cytology (haematology 16-17) Flashcards by Lucy Forgan

why do we evaluate air cytology slides both stained and unstained?

unstained - for mites
stained - for bacteria, yeast, inflammatory cells

How well did you know this?

Not at all

Perfectly

which method would you use to obtain a sample from mucosal surfaces (oral, vaginal, nasal, conjunctiva, ear cytology, fistulous tracts)?
a. Fine needle aspirate (aspiration or nonaspiration)
b. Impression smear
c. Scraping
d. Swabs

d. Swabs

How well did you know this?

Not at all

Perfectly

what are the four main cytology sample collection methods?

Fine needle aspirate (aspiration or nonaspiration)
Impression smear
Scraping
Swabs

How well did you know this?

Not at all

Perfectly

what are the advantages of a fine needle aspirates (FNA’s)?

least invasive, most commonly used
- no sedation or general anaesthesia required
- minimal equipment (5-20ml syringe, 22-25g needle, microscope slide)

How well did you know this?

Not at all

Perfectly

how do you do a negative pressure/aspiration technique (type of fine needle aspirate / FNA)?

insert needle (attached to syringe)
draw back, aiming to suck cells into needle (not syringe)
release plunger before removing needle
take needle off, draw air into syringe, reattach and “squirt” cells into microscope slide

How well did you know this?

Not at all

Perfectly

how do you do a non aspiration (stab technique) fine needle aspirate / FNA?

insert the needle (doesn’t matter if syringe is attached or not)
redirect several times within the mass
withdraw
fill a syringe with air, THEN attach it to the needle. squirt contents onto microscope slide.

How well did you know this?

Not at all

Perfectly

which form of FNA would you use for deeper, firm, fibrous masses?
a. aspiration technique
b. non aspiration technique

a. aspiration technique (but need to try and avoid blood contamination)

How well did you know this?

Not at all

Perfectly

which form of FNA would you use for delicate cells (eg lymphocytes in lymph nodes)?
a. aspiration technique
b. non aspiration technique

b. non aspiration technique - this technique also reduces blood contamination

How well did you know this?

Not at all

Perfectly

Impression smears are made from tissue samples collected at surgery (for biopsy) or lesions detected at necropsy (autopsy). They could also be made from ulcerative or exudative superficial lesions.
how do you make one?

cut the mass
dab with a paper towel/absorbent material till dry
gently dab onto slide (do not smear) several times in different locations on the slide.

How well did you know this?

Not at all

Perfectly

scrapings are useful for shallow ulcerated lesions that would be difficult to insert a needle into, or lesions found in an autopsy.
how do you make one?

clean with saline, blot area dry
gently scrape surface with a fresh scalpel blade at a 45 degree angle to the skin
then slide the scalpel blade (also at 45 degrees) along the glass slide
make a “trunk” (main strip down the middle) then make “branches” by smearing material from the centre outwards with scalpel tip

How well did you know this?

Not at all

Perfectly

swabs are used when you want to obtain samples from mucosal surfaces (vaginal, oral, nasal, conjunctiva), ear cytology and, from fistulous tracts.
how do you make one?

use a dry or moistened (w. sterile saline) cotton swab
collect sample from area/lesion
gently roll swab onto the slide to transfer cells without excess damage

How well did you know this?

Not at all

Perfectly

you’ve got the sample on the slide - which slide prep would you use if the sample is of a solid tissue aspirate or highly cellular?
a. slide-over slide (squash preps)
b. blood smear technique
c. trunk and branches smear

a. slide-over slide (squash preps)

How well did you know this?

Not at all

Perfectly

you’ve got the sample on the slide - which slide prep would you use if the sample is a very fluidic aspirate (cystic lesion, effusion)?
a. slide-over slide (squash preps)
b. blood smear technique
c. trunk and branches smear

b. blood smear technique

How well did you know this?

Not at all

Perfectly

you’ve got the sample on the slide - which slide prep would you use if the sample is sticky and viscous?
a. slide-over slide (squash preps)
b. blood smear technique
c. trunk and branches smear

c. trunk and branches smear

How well did you know this?

Not at all

Perfectly

true or false - it’s good practice to keep cytology slides in the fridge

false! water condensation will destroy the cells

How well did you know this?

Not at all

Perfectly

true or false - samples in formalin are fine to keep in the same box as your cytology slides

false! keep slides away from formalin, in seperate packaging where possible - it’ll destroy the cells in your cytology slides.

How well did you know this?

Not at all

Perfectly

true or false - you don’t need to include a history with your cytology slides, the pathologist can tell from the cells

false - be precise with your description of the location of a lesion (for e.g. “thoracic lesion” - does this mean in the skin over the thorax, in the SQ tissue, affecting the ribs, inside the pleural cavity and affecting the lungs?) the actual location will be crucial to the pathologists interpretation of the cytology.

How well did you know this?

Not at all

Perfectly

are you better off labelling the frosted ends of slides with…
a. pencil
b. pen/permanent marker

a. pencil - the stains used to prep the slides later are alcohol based, will dissolve pen/permanent marker

How well did you know this?

Not at all

Perfectly

are you better off making extra slides, or saving time and just making one?

make more! quite often only 1 out of 4 or 5 slides may have cells that are diagnostic
note - if you want to stain some to have a look before sending them to the lab, only stain one or two and let the lab stain the rest :)

How well did you know this?

Not at all

Perfectly

what is an effusion?

abnormal accumulation of fluid in a body cavity

How well did you know this?

Not at all

Perfectly

how does effusion (abnormal accumulation of fluid in a body cavity) occur?

hint - four types

changes in vascular permeability, hydrostatic pressure, oncotic pressure, or lymphatic drainage

How well did you know this?

Not at all

Perfectly

specific types of effusions: which is made up of lymphatic fluid rich in chylomicrons and triglycerides?
a. chylous effusions
b. haemorrhagic effusions
c. bile peritonitis
d. uroperitoneum
e. neoplastic effusions
f. FIP (feline infectious peritonitis) effusion

a. chylous effusions (chylous, chylomicrons)

How well did you know this?

Not at all

Perfectly

specific types of effusions: which is made up of whole blood (clotted or not)
a. chylous effusions
b. haemorrhagic effusions
c. bile peritonitis
d. uroperitoneum
e. neoplastic effusions
f. FIP (feline infectious peritonitis) effusion

b. haemorrhagic effusions (think bleeding)

How well did you know this?

Not at all

Perfectly

specific types of effusions: which is made up of green/yellow fluid high in bilirubin, bile crystals, and neutrophils?
a. chylous effusions
b. haemorrhagic effusions
c. bile peritonitis
d. uroperitoneum
e. neoplastic effusions
f. FIP (feline infectious peritonitis) effusion

c. bile peritonitis

How well did you know this?

Not at all

Perfectly

specific types of effusions: which is made up of urine-like fluid, high in creatine? a. chylous effusions b. haemorrhagic effusions c. bile peritonitis d. uroperitoneum e. neoplastic effusions f. FIP (feline infectious peritonitis) effusion

d. uroperitoneum (uro - urine)

specific types of effusions: which is made up of variable inflammation, possible haemorrhagic and protein like contents, neoplastic cells a. chylous effusions b. haemorrhagic effusions c. bile peritonitis d. uroperitoneum e. neoplastic effusions f. FIP (feline infectious peritonitis) effusion

e. neoplastic effusions

specific types of effusions: which is made up of high protein, low to moderate cellularity, mostly neutrophils and macrophages? a. chylous effusions b. haemorrhagic effusions c. bile peritonitis d. uroperitoneum e. neoplastic effusions f. FIP (feline infectious peritonitis) effusion

f. FIP (feline infectious peritonitis) effusion

sample tubes for fluid analysis: which would you use for cell counts and cytology? a. purple top vacutainer (EDTA, anticoagulant tube) b. red top vacutainer (no anticouagulant)

a. purple top vacutainer - this stops the fluid from clotting

sample tubes for fluid analysis: which would you use for growing a culture of the bacteria or extra sensitivity? a. purple top vacutainer (EDTA, anticoagulant tube) b. red top vacutainer (no anticouagulant)

b. red top vacutainer (no anticouagulant) - anticoagulant is antibacterial, you'll kill everything lol (can't grow a sample from fluid in a purple top tube)

making a cytology slide from effusion fluid - how do you handle thick fluid?

- expel a couple of drops from the collection syringe onto the slide - do a slide on slide (squash) prep, same as for thick tissue cells

making a cytology slide from effusion fluid - how do you handle extremely thin, watery fluid?

- ideally, concentrate (via centrifuge) before making a smear - otherwise do a stop prep (same as a blood smear, but stopping suddenly instead of spreading all the way to the end)

which is formed with increased hydrostatic pressure? a. transudate b. exudate

a. transudate

which is formed due to increased vascular permeability? a. transudate b. exudate

b. exudate

which is formed after decreased lymphatic drainage? a. transudate b. exudate

a. transudate

which is formed due to hypoalbuminaemia? a. transudate b. exudate

a. transudate - low albumin means low oncotic pressure, meaning there's nothing to draw the fluid back into the capillaries

general classifications of effusions - is it: a. transudate b. modified transudate c. exudate

a. transudate

general classifications of effusions - is it: a. transudate b. modified transudate c. exudate

b. modified transudate

general classifications of effusions - is it: a. transudate b. modified transudate c. exudate

c. exudate

which cytology collection technique would be best for a 5cm subcutaneous mass or enlarged liver? a. FNA b. impression smear c. scraping

a. FNA

which cytology collection technique would be best for a biopsy of an intestinal mass, or a lesion found at necropsy (autopsy)? a. FNA b. impression smear c. scraping

b. impression smear

which cytology collection technique would be best for a shallow ulcerated lesion on the nose? a. FNA b. impression smear c. scraping

c. scraping

which cytology preperation technique would be best for a highly cellular carcinoma, or a lymph node aspirate? a. squash smear (slide on slide) b. blood smear technique c. trunk and branches technique

a. squash smear (slide on slide)

which cytology preperation technique would be best for a highly fluidic mass, or low cellularity fluid? a. squash smear (slide on slide) b. blood smear technique c. trunk and branches technique

b. blood smear technique

which cytology preperation technique would be best for a sticky, mucinous sample, or a soft tissue sarcoma? a. squash smear (slide on slide) b. blood smear technique c. trunk and branches technique

c. trunk and branches technique

results come back with - TP of <25g/L - nucleated cell count <1.5x10^9/L for small animals or <5.0x10^9/L large animals - specific gravity of <1.017. a. transudate b. modified transudate c. exudate

a. transudate - low TP, NCC, specific gravity

results come back with - TP of 25 to 50 g/L - nucleated cell count 1.5 to 7.0 x10^9 /L (SA) - clear to slightly cloudy, pink or yellow a. transudate b. modified transudate c. exudate

b. modified transudate (TP between 25 - 50)

test results come back with: - TP >30 g/L - specific gravity >1.025 - nucleated cell count >5 to 7 x10^9/L a. transudate b. modified transudate c. exudate

c. exudate

The CSI-TM approach: how cytological samples are evaluated and described. what does CSI-TM stand for?

C: are there useful Cells Present? S: is the Staining adequate I: inflammatory vs. non-inflammatory (?neoplasia) T: cell Type M: if neoplastic – Malignant vs. Benign

are there useful cells in this image?

nope - almost all the cells are ruptured with nuclear material spread on the slide

are there useful cells present in this image?

no - there are cells but they've been spread too thick, can't see individual cell detail.

what is a splattergram?

when material has been expelled onto the slide but not properly spread

if you're seeing naked nuclei (i.e. nuclei with no cytoplasm), or others with their nucleus smeared across the slide in thin purple strands - what likely happened to these cells during prep?

they got squished, and ruptured

what two factors are you looking for in an adequately stained sample?

1. Varying shades of pinks, blues and purples 2. Clear differentiation between the cytoplasm, nucleus and smear background

fine needle aspirate (FNA) of liver - is this suitable for sending to the diagnostic laboratory? a. Yes b. No, too thick, cells not well spread out c. No, not well stained d. No, cells not intact

b. No, too thick, cells not well spread out

fine needle aspirate (FNA) of liver - is this suitable for sending to the diagnostic laboratory? a. Yes b. No, too thick, cells not well spread out c. No, not well stained d. No, cells not intact

c. No, not well stained - this slide is too pink

fine needle aspirate (FNA) of liver - is this suitable for sending to the diagnostic laboratory? a. Yes b. No, too thick, cells not well spread out c. No, not well stained d. No, cells not intact

a. Yes - slide is well stained, cells intact and well spread out

fine needle aspirate (FNA) of a lymph node - is this suitable for sending to the diagnostic laboratory? a. Yes b. No, too thick, cells not well spread out c. No, not well stained d. No, cells not intact

d. No, cells not intact - cells ruptured and only naked nuclei present

a. Yes - majority of these lymphocytes are intact and have cytoplasm surrounding the nucleus

which two cells are the main indicators of inflammation to look for?

1. neutrophils 2. macrophages *eosinophils, plasma cells, lymphocytes, or occasional mast cells can also be present but less likely to indicate inflammation

classifying the lesion - what's it called when more than 85% of cells are neutrophils? a. supprative (purulent) inflammation b. mixed (pyogranulomatous) inflammation c. granulomatous inflammation d. eosinophilic inflammation

a. supprative (purulent) inflammation - when more than 85% of cells are neutrophils *pus central lol

classifying the lesion - what's it called when there's a mix of neutrophils, macrophages and possibly multinucleated giant cells? a. supprative (purulent) inflammation b. mixed (pyogranulomatous) inflammation c. granulomatous inflammation d. eosinophilic inflammation

b. mixed (pyogranulomatous) inflammation

classifying the lesion - what's it called when there's predominantly macrophages, with some multinucleated giant cells and minimal neutrophils? a. supprative (purulent) inflammation b. mixed (pyogranulomatous) inflammation c. granulomatous inflammation d. eosinophilic inflammation

c. granulomatous inflammation (the macrophage one)

what percent of eosinophils do you need to be seeing before it's considered eosinophilic inflammation? a. 5% b. 10-20% c. >50%

b. 10-20% eosinophils - often allergic, parasitic, or eosinophilic granulosa complex

what cells would you expect to see with acute inflammation? a. mostly neutrophils b. mix of neutrophils and macrophages c. >50% macrophages with fewer neutrophils

a. mostly neutrophils - acute

what cells would you expect to see with subacute inflammation? a. mostly neutrophils b. mix of neutrophils and macrophages c. >50% macrophages with fewer neutrophils

b. mix of neutrophils and macrophages - subacute

what cells would you expect to see with chronic inflammation? a. mostly neutrophils b. mix of neutrophils and macrophages c. >50% macrophages with fewer neutrophils

c. >50% macrophages with fewer neutrophils - chronic