nucleus is roundish to oval sometimes indented. It has dense clumps of dark chromatin and has no visible nucleoulus

Question 15

Tissue/organ-specific cell types can be grouped into three basic forms based on their cytological characteristics. What are these 3 groups?

Answer 15

Question 16

Why do we collect cell samples for Cytology?

Answer 16

• Detect and classify inflammation
• Determine the cause of an inflamatory response
• Detect the presence of Neoplasia
• Classify and define the neoplastic process
• Determine the cause of a body cavity effusion
• Aid in diagnosis of joint disease

Question 17

• What is the preferred method for collecting cells from a mass for cytology?
• Why do we use this method?
• What are the two different techniques?
• What size needles do you use?

Answer 17

• Fine Needle Aspirate (FNA)
• Avoids superficial contamination, represents several areas of the mass
• Aspiration vs non-aspiration
• 21-23g needles only

Question 18

What is hyperplasia?

Answer 18

Proliferation of normal cells

Question 19

What features of Malignancy do you see here?

Answer 19

• Abnormal mitotic figures
• Binucleate cells with different sized daughter nuclei

Question 20

How can you tell if the lymphnodes have inflammation within them?

Answer 20

Do a FNA and you will see Neutrophils and bacteria

Question 21

What is

• Karyolysis
• Pyknosis
• Karyorrhexis

Answer 21

Question 22

Round Cell Tumours have what indicators?

Answer 22

• Known as discrete cells (sit on their own and do not packet tightly)
• Cells appear as individuals
• Small to medium size
• Round Shape

Question 23

• In cytology a diagnosis of malignancy of only possible when?
• What is required to make such a dianosis?

Answer 23

• When four or more nuclear criteria for malignancy are observed.
• Need adequate cell collection, Well preserved Cells, Minimal numbers of inflammatory cells, cannot make a diagnosis based on the appearance of a single cell.

Question 24

What is the arrow pointing to?

Answer 24

Fungus

Question 25

What is Anisocytosis?

Answer 25

Variation of Cell Size

Question 26

What is Pleomorphism?

Answer 26

Variation in cell shape

Question 27

What is the limitation of cytology?

Answer 27

* Not always definitive * Inflammation is a complicating factor - Neoplasia vs dysplasia

Question 28

What is the General approach to the evaluation of the cytology smear?

Answer 28

* Need a methodical approach * Note the background of the smear * Note the presence of red cells, crystals, debris * Examine smear for the presence of nucleated cells * Are cells normal or abnormal * If abnormal - is the lesion inflammatory or non-inflammatory * If have inflammation - is it septic or non-septic * Non-inflammatory lesions may be either neoplastic or non-neoplastic * If neoplastic attempt to identify tissue of origin * Neoplasia may be malignat or benign * Some neoplastic lesions may also have inflammation

Question 29

Describe in a flow chart the general approach to a cytology smear

Answer 29

Question 30

Where is a Mast cell tumor commonly found?

Answer 30

In the skin

Question 31

What are the 5 round cell tumours?

Answer 31

1. Lymphoma 2. Histiocytoma 3. Plasmacytoma 4. Mast Cell Tumour 5. Transitional Venereal Tumour

Question 32

What is Anisokaryosis

Answer 32

Variation in nuclear size

Question 33

* As inflammatory reactions progress what would you see more of? * If these Cells are present how long at a minimum has the lump/mass been there for?

Answer 33

* You would see more macrophages and often these can be seen mopping up the inflammatory debris, including spend neutrophils and other cell detritus * 4-5days minimum