Cytology For The Endocrinologost

Question 1

Which stain is used in cytology slides?

Answer 1

Diff Quick

Question 2

Which preservative is used in cytology slides?

Answer 2

Formalin of Cytolyt

Question 3

How is a direct smear done?

Answer 3

Can be done like a peripheral blood smear or “book technique”

Question 4

What is cytospin?

Answer 4

Centrifugation of needle washings onto a slide, to concentrate material.

Question 5

What is a cell block?

Answer 5

Needle washing is spun down and clotted to embed and cut like tissue.

Question 6

What are the two fixation techniques used in preparing slides?

Answer 6

• Air drying

- Alcohol fixed

Question 7

Which stains need the air drying method for fixation?

Answer 7

• Diff-Quick

- Wright-Geimsa

Question 8

What is the disadvantage of air drying method of fixation?

Answer 8

Cells tend to ‘spread out’ introducing some distortion.

Question 9

What two types of alcohol fixation methods are they?

Answer 9

• Dip

- Spray

Question 10

Which stains are best with the alcohol method for fixation?

Answer 10

• Pap

- Hematoxylin and Eosin

Question 11

What is the advantage of alcohol fixation method?

Answer 11

Preserves the cytomorphologic detail.

Question 12

What is Diff-Quick good for?

Answer 12

Good for nuclear size and shape.

Question 13

What color is cytoplasm in Diff-Quick?

Answer 13

Pink

Question 14

What color are nuclei in Diff-Quick?

Answer 14

Purple

Question 15

What color is cytoplasm in Papanicolaou?

Answer 15

Pink-orange to green-grey

Question 16

What color are nuclei in Papanicolaou?

Answer 16

Purple to blue

Question 17

What is Papanicolaou good for?

Answer 17

Nuclear detail

Question 18

What is Hematoxylin and Eosin stain good for?

Answer 18

Classic tissue stain for cell block material.

Question 19

What color is cytoplasm on Hematoxylin and Eosin stain?

Answer 19

Pink

Question 20

What color are nuclei on Hematoxylin and Eosin stain?

Answer 20

Purple

Question 21

What are the three stains in the Diff-Quick?

Answer 21

First - 95% alcohol
Second - Orange G
Third - Hematoxylin

Question 22

How long is the slide dipped into each of the three solutions in Diff-Quick?

Answer 22

30 seconds each.

Question 23

What four things are assessed with checking for adequacy?

Answer 23

• Cellularity
• Cell types
• Colloid
• Architecture

Question 24

Adequate:

____ groups of well-preserved cells with each group having at least _____ cells.

Answer 24

5 - 6 groups

10 to 15 cells

Question 25

Adequate: Greater than ____ cell groups with at least ____ well-preserved cells per group.

Answer 25

8 cell groups | 10 cells per group

Question 26

The Papanicolaou Society of Pathology defines an adequate thyroid FNA biopsy as: _____ groups of well-preserved follicular cells (____ cells per group)

Answer 26

6 - 8 groups | 10 or more cells

Question 27

The Papanicolaou Society of Pathology defines an adequate thyroid FNA biopsy as: _____ groups of follicular cells on at least ____ slides from separate passes with a minimum of _____ clusters of follicular cells (____ cells/cluster)

Answer 27

6 groups 2 slides 10 clusters 20 cells/cluster

Question 28

What four things are needed for ROSE (rapid on-site evaluation)?

Answer 28

- Patient sample on immediately prepared slides - Diff Quick stains - Microscope - Ability to recognize and count follicular cell and Hurthle cell clusters

Question 29

What is the billing code for the first pass?

Answer 29

88172

Question 30

What is the billing code for each subsequent pass after the second?

Answer 30

88177

Question 31

Billing for ROSE Documentation must exist stating what was seen on each pass and if it was adequate or not. True or false?

Answer 31

True

Question 32

Is a CLIA license needed for FNA biopsy with ROSE (rapid on-site evaluation)?

Answer 32

No

Question 33

What 6 categories exist in the Bethesda system for reporting thyroid cytopathology?

Answer 33

- Non-diagnostic or Unsatisfactory - Benign - Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance - Follicular Neoplasm or Suspicious for a Follicular Neoplasm - Suspicion for Malignancy - Malignant

Question 34

If Bethesda system reports: Non diagnostic or Unsatisfactory Then what's the usual management?

Answer 34

Repeat FNA with ultrasound

Question 35

If Bethesda system reports: Benign Then what's the usual management?

Answer 35

Clinical follow-up

Question 36

If Bethesda system reports: Atypical of undetermined significance or follicular lesion of Undetermined Significance... Then what's the usual management?

Answer 36

Repeat FNA

Question 37

If Bethesda system reports: Follicular neoplasm or Suspicious for a follicular neoplasm... Then what's the usual management?

Answer 37

Surgical lobectomy

Question 38

If Bethesda system reports: Suspicious for malignancy... Then what's the usual management?

Answer 38

Near-total thyroidectomy or surgical lobectomy

Question 39

If Bethesda system reports: Malignant... Then what's the usual management?

Answer 39

Near-total thyroidectomy

Question 40

What should the glass slides be labeled with?

Answer 40

Pencil

Question 41

What four things can cause unsatisfactory / non-diagnostic classification of FNA sample?

Answer 41

- Cyst fluid - Acellular - Blood only - Foreign material

Question 42

What four things can cause benign classification of FNA sample?

Answer 42

- Hyperplastic nodule - Lymphocytic thyroiditis (Hashimoto's or Graves' disease) - Granulomatous thyroiditis (Reidels) - Acute thyroiditis

Question 43

What four types of cells / cellular material do you see in lymphocytic thyroiditis?

Answer 43

- Follicular cells - Hurthle cells - Variable colloid - Lymphocytes

Question 44

What five things can cause 'follicular neoplasm or suspicious for a follicular neoplasm' classification of FNA sample?

Answer 44

- Follicular adenoma - Follicular carcinoma - Hurthle cell adenoma - Hurthle cell carcinoma - Rare hyperplastic nodules

Question 45

What four things can cause 'suspicious for malignancy' classification of FNA sample?

Answer 45

- Papillary carcinoma - Medullary carcinoma - Metastatic carcinoma - Lymphoma

Question 46

What should you check for medullary carcinoma?

Answer 46

Calcitonin

Question 47

What 7 things can cause 'malignant' classification of FNA sample?

Answer 47

- Papillary thyroid carcinoma - Poorly differentiated carcinoma - Medullary thyroid carcinoma - Undifferentiated (Anaplastic) carcinoma - Squamous cell carcinoma - Metastatic carcinoma - Non-Hodgkin lymphoma

Question 48

What are four histological signs of papillary thyroid carcinoma?

Answer 48

- Enlarged follicular cells - Nuclear pseudo-inclusions - Nuclear grooves - Psammoma bodies

Question 49

Where does medullary thyroid cancer originate from?

Answer 49

C-cells

Question 50

What are five histological signs of medullary thyroid carcinoma?

Answer 50

- Salt and pepper neuroendocrine nuclei - Abundant granular cytoplasm - Multi-nucleation - More discohesive - Plasmacytoid, follicular or spindled

Question 51

What is the only way to diagnose follicular carcinoma?

Answer 51

On surgical pathology

Question 52

What two types of follicular carcinoma are they?

Answer 52

- Follicular type | - Hurthle

Question 53

What are five histological signs of follicular thyroid carcinoma?

Answer 53

- Back to back follicles - Over-lapping nuclei - Scant colloid - Invasion through capsule - Lymphovascular space involvement

Question 54

What two possible diagnoses show pleomorphic atypical cells?

Answer 54

- Anaplastic thyroid carcinoma | - Metastatic carcinoma