Cytology: Inflammation & Cancer

Question 1

what are the main differences between cytology and histopathology

Answer 1

cytology: relatively non invasive, rarely requires sedation or GA, minimal tissue disruption during sampling, rapidly performed, rapid results, cells only, cannot assess tumour grade, accurate assessment of tumour type may be impossible, cheap
histopathology: invasive, GA or sedation required, moderate tissue disruption during sampling, more time consuming, delay as sample is fixed/sectioned, larger more representative sample, tissue architechture interpreted, possible to assess tumour grade, immunohistochemical stains may allow accurate diagnosis, costly

Question 2

what are the indications to perform cytology (8)

Answer 2

1. skin and subcut masses
2. lymphadenopathy
3. intrathoracic and intra-abdominal masses
4. body cavity effusions
5. urine sediment
6. traumatic catheterization (bladder neoplasia)
7. prostatic washes, bronchoalveolar lavage
8. bone marrow samples

Question 3

what are the basics to collecting a good cytology sample (4)

Answer 3

1. collection of good quality sample (non-aspiration, aspiration)
2. prep of a good quality smear
3. correct sample staining for in house analysis
4. support of experienced and well trained clinical pathologist for external analysis

Question 4

what are the benefits of non-aspiration sample (5)

Answer 4

1. minimal cell disruption (tumour cells may be fragile)
2. reduces hemodilution
3. excellent for lymph node aspirates
4. effective for many skin tumours (mast cell, lipoma)
5. may not yield a cellular sample (mesenchymal cells)

Question 5

how is an aspirate sample attained

Answer 5

use needle with syringe attached

suction can be continuous or intermittent

avoid needle exiting the tumour

often used if non-aspiration technique doesnt yield sample

can be ultrasound guided

Question 6

what are the reasons for poor quality samples (5)

Answer 6

1. poor technique
2. intrinsic nature of the lesion being sampled (fibrous, vascular, cystic, necrotic)
3. hemodilution
4. dirty slides
5. ultrasound gel contamination

Question 7

what are potential complications of obtaining a sample (4)

Answer 7

1. intro of infection
2. hemorrhage
3. pneumothorax
4. tumour seeding

Question 8

how do you prepare a cytology smear (7)

Answer 8

1. fill syringe with air and attach, detach from needle first if aspiration method
2. expel sample briskly onto slide
3. prepare smear
4. air dry quickly
5. label carefully
6. stain and examine in house
7. send air dried, unstained smears to external lab

Question 9

what are the stains used

Answer 9

modified romanowsky stain (diff quik rapid stain)

3 solutions

methancol (fixative)

solution I (eosinophilic dye)

solution II (basophilic dye)

Question 10

what is the diagnostic approach to a cytology sample

Answer 10

Question 11

what should you note on the first look

Answer 11

scan slide at low power (10x)

what is the cellularity?

how are the cells distributed?

are they inflammatory cells or tissue cells?

what is the background? (red cells)

Question 12

what cells can indicate neutrophilic inflammation

Answer 12

neutrophilic inflammation (suppurative, acute)

degenerative change may be seen

bacteria may be seen (septic) ex. cat bite abscess, surgical site infection

Question 13

what is shown here

Answer 13

neutrophilic inflammation

bacteria seen

Question 14

what cells would be present in a pyogranulomatous inflammation and where would this be seen

Answer 14

macrophages and neutrophils

ex. foreign body reactions, fungal infections, chronic injury

Question 15

what cells would be present in a granulomatous inflammation and where would this be seen

Answer 15

macrophages and lymphocytes

chronic inflammation, specific infections (mycobacteria)

Question 16

what is an eosinophilic inflammation

Answer 16

allergic/hypersensitivity reactions

parasitism

eosinophilic granuloma

neoplasia: mast cell tumour, some lymphomas

Question 17

what is an lymphoplasmacytic inflammation

Answer 17

allergic/immune reactions

chronic inflammation

Question 18

what inflammation type is shown here

Answer 18

eosinophilic

Question 19

what inflammation is shown here

Answer 19

granulomatous inflammation

Question 20

what inflammation is shown here

Answer 20

pyogranulomatous inflammation

Question 21

what types of cells can be present in neoplasia (3)

Answer 21

1. round cells
2. epithelial cells
3. mesenchymal cells

Question 22

what is the cellularity of round cells

Answer 22

high

Question 23

what is the cellularity of the epithelial cells

Answer 23

high

Question 24

what is the cellularity of samples of mesenchymal cells

Answer 24

low to high

Question 25

what is the cell distribution of round cells

Answer 25

evenly distributed

Question 26

what is the cell distribution of epithelial cells

Answer 26

clusters or rafts

Question 27

what is the cell distribution of mesenchymal cells

Answer 27

discrete cells

Question 28

what are the cell size/shape of round cells

Answer 28

round, distinct borders

Question 29

what are the cell size/shape of epithelial cells

Answer 29

round to cuboidal cell to cell borders

Question 30

what are the cell size/shape of mesenchymal cells

Answer 30

spindle shaped wispy cytoplasmic tails

Question 31

what other features are commonly seen in round cells

Answer 31

distinctive morphology

Question 32

what other features are commonly seen in epithelial cells

Answer 32

possible acini

Question 33

what other features are commonly seen in mesenchymal cells

Answer 33

production of matrix

Question 34

what are criterias of malignancy (7)

Answer 34

1. pleomorphism 2. increased nuclear:cytoplasmic (N:C) ratio 3. immature (coarse) chromatin pattern 4. prominent and/or multiple nucleoli 5. multinucleation 6. nuclear moulding 7. increased and/or abnormal mitotic figures

Question 35

what are pleomorphism changes seen in malignancy (4)

Answer 35

1. cell shape 2. cell size (anisocytosis) 3. nuclear size (anisokaryosis) 4. nucleolar size (anisonucleoliosis)

Question 36

what origin is frequenlty seen in round cell tumours

Answer 36

hematopoietic orgin

Question 37

what is the shape of the cytoplasm in round cell tumours

Answer 37

round shape with distinct cytoplasmic border and round to indented nucleus

Question 38

what cell type is seen here

Answer 38

round cell tumour

Question 39

what are the round cell tumour types

Answer 39

LYMPH L- lymphoma Y- transmissible venereal tumour (TVT) M- mast cell tumour P- plasma cell tumour H- histiocytic tumour

Question 40

what tumour type would this be

Answer 40

round cell tumour lymphoma

Question 41

what cell tumour type is this

Answer 41

round cell tumour lymphoma

Question 42

what cell tumour type is this

Answer 42

round cell tumour lypmhoma

Question 43

what tumour type is this

Answer 43

round cell tumour lymphoma

Question 44

what cell tumour type is seen here

Answer 44

round cell tumour mast cell tumour granulation nucleus is difficult to see because there is purple staining granules within the cytoplasm high #s of eosinophils because mast cell tumours release cytokines

Question 45

what cell tumour type is this

Answer 45

round cell tumour mast cell tumour

Question 46

what tumour type is this

Answer 46

round cell tumour mast cell tumour

Question 47

why do you need to be careful when staining mast cell tumours with diff quik

Answer 47

granules are not always picked up

Question 48

what tumour type is seen here

Answer 48

round cell plasma cell tumour very round nucleus that sits to one side of the cell, dark blue cytoplasm with clearing beside the nucleus bi nucleation is seen more freq

Question 49

what tumour type is seen here

Answer 49

round cell tumour plasma cell tumour

Question 50

what tumour type is seen here

Answer 50

round cell tumour plasma cell tumour

Question 51

what tumour type is seen here

Answer 51

round cell tumour histiocytoma marcophage lineage, lots of cytoplasm that is pale in colour common in young animals

Question 52

what tumour type is seen here

Answer 52

round cell tumour histiocytoma

Question 53

what tumour type is seen here

Answer 53

round cell tumour histiocytoma

Question 54

how do cells exfoliate in mesenchymal tumours

Answer 54

poorly exfoliate as non-cohesive aggregates and/or individual discrete cells

Question 55

what are the shapes of mesenchymal cells

Answer 55

spindle to oval shaped with wispy cytoplasmic tails

Question 56

what cell tumour type is this

Answer 56

mesenchymal cells

Question 57

what can mesenchymal cells produce

Answer 57

matrix (pink)

Question 58

what is usually required to classify mesenchymal cells

Answer 58

histopathology aspiration generally required

Question 59

what benign mesenchymal tumour types (5)

Answer 59

1. fibroplasia 2. inflammation: granulation tissue 3. lipoma 4. fibroma

Question 60

what tumour type is seen here

Answer 60

benign mesenchymal tumour lipoma

Question 61

what tumour type is seen here

Answer 61

benign mesenchymal tumour lipoma

Question 62

what are malignant mesenchymal tumour types

Answer 62

sarcomas (hemangiosarcoma, leiomyosarcoma, liposarcoma) melanoma soft tissue sarcoma

Question 63

what tumour type is this

Answer 63

malignant mesenchymal sarcoma

Question 64

what tumour type is this

Answer 64

malignant mesenchymal sarcoma

Question 65

what tumour type is seen here

Answer 65

malignant mesenchymal sarcoma

Question 66

what tumour type is seen here

Answer 66

malignant mesenchymal sarcoma

Question 67

where can epithelial cell tumours originate from

Answer 67

skin, resp tract, GI tract, urogenital tract, tumours of glands and organs

Question 68

how do epithelial tumours exfoliate

Answer 68

in cohesive clumps in rafts

Question 69

how are epithelial arranged

Answer 69

intracellular adhesions seen as tight line

Question 70

what are the shapes of epithelial cell tumours

Answer 70

polygonal, ovoid, round, angular, cuboid, columnar

Question 71

what tumour type is seen here

Answer 71

epithelial tumours

Question 72

what are benign epithelial tumours (4)

Answer 72

1. follicular or epidermal inclusion cysts 2. basal cell tumours 3. sebaceous adenoma 4. epithelioma

Question 73

what are malignant epithelial tumours

Answer 73

carcinomas

Question 74

what cell tumour type is this

Answer 74

epithelial tumour

Question 75

what tumour type is seen here

Answer 75

epithelial tumour sebaceous adenoma

Question 76

what tumour type is seen here

Answer 76

epithelial tumour

Question 77

what arrangements can carcinomas be in

Answer 77

acinar, palisading, honeycomb, papillary etc

Question 78

what tumour type is seen here

Answer 78

epithelial cell carcinomas

Question 79

what tumour type is seen here

Answer 79

malignant epithelial cell tumour carcinoma

Question 80

what tumour type is this

Answer 80

malignant epithelial cell tumour carcinoma

Question 81

what tumour type is this

Answer 81

malignant epithelial cell tumour carcinoma

Question 82

what tumour type is seen

Answer 82

malignant epithelial cell tumour carcinoma

Question 83

what tumour cell type is this

Answer 83

malignant epithelial cell tumour carcinoma

Question 84

what tumour type is this

Answer 84

malignant epithelial cell tumour carcinoma

Question 85

what tumour type is this

Answer 85

malignant epithelial cell tumour carcinoma

Question 86

what is the cellularity of naked nuclei tumours

Answer 86

highly cellular

Question 87

how are naked nuclei tumours arranged

Answer 87

loosely adherent cell arrangement occasional clusters

Question 88

what are the features of cell borders of naked nuclei tumours

Answer 88

indistinct cell borders

Question 89

what are the features of the nuclei in naked nuclei tumours

Answer 89

many free nuclei nuclei round to indented minimal anisokaryosis

Question 90

what are the origins of naked nuclei tumours

Answer 90

endocrine/neuroendocrine anal sac adenocarcinoma insulinoma thyroid tumours

Question 91

what cell tumour type is this

Answer 91

naked nuclei tumour

Question 92

what cell tumour is this

Answer 92

naked nuclei tumour

Question 93

what tumour cell type is this

Answer 93

naked nuclei tumour