[F] Week 14: Diagnostic Cytology - Part 1 Flashcards
(100 cards)
1
Q
Defined as the microscopic examination of cells
A
CYTOPATHOLOGY/ CYTOLOGY
2
Q
Specimen for cytologic examination may be derived from rious sources:
A
- Exfoliative cytology
- Fine needle aspiration
- Body fluids
3
Q
A process of obtaining cells using a needle and can be aided or guided by ultrasonography or CT scan
A
Fine Needle Aspiration (FNA)
4
Q
- Deals with the microscopic study of cells that have been desquamated from epithelial surfaces.
- Spontaneously shed or physically removed from epithelial & mucous membranes
A
Exfoliative Cytology
5
Q
For exfoliative cytology, cells are collected by?
A
SPONTANEOUS or
MECHANICAL exfoliation
6
Q
EXFOLIATIVE CYTOLOGY
when cells of the pleural cavity or peritoneal cavity are shed into the pleural or peritoneal fluid.
- Cells are collected after they have been either spontaneously shed by the body.
A
Spontaneous exfoliation
7
Q
EXFOLIATIVE CYTOLOGY
Pap smears, where cells are scraped from the cervix with a cervical spatula, or bronchial brushings.
- Cells are manually scraped/brushed off of a surface in the body.
A
Mechanical exfoliation
8
Q
USES OF EXFOLIATIVE CYTOLOGY
- Detection of ____ cells mainly for cancer staging
- Detection of ____ cervical lesions (cervicovaginal smear/Pap smear).
- Assessment of ____ status in case of sterility and endocrine disorders
- Determination of ____
- Detection of ____ agents
A
- Malignant
- Precancerous (Pre malignant can also apply)
- Hormonal
- Genetic sex
- Infectious
9
Q
What are the concepts under the detenction of malignant cells
A
- Changes in intercellular structural pattern
- Cytoplasmic changes
- Nuclear changes
10
Q
Detection of Malignant Cells
- Increase in size
- Irregular shape
- Irregular pattern
- Anisocytosis and anisokaryosis
- Indistinct cell membrane
- Excessive grouping & crowding to form cell clusters
A
Changes in intercellular structural pattern
11
Q
Detection of Malignant Cells
- Acidophilia or marked orangeophilia
- Excessive cytoplasmic inclusion bodies: e.g., wbc and pigment granules
- Abnormal vacuolation
A
Cytoplasmic changes
12
Q
Detection of Malignant Cells
- Larger nucleus and increased N:C ratio
- Pleomorphic
- Hyperchromatic
- Bizarre mitotic figures
- Increase in number and size of nucleoli
- Coarse chromatin pattern
- Markedly thickened nuclear membrane
- Necrotic or degenerative changes (vacuoles)
A
Nuclear changes
13
Q
Nuclear changes
-
Eosinophilic cytoplasm
with pyknotic nuclei - Presence of intermediate cells having epithelial-like or elongated in appearance which have slightly larger nuclei compared to mature superficial cells and also having basophilic cytoplasm.
A
Mature Superficial Cells
14
Q
Nuclear changes
- Pleomorphism
- Hyperchromatism of the nuclei
- Marked orangeophilia of the cytoplasm
A
Neoplastic Cells
15
Q
Cervical intraepithelial lesion or neoplasia is considered as?
A
premalignant lesion
16
Q
DETECTION OF PREMALIGNANT LESIONS
Cervical intraepithelial lesion or neoplasia is a premalignant lesion that can be classified as?
A
CIN-I, CIN-II, and CIN-III
17
Q
DETECTION OF PREMALIGNANT LESIONS
If left untreated, CIN-II and CIN-III can progress into a?
A
malignant lesion or cervical cancer
18
Q
DETECTION OF PREMALIGNANT LESIONS
eurt or not?
cytologyy can detect premalignant lesions which can help the patient
A
NOOTT
cytology only not cytolgyy
19
Q
DETECTION OF PREMALIGNANT LESIONS
CANNOT exclude hybrid squamous intraepithelial lesion
A
Atypical Squamous Cell (ASC-H)
20
Q
this cervical intraepthelial neoplasia will show such neoplastic changes such as:
- Pleomorphism
- Hyperchromatism of the nuclei
- Increased N:C ratio
- Crowding of the cells forming clusters (as seen in the picture on the lower right)
A
- LSIL
- HSIL (CIN-II)
- HSIL (CIN-III)
21
Q
CLASSIFICATION SYSTEMS FOR SQUAMOUS CERVICAL PRECURSOR LESIONS
- Dysplasia/ Carcinoma in Situ: ?
- Cervical Intraepithelial Neoplasia: CIN-I
- Squamous Intraepithelial Lesion (SIL), Current Classification: Low-grade SIL (LSIL)
A
Mild Dysplasia
22
Q
CLASSIFICATION SYSTEMS FOR SQUAMOUS CERVICAL PRECURSOR LESIONS
- Dysplasia/ Carcinoma in Situ: Moderate Dysplasia
- Cervical Intraepithelial Neoplasia:?
- Squamous Intraepithelial Lesion (SIL), Current Classification: High-grade SIL (HSIL)
A
CIN-II
23
Q
CLASSIFICATION SYSTEMS FOR SQUAMOUS CERVICAL PRECURSOR LESIONS
- Dysplasia/ Carcinoma in Situ: Sever Dysplasia
- Cervical Intraepithelial Neoplasia:?
- Squamous Intraepithelial Lesion (SIL), Current Classification: High-grade SIL (HSIL)
A
CIN-III
24
Q
CLASSIFICATION SYSTEMS FOR SQUAMOUS CERVICAL PRECURSOR LESIONS
- Dysplasia/ Carcinoma in Situ: Sever Dysplasia
- Cervical Intraepithelial Neoplasia: CIN-III
- Squamous Intraepithelial Lesion (SIL), Current Classification: ?
A
High-grade SIL (HSIL)
25
# Lesion Classification
Equivalent to **CIN-I** wherein the lesion is located in the **lower-third of the cervical epithelium** which is also equivalent to a low-grade SIL.
Mild dysplasia
26
# Lesion Classification
Equivalent to **CIN-II** wherein the neoplastic changes are seen in the **two-thirds or approximately half of the cervical epithelium** and is equivalent to HSIL
Moderate Dysplasia
27
# Lesion Classification
Equivalent to **CIN-III**, up to the **upper-third of the cervical epithelium**, which is also equivalent to HSIL of the current classification.
Severe dysplasia
28
# Lesion Classification
Equivalent to **CIN-III and HSIL** of the current classification, the neoplastic changes are seen in the **entire thickness of the cervical epithelium** but not breaking or invading the basement membrane.
Carcinoma in situ
29
# ASSESSMENT OF HORMONAL STATUS
for the assesment of hormonal status, whatr index is used?
Maturation index (M.I.)
30
# ASSESSMENT OF HORMONAL STATUS
is the % of cells from the main layers of the vaginal epithelium, namely, **parabasal**, **intermediate**, and **superficial cells**
Maturation index (M.I.)
31
# ASSESSMENT OF HORMONAL STATUS
TOF
The patient’s maturation index varies on a day-to-day basis and from patient to patient
T
32
# ASSESSMENT OF HORMONAL STATUS
used as criterion for mature superficial cells
PYKNOSIS
33
# ASSESSMENT OF HORMONAL STATUS
What are the components of Maturation Index
PIS
- Parabasal
- Intermediate
- Superficial cells
34
M.I (PIS) Example - 70/20/10
interpret
70% Parabasal cells
20% Intermediate cells
10% mature superficial cells
35
# ASSESSMENT OF HORMONAL STATUS
* Are the **least mature cells**, having **not been affected by estrogen or progesterone**
* It displays **mild maturation**, having been affected by **progesterone** (Little clinical usefulness)
* It displays the **most maturity**, having been affected by **estrogen**.
* Parabasal cells
* Intermediate cells
* Mature superficial cells
36
There are only 2 absolute when it comes to cellular pattern in the maturation index, what are those?
* Predominance of **parabasal cells** indicate *absence* of **estrogen stimulation**.
* Predominance of **superficial cells** indicates **estrogen stimulation**.
37
if u see this card
twerk then study the typical maturation index
38
The sample is taken from scrapings of the buccal and vaginal mucosa based on the presence of **“BARR
BODIES”**
DETERMINATION OF GENETIC SEX
39
# DETERMINATION OF GENETIC SEX
Give the percentage of soamtic cells and vaginal epithelial cell in female that is causative for barr bodies
- 20-90% of somatic cells
- 60-90% of vaginal epithelial cells
40
# DETERMINATION OF GENETIC SEX
how many percentage in man? (idk how to iphrase mbmb)
<4% in males
41
# DETERMINATION OF GENETIC SEX
named after discoverer Murray Barr, is the **inactive X chromosome** in a **female somatic cell**
Barr body
42
# DETERMINATION OF GENETIC SEX
A genotypical human female has only one Barr body per somatic cell, while a genotypical human male has?
NONE
| they can be gay tho so
43
# DETERMINATION OF INFECTIOUS AGENT
Infectious agents that can be detected in PAP smear
include:
* Candida albicans
* Gardnerella vaginalis
* Trichomonas vaginalis
* Viral infections e.g., Herpes
44
# DETERMINATION OF INFECTIOUS AGENT
* Hyphal elements, yeast cells, pseudo-hyphal elements are present
* Normal flora of the vagina: **Lactobacilli**
Vaginal Candidiasis
45
# DETERMINATION OF INFECTIOUS AGENT
* There will be a shift in flora from lactobacilli to **COCCOBACILLI**
* **CLUE CELLS** are the diagnostic feature which are mature
superficial cells covered with **coccobacilli**.
* Causative agent is **Gardnerella vaginalis**
Bacterial Vaginosis
46
# DETERMINATION OF INFECTIOUS AGENT
A flagellated protozoa and can be detected in PAP smear
Trichomoniasis
47
# DETERMINATION OF INFECTIOUS AGENT
* **Herpes simplex**
* Appearance of **multinucleated cells** having ground glass appearance
Viral Cytopathic Effect
48
what are the specimen for cytology?
* Cervicovaginal (PAP smear)
* Nipple discharge
* Gastric or bronchial secretions
* Pleural, peritoneal & pericardial fluids
* Sputum
* Urine sediment
* CSF
49
# SMEAR PREPARATION
- Direct smear preparation is done wherein ____ ____ is smeared evenly on a clean slide.
- Laboratory identification number is assigned on the ____ slide.
- fresh material
- Glass
50
# FIXATION
* Smears are immediately fixed by?
* Drying rapidly will destroy?
* Effusions: Placed in?
- If mailed to the lab: It should be air-dried after fixation for ____ minutes and placed in suitable containers.
* quick immersion or sprayed
* cellular & nuclear details
* 50% alcohol or Saccomano preservative (composed of 50% alcohol & carbowax)
* 10-15
51
# FIXATION
* Fluids are centrifuged at moderate speed ____ for 2 minutes.
* Smear from sediment or cytocentrifuged, 2 smears and ____ prepared.
* Smears may be left in ____ for weeks or months before staining.
* Sometimes, you will receive specimen in a container with fixative (TOF)
* 2000 rpm
* Cell block
* alcohol-based fixatives
* True
52
What are the common fixative for cytologic smears
* Equal parts of 95% ethyl alcohol & ether
* 95% ethyl alcohol
53
# COMMON FIXATIVES FOR CYTOLOGIC SMEARS
* Fixative of choice: ?
* Best fixative: ?
* Best choice: ?
* Fixative of choice: **90% alcohol** for 10 minutes
* Best fixative: **Ether-alcohol**, however, it is flammable, volatile, and a fire hazard, thus, abandoned.
* Best choice: **95% ethyl alcohol**
54
use this card to familliariz precaution obsereved during fixation
* Identify the slides before preparing smears
* Attach a paper clip
* Smears placed immediately onto fixative
○ Single uninterrupted motion
○ Avoid striking the bottom of the container; used of
forceps or clips can be done
○ Spray approximately 12 inches away
55
What is the principle for conventional/liquid-baseed method?
**Cervical CA** and **precancerous lesions** that arise from the junction of *endocervical/ectocervical mucosa*
which is the **TRANSFORMATION ZONE**
56
# CONVENTIONAL/LIQUID-BASED METHOD
squamous cells abut or border columnar cells. This is also the zone where squamous metaplasia occurs.
**Transformation zone**
These newly formed squamous cells are immature, rendering the zone highly prone to infections such as HPV. If the HPV serotype causes cancer, like **HPV-16**, it can lead to the
development of precancerous lesions or cancer within this zone.
57
Type of specimen used for conveional/liquid-based method
Optimal sample should include:
- squamous cells
- columnar cells
- metaplastic cells
58
# CYTOLOGIC COLLECTION AND PREPARATION
MATCH:
1. Endocervical Brush
2. Vaginal Scrape
3. Lateral Vaginal Scrape
4. Four Quadrant Vaginal Scrape
5. Vulvar Scrape
A. Vaginal adenosis
B. For hormonal evaluation
C. For endocervical canal
D. Herpetic lesions or carcinoma
E. Hysterectomy specimen
1. C
2. E
3. B
4. A
5. D
59
In doing a Pap smear, for obtaining the specimen, we use a ____ which is inserted into the vaginal canal of the
patient to visualize the cervix
SPECULUM
60
# PAP SMEAR
In here, cells are scraped from the ____ and examined under a microscope to check for disease or other problems.
- Cervix
61
# PAP SMEAR
PAP SMEAR sample can be obtained using?
- Spatula
- sterile cotton pledget
- cotton swab
- brushes
62
# CERVIX
- the lighter part, which is lined by **squamous epithelium**
- Middle portion, lined by **columnar epithelium.**
- Ectocervix
- Endocervix
63
# Cervix
**squamous cells abut or border columnar cells**. This is also the zone where **squamous metaplasia** occurs. These newly formed squamous cells are immature,
Transformation Zone
64
# Cervix
prone to formation of **premalignant lesions** and eventually, if not treated, it can transform into a **malignant lesion**.
Transformation Zone
65
What are the methods of PAP SMEAR
1. Convetional Method
2. Thin Layer Preparation/ Liquid-based method
66
# METHODS OF PAP SMEAR
* PRINCIPLE: **Cervical CA and precancerous lesions** that arise from the junction of endocervical/ectocervical mucosa which is the **TRANSFORMATION ZONE**
* TYPE OF SPECIMEN: Optimal sample should include **squamous, columnar, and metaplastic cells.**
Conventional method
67
# METHODS OF PAP SMEAR - Convetional
* PROCEDURE: Sample is smeared on the glass slide after obtaining it from the cervix. Then, ____ or ____ fixatives are used.
* This is the traditional method, wherein most of the samples can be ____. That’s the disadvantage, as some of the cells may be left on the swab, brushes, or spatula.
* 95% alcohol or spray
* Discarded
68
# METHOD OF PAP SMEAR
- The materials used are **brushes** and a **special medium** or **container** where there is a *liquid preparation*. After collection of the specimen, the brush is placed in the container.
* The sample is placed on a **sample container via**l where cells are immediately **preserved** and sent to laboratory.
Thin Layer Preparation/ Liquid-based method
69
# METHOD OF PAP SMEAR - Thin Layer Preparation/ Liquid-based method
* This will be placed on a glass slide as a **smear** where there will be even ____ dispersion of cells
* More ____ ____ are present in the thin layer preparation so there will be **increased opportunity** to detect early signs of abnormality.
- randomized
- representative cells
70
# METHOD OF PAP SMEAR
* The cells will be more **evenly distributed** because of the
filtration process
* Unlike the **conventional method** where most of the cells will be left on the brushes or spatula causing **overlapping of cells**
Thin Layer Preparation/ Liquid-based method
71
What are the staining techniques for PAP smear?
1. Papanicolaou Method
2. Modified PAP Staining Procedure
72
# STAINING TECHNIQUE
The method of choice for both **conventional and liquid based**
Advantages:
- Transparent blue staining of cytoplasm which allows overlapping cells to be seen
- Excellent nuclear detail
- Good differential coloring
- Valuable in comparing cellular appearances
Papanicolaou Method
73
# STAINING TECHNIQUE
* Provides *optimum nuclear detail* important for cytologic evaluation of **Pap smears, non-gynecological & FNA cytologic specimens**
* Pap smears, prepared by liquid based technique, use an **automated stainer.**
Modified PAP Staining Procedure
74
# STAINING TECHNIQUE
use this card to familliarize "avoiding contamination when using Modified PAP Staining Procedure"
- Stain non-gynecologic specimen & FNA **separately**.
- Don’t stain fluid specimens in **close proximity**.
- Stain suspicious cases **separately** when necessary.
- Assess cellularity of fluids & FNA specimen; **stain separately** those with high potential for *cross contamination*
- Change all stains **weekly or as needed.**
- **Discard first rinsing alcohol daily**, advance subsequent rinses and place new alcohol on the last rinse; do the same for xylene.
- **Don’t allow slide to dry** in *between staining steps*.
- Keep a **record of change**s in staining procedure next to the stainer.
- All problems with staining should be **identified, monitored, corrected, and recorded**
75
# CELLS IN CERVICOVAGINAL SMEARS
Other cells that are looked for:
o Navicular cells
o Pregnancy cells
o Endometrial cells
o Endocervical glandular cells
76
# CELLS IN CERVICOVAGINAL SMEARS
Polygonal squamous cells with pale pink cytoplasm and dark pyknotic nuclei
40-45 um in size
Mature Superficial Cells
77
# CELLS IN CERVICOVAGINAL SMEARS
Medium polyhedral sized or elongated cells with basophilic and **vacuolated cytoplasm**
**NAVICULAR CELL**: boat shaped intermediate cell with folded or curled edges; usually seen increased
in the latter half of menstrual cycle and pregnancy.
Intermediate Cells
78
# CELLS IN CERVICOVAGINAL SMEARS
Round or oval cell with small dense basophilic cytoplasm and large vesicular nucleus
Increased after childbirth, abortion and after menopause
15-30 um in size
Parabasal Cells
79
# CELLS IN CERVICOVAGINAL SMEARS
Occurs in **sheets or honeycomb pattern** with finely vacuolated cytoplasm
Their presence means that sampled. the **transformation zone** component is sampled
This means that we already reached the ectocervix up to the endocervix, **passing through the transformation zone.**
It can be seen as **layers or honeycomb patterns.**
Endocervical Cells
80
# CELLS IN CERVICOVAGINAL SMEARS
Small, **cylindrical** slightly cell in tightly packed groups of 3 or more
Usually seen in gross and during and **1-10 days after menstruation**
In females, **clumps of blood** can be seen, and endometrial cells may be present there.
Endometrial Cells
81
# PAP SMEAR CLASSIFICATION
PAP SYSTEM Nomenclature: Class 1 Normal
WHO: Normal
Bethesda System: ?
Within Normal Units
82
# PAP SMEAR CLASSIFICATION
PAP SYSTEM Nomenclature: atypical
cells are present but no evidence of
malignancy
WHO: Atypical
Bethesda System: ?
Reactive or reparative change
83
# PAP SMEAR CLASSIFICATION
PAP SYSTEM Nomenclature: ?
WHO: Dysplasia (cervical intra epithelial neoplasia) Mild, moderate,
severe
Bethesda System: Squamous epithelial cell abnormality/SIL
- Low grade (LSIL) and High grade (HSIL)
Class III – suggestive but not conclusive of malignancy
84
# PAP SMEAR CLASSIFICATION
PAP SYSTEM Nomenclature: ?
WHO: Carcinoma in situ
Bethesda System: High grade SIL
Class IV – strongly suggestive of malignancy
85
# PAP SMEAR CLASSIFICATION
PAP SYSTEM Nomenclature: ?
WHO: SCCa/ Adenocarcinoma/ other CA
Bethesda System: SCCa Glandular cell abnormalities (Adenoca); other CA
Class V – conclusive of
malignancy
86
What are the other Non-gynecologic specimens
1. RESPIRATORY TRACT SPECIMENS
2. GASTROINTESTINAL SPECIMENS
3. PLEURAL, PERITONEAL & PERICARDIAL FLUIDS
4. BREAST SECRETIONS
5. URINARY TRACT SPECIMENS
87
What is the principle why respiratory tract specimens are used?
To exclude the possibility of malignant or infectious agents
88
what are the types of specimens for Respiratory tract
- Sputum
- Bronchoalveolar Lavage (BAL)
- Bronchial Washing (BW)
- Bronchial Brushing (BB)
89
# SPUTUM
* ____ consecutive morning sputum by doing a deep cough
* CONTAINER: Wide-mouthed Jar with ____
* A minimum of ____ slides is prepared
- Three
- Saccomano fluid (50% ethyl alcohol + 2% carbowax)
- 2 to 4
90
For sputum specimen, how many is for air dried giems and for PAP smear
One (1) air dried for Giemsa and at least two (2) Pap
Smear
91
# Sputum
- The sample is then poured into Petri dish, blood flecked or solid particles places on slides, crushed, and spread (TOF)
- It is placed on a fixative for aminimum of 2 hour and alveolar macrophages should be present (TOF)
- True
- False (1 hour minimum)
92
# RESPIRATORY TRACT SPECIMENS
- is prepared by a **direct smear**
- The specimen is placed on a glass slide and another slide is placed on top of it and then **pull apart technique** is performed.
- Then, there are already **two slides** containing the specimen.
* The specimen is sprayed with a **fixative or immersed in a 95% alcohol immediately.**
Bronchial Brushing (BB)
93
# RESPIRATORY TRACT SPECIMENS
Method of collection: **BRONCHOSCOPY**
- A bronchoscope is inserted to view the airway and checks for any abnormalities. It is also used to obtain the sample.
- It is primarily done by a **pulmonologist**.
After collection, it is hand delivered to the laboratory.
Bronchial Washing (BW)
94
# RESPIRATORY TRACT SPECIMENS
Method of collection: BY ASPIRATION INTO A **GLASS
SUCTION APPARATUS**
Bronchial Aspirates
95
# RESPIRATORY TRACT SPECIMENS
what is the optimum amount and viability for cell suspension
* Optimum amount: **20-30 ml**
* Remain viable up to **4 days if refrigerated at 4°C**
96
# RESPIRATORY TRACT SPECIMENS
* Usually done for **very small amounts** of specimen like CSF
* If smears cannot be prepared immediately, **cover sediment
with absolute alcohol & refrigerate**.
* **Transbronchial fine needle aspiration (FNA):** drop or two
then pull-apart technique & fix
PREPARATION OF CYTOSPIN SLIDES
97
# PREPARATION OF CYTOSPIN SLIDES
1. Centrifuge ____ for 1 min.
2. Make a smear out of the ____
3. Coat the slide with a thin layer of ____ (used as an adhesive)
4. Fix in ____
1. 1000 rpm
2. Sediment
3. egg albumin
4. 95% Alcohol
98
Staining technique used for Respiratory Tract specimens
MODIFIED PAPANICULAOU TECHNIQUE
99
Stain used for respiratory tract specimesn
* **Harris’ Hematoxylin** is optimum for nuclear staining.
* Combination of **OG-6** and **EA 50** gives a subtle range of green, blue, and pink hues to the cytoplasm
100
