Exfoliative And Aspiritive Cytology

Question 1

What are exfoliating cells

Answer 1

Cells that are shed spontaneously

Question 2

What is Fine Needle Aspiration Cytology (FNAC)

Answer 2

A technique in which a needle is used to obtain cells

Question 3

What is the role of the BMS in exfoliative Cytology

Answer 3

Preparation of samples - sample them, retrieve them, stain them
Quality control
Primary screening
Reporting negative samples
Prepar agars

Question 4

Why are cells fixated

Answer 4

To prevent petrifaction (breakdown via microbes) and autolysis of cells by enzymes

Question 5

What does fixation do on a cellular level

Answer 5

Works by stabilising proteins, denaturing or coagulating proteins and may disrupt chemical bonds

Question 6

How does alcoholic fixation work

Answer 6

Dehydrated cells called a Coagulative fixative

Cells contract, appearing round or spherical

Provides excellent preservation of both nuclear and cytoplasmic details

Cheap fast convenient easy

Question 7

How does air dry fixation work

Answer 7

Removes water from cells

Flattens call against glass slide creating impression of enlargement

Especially useful at on site adequacy assessments

Cheap fast convenient easy

Question 8

Why do we stain sample and how does it work

Answer 8

To bring out components as they are all similar contrast and refractive index
They bind to tissues (specific chemicals)

Question 9

Name the main three agents used in PAP stain

Answer 9

Haemotoxylin
Eosin azure (EA)
Orange G (OG)

Question 10

Describe haemotoxylin

Answer 10

It’s a nuclear stain which is important as disease alters nuclear structure & contents

Question 11

Describe Eosin Azure (EA)

Answer 11

Contains light green and eosin to stain cytoplasm Pink or Green

Question 12

Describe Orange G (OG)

Answer 12

Small dye that penetrates dense structures e.g. keratin and stains Orange

Question 13

Give 2 examples of exfoliative samples

Answer 13

Urine and body fluid samples

Question 14

What 3 places are FNA used to sample

Answer 14

FNA Neck, FNA Lung, FNA Lymph Nodes

Question 15

Give some examples of places cells shed spontaneously (internally)

Answer 15

UT, respiratory tract, serous cavities

Question 16

What are some reasons for looking at urine Cytology in a patient

Answer 16

Tumour detection

Screen high risk (asymptomatic patients)

Question 17

How is a urine sample prepared

Answer 17

Served fresh

May be fixed

Concentrated centrifuge

Layered onto slide by cytocentrifuge or liquid based Cytology

Question 18

Where may a respiratory sample be taken from

Answer 18

Sputum
Bronchial brush
Bronchial tan
Bronchial Lavage
Broncioalveolar lavage

Question 19

What are the general features of malignancy

Answer 19

High nuclear:cytoplasm ratio
Hyperchromatic nuclei
Abnormal chromatin pattern
Irregular nuclear membranes
Nuclear polymorphism 
Abnormal mitosis
Irregular nucleoli

Question 20

What are the 2 types malignant lung cancers

Answer 20

Small cell carcinoma (SCC)

Non-small cell carcinoma (NSCC)

Question 21

Describe a small cell carcinoma (SCC)

Answer 21

Small tumour cells
Dissociated cells
Necrosis
Dense or coarse chromatin

Question 22

Describe a Non-small cell carcinoma (NSCC) (Adenocarcinoma)

Answer 22

Crowded sheets, balls, papillae and microacini, eccentrically placed, shaped or lobed nuclei
Finely granular chromatin
Centrally place macronucleoli
Intracytoplasmic mucin

Question 23

Name the 5 Immunohistochemistry (IHC) markers (stains) used to detect lung cancers

Answer 23

TTF-1 (thyroid transcription factor)
Napsin A
CK7 (cytokeratin 7)
CK5/6
P63

Question 24

What out of the 5 IHCs don’t test for adenocarcinoma

Answer 24

TTF-1 and Napsin A (test for squamous cell carcinoma)

Question 25

What out of the 5 IHCs don’t test for squamous cell carcinoma

Answer 25

CK7, CK5/6, P63 (test for Adenocarcinoma)

Question 26

Describe the characteristics of Squamous cell carcinoma

Answer 26

``` Single malignant and loose clusters Dense cytoplasmic keratinisation Intracellular bridges Hyperchromatic nuclei Abnormal nuclear:cytoplasm Bizarre cells - tadpole, snake and fibre cells Multinucleated giant cells Necrosis ```

Question 27

Define necrosis

Answer 27

Death of all or most of the cells in an organ or tissue due to disease or failure of blood supply

Question 28

What are some granulomatous infections

Answer 28

TB Sarcoid Fungi

Question 29

Characteristics of serous fluid

Answer 29

Small amount present under Normal conditions Accumulation in serous cavities reflects local or systemic disease Effusions can be classified in to transudates and exudates

Question 30

What are the two classes of effusion in serous effusion Cytology

Answer 30

Transudates and exudates

Question 31

How are serous fluid samples prepared

Answer 31

Received fresh 50-100ml Concentrated in centrifuge Layered on slide by cytocentrifuge and Liquid based Cytology

Question 32

Describe the characteristics of a Mesothelial cell

Answer 32

``` Single or in small clusters 15-30micrometers in diameter Varied staining endoplasm and ectoplasm Nuclei central or paracentral Contain nucleoli ```

Question 33

In terms of mesothelial cells, what are the possible routes of a cancer

Answer 33

Benign mesothelial proliferation Malignant mesothelioma Reactive mesothelial cells Adenocarcinoma