Cytopathology

Question 1

What is cytopathology?

Answer 1

The morphological study of dissociated cells.

Question 2

Why wouldn’t histopathology always be used instead of cytopathology?

Answer 2

• Histopathology requires fragments of tissue (biopsies) which are usually obtained through an invasive procedure given that forceps and similar instruments are needed. This can cause bleeding and trauma.

Question 3

Compare the cell samples needed for cytopathology and histopathology.

Answer 3

Cyto - detached cells

Histo - structure and architecture biopsy

Question 4

Compare the equipment needed for cytopathology and histopathology.

Answer 4

Cyto - fine needle, fluid and brushing

Histo- large needed, forceps

Question 5

Compare the time taken to carry out a cytopatholigcal cell removal compared to that of a histological study.

Answer 5

Cyto - 5 mins to 2 hours

Histo- 30 mins to 2 hours

Question 6

Compare the diagnosis time of cytopathological and histopathological studies.

Answer 6

Cyto - mins to 24 hours

Histo - 24 to 48 hours

Question 7

Describe the stains used in cytopathology and histopathology.

Answer 7

Cyto: PAP and H&E
Histo: H&E

Question 8

What is exfoliative cytology used on?

Answer 8

All mucosal surfaces, uterine cervix, oral-pharyngeal mucosa, gastrointestinal mucosa, urinary tract.

Question 9

What is aspiration cytology used on?

Answer 9

All superficial lumps, breast growths, thyroid nodules, enlarged lymph nodes.

Question 10

Name some potential samples sources for cytology.

Answer 10

• Urine
• Bladder washes and brushings.
• Body cavities
• Fluid from the body cavities.

Question 11

What body cavities can be used as sample source for cytology?

Answer 11

Pleural cavity, Peritoneal cavity, pericardial cavity.

Question 12

What type of lining lines the body cavities?

Answer 12

Mesothelium.

Question 13

What about fluid from body cavities is analysed during cytopathology?

Answer 13

Cytological changes and for the presence of biochemicals.

Question 14

What influences the type of staining used in cytopathology?

Answer 14

The cell type being analysed and the pathology that is being looked for.

Question 15

What might be targeted during immunocytochemistry?

Answer 15

Cytoplasmic targets, nuclear targets, cell membranes, lipids, proteins.

Question 16

What might affect the immunochemical staining of a sample?

Answer 16

Fixation

Question 17

Describe the degeneration of epithelial cells.

Answer 17

• Normal cell
• Blurring of chromatin, breakdown of nuclear membrane, cytoplasmic vacuolation
• Nuclear shrinkage and condensation of chromatin by Karyokinesis
• Nuclear fragmentation and agglutination of chromatin by Karyorrhexis
• Almost complete dissolution of nucleus by karyolysis

Question 18

Describe the repair of damaged epithelial cells.

Answer 18

• Nuclear enlargement, prominent nuclear border
• Multinucleation
• Slight coarsening of chromatin, slight nuclear hyperchromasia, undulations in the nuclear membrane
• Prominent nucleoli

Question 19

What causes cell death ?

Answer 19

• Unplanned and irreversible damage to the cell (necrosis)

- Regulated processes such as apoptosis - programmed cell death

Question 20

What is a neoplasm?

Answer 20

Abnormal growth of cells - tumour

Question 21

What causes cancers to be frequently detected by cytology?

Answer 21

Cancer cells lose their cohesive properties early in the disease process. This encourages the shedding of cells from tissue surfaces, thereby increasing the likelihood that cancer cells will be detected.

Question 22

What may cause a tumour to suddenly shrink?

Answer 22

The tumour may outstrip its own blood supply.

Question 23

What is metastasis ?

Answer 23

The invasion of malignant cells into surrounding tissues.

Question 24

What does the invasiveness of a malignant cell change due to ?

Answer 24

o Mechanical pressure of the growing tumour
o Motility of the malignant cells
o Enzymes produced by the malignant cells

Question 25

Wha is Human Papillomavirus?

Answer 25

A small DNA virus which infects deeper layers of the skin and internal lining of organs such as the vagina and mouth.

Question 26

What people are likely to get Human Papillomavirus and when?

Answer 26

- Detectable in more than 99% of cervical cancer cases. - 75% of women have been infected by the age of 50. - Women are likely to be infected in their later teens and early 20s. - Rate of HPV increases from the age of 14

Question 27

What are the effects of HPV ?

Answer 27

Infects cells and then integrates its DNA to the DNA of the host cell. Persistent infection leads to cells becoming damaged and pre-cancerous. Eventually cancer - abnormal uncontrolled growth of tissues occurs after many years.

Question 28

Describe the treatment of HPV

Answer 28

Cannot be treated but pre-cancerous changes can be detected by screening and removed.

Question 29

What are the categories of genital HPV infection ? Describe each.

Answer 29

- High risk which causes cervical intraepithelial neoplasia and invasive cancer. - Low risk

Question 30

What type of HPV causes genital warts?

Answer 30

Mainly 6 and 11

Question 31

What is the vaccine used to treat HPV?

Answer 31

Gardasil

Question 32

Who is given the Gardasil vaccine against HPV and what is the purpose of this?

Answer 32

School age girls to protect them against cervical cancer.

Question 33

What types of HPV does the Gardasil vaccine protect against?

Answer 33

6, 11, 16 and 18

Question 34

What is the aim of the NHS cervical screening programme?

Answer 34

To reduce the incidence and mortality of cervical cancer by detecting and treating potentially precancerous lesions of the cervix.

Question 35

What are the major problems with cytological and histological assessment?

Answer 35

- Distinction between non-dysplastic and dysplastic phenotypes. - Grading of dysplastic and correlation with cancer risk. - Distinction between high-grade dysplasia and early invasive gastric cancer.

Question 36

What is dysplasia?

Answer 36

A term used to describe the presence of abnormal cells within a tissue or organ. Dysplasia is not cancer, but it may sometimes become cancer