HISTOPATH 2 Flashcards
1
Q
Branch of general cytology; deals with microscopic study of cells desquamated (shed) from epithelial surfaces
A
EXFOLIATIVE CYTOLOGY
2
Q
step required to be performed STAT in exfoliative cytology
A
Fixation
(cells decompose/degenerate easily)
3
Q
PURPOSE OF EXFOLIATIVE CYTOLOGY
A
- Detect cancerous / malignant conditions
- Detect asymptomatic CA in women or pre-CA cervical lesions
- Genetic sex determination
- Detection of infection (i.e HPV, trichomoniasis, yeast infection)
- Evaluate female hormonal status in case of sterility
4
Q
3 DIFFERENT TYPES OF SPECIMENS PROCESSED IN HISTOPATH
A
- Autopsy
- Biopsy
- Cytology specimens
5
Q
TYPES OF CYTOLOGY SPECIMENS
A
Gynecological
Non-gynecological (fluid specimens)
6
Q
Example of Gynecological spx
A
Cervicovaginal smear (PAP smear)
7
Q
Example of Non-gynecological (fluid specimens)
A
- Sputum
- Smears of urine sediments
- Endometrial and endocervical smears
- Prostatic and breast secretions
- Pleural and peritoneal fluids
- Gastric and bronchial secretions
- CSF
8
Q
THREE TYPES OF PREPARATION FOR NON-GYNECOLOGIC (FLUID) SPECIMENS
A
- Smears
- Cell block – BEST
- Cytospin
9
Q
type of preparation for non-gynecological (fluid) spx that requires 2 slides
A
Smears
10
Q
type of preparation for non-gynecological (fluid) spx that is known to be the BEST method to collect cells in fluids
A
Cell block
11
Q
type of preparation for non-gynecological (fluid) spx that includes centrifugation at 1000 rpm for 1 minute
A
Cytospin
12
Q
Enumerate RESPIRATORY TRACT SPECIMENS
A
BAL
Bronchial washings
Bronchial brushings
Sputum
13
Q
Specimen used to detect pneumocystis jirovecii (among AIDS px)
A
BRONCHOALVEOLAR LAVAGE (BAL)
14
Q
Manner of collection for SPUTUM
A
deep cough, 3 consecutive mornings
15
Q
Used to confirm SPUTUM
A
microscopic evaluation of ALVEOLAR MACROPHAGE
16
Q
Indicator cell for satisfactory sputum collection
A
Alveolar macrophage
17
Q
Fixative used for SPUTUM in exfoliative cytology
A
Saccomano’s fluid
18
Q
Fixative used for BRONCHIAL BRUSHING in exfoliative cytology
A
Spray fixative or
95% ethanol
19
Q
These specimen requires at least 8 hours fasting prior collection
A
GASTRIC SECRETIONS / ASPIRATES / LAVAGE
20
Q
These specimen requires immediate transport to the lab; no delay beyond 30 minutes
A
GASTRIC SECRETIONS / ASPIRATES / LAVAGE
21
Q
Requirement for GASTRIC SECRETIONS / ASPIRATES / LAVAGE prior to collection
A
at least 8 hours fasting
22
Q
Specimen with LOW diagnostic yield for breast CA diagnosis
A
BREAST SECRETION
(NIPPLE DISCHARGE)
23
Q
T/F
Discharge during and post lactation may be abnormal
A
FALSE
NORMAL
24
Q
Nipple discharge during these conditions may be normal
A
during and post lactation
25
Discharge from breast nipple is usually _______ & may be due to ________________
benign
lesion like duct ectasia & papilloma
26
Smear preparation for breast secretion
Pull apart technique
27
Fixative of breast secretion for exfoliative cytology
Spray fixative or
95% IPA
28
Other methods to detect breast CA
Mammography
Breast ultrasound
Biopsy if lump is present
29
SMEAR PREPARATION TECHNIQUES
Streaking
Spreading
Pull-apart
Touch prep. (Impression smear)
30
SMEAR PREPARATION TECHNIQUE:
Apply spx at one corner of the slide, spread in a zigzag manner
Streaking
31
SMEAR PREPARATION TECHNIQUE:
Apply spx at the center, spread by teasing
Spreading
32
SMEAR PREPARATION TECHNIQUE:
Recommended for thick secretions
Apply spx at the center then place another slide (two slides used), slides are moved in opposite direction
Pull-apart
33
SMEAR PREPARATION TECHNIQUE:
Gentle smearing of the specimen across the slide
Touch prep. (Impression smear)
34
BODY CAVITY FLUIDS
Peritoneal-Pleural-Pericardial Fluids
35
Common problem in body cavity fluids (Peritoneal-Pleural-Pericardial Fluids)
JELLY CLOTS
36
Remedy for Jelly clots in body cavity fluids (Peritoneal-Pleural-Pericardial Fluids)
add 300 units heparin/100 mL of aspirate
37
Types of urinary tract specimens for exfoliative cytology
Voided
Catheterized
Washing from bladder/renal pelvis
38
Urinary tract specimens are used to detect
urothelial malignancies
39
Guidelines for proper urinary specimen collection
* First voided urine must be discarded (overnight cell degeneration)
* Second void is preferred
* Delay: refrigeration
* NO preservative
AMOUNT: 50 ml
40
BODY CAVITY EFFUSIONS
CSF, ascitic fluid
41
Guidelines for proper body cavity effusion collection
* Submitted fresh
* Formalin or alcohol should NOT be used
CSF AMOUNT: 1 mL
42
rpm and duration of centrifugation of spx for exfoliative cytology
1000 rpm for 1 minute
43
Extra sediments obtained after centrifugation is used for
cell block technique
44
METHODS OF CELL BLOCK PREPARATION
Direct Filtration – ROUTINELY PERFORMED
Plasma Thrombin method
Carbowax method
45
Routinely performed method of cell block preparation
Direct Filtration
46
* Centrifuge fluid, decant, collect sediment
* Add 10% formalin to sediment
* Embed using paraffin
Direct Filtration
47
Disadvantage of Direct Filtration
easily washed out
48
* Centrifuge fluid, decant, collect sediment
* Add 1 ml plasma and add thrombin → forms gel-like substance
* Place in a filter paper (reduces washing out)
* Add 10% formalin
Plasma Thrombin method
49
Advantage and disadvantage of Plasma Thrombin method
Advantage: reduced washing out
Disadvantage: expensive
50
* Centrifuge fluid, decant, collect sediment
* Add carbowax to sediment
* Place in a paraffin block
Carbowax method
51
Advantage and disadvantage of Carbowax method
Advantage: no dehydration step
Disadvantage: expensive
52
T/F
Smears should be prepared from fresh material and must be prepared and FIX while moist. We must prevent drying of specimens.
T
53
Duration of smear fixation for cytology
10-15 minutes
54
ensure that the cells attach to the slides
Adhesives
55
Spx not requiring adhesives
Specimens with ↑ proteins
56
Spx requiring adhesives
▪ Urinary sediments
▪ Bronchial lavage
▪ Concentrated sputum
▪ Specimens with trypsin
57
ADHESIVES FOR CYTOLOGY
* Pooled serum or plasma
* Celloidin ether alcohol
* Leuconostoc culture
* APES – 3 aminopropyltriethoxysilane
58
Bacteria used in Leuconostoc culture
gram positive cocci
59
most common TISSUE adhesive
Mayer’s egg albumin
60
T/F
Mayer’s egg albumin is also used in cytology as an adhesive
F
NOT used in cytology: stained intensely by the PAP counterstain
61
Best fixative for Cytology
95% ethanol with ether (not commonly used, ether is flammable)
62
Best tissue fixative
10% buffered neutral formalin
63
Commonly used fixative for Cytology
95% ethanol
64
May be used but slide must be kept at a distance of 1 foot (12 inches or 30. 5 cm) from the spray
Spray fixative
65
Combination of 50% alcohol and 20% carbowax
Saccomano’s fixative
66
Composition of Saccomano’s fixative
50% alcohol
20% carbowax
67
Used fixative for ALL types of effusions
50% alcohol
68
Fixative for peritoneal and pleural fluids
50% alcohol
69
Fixative for sputum
70% alcohol
70
Fixative for urine, gastric, and bronchial aspirates
95% alcohol
71
Best fixative for bloody specimens (in tissue processing)
Carnoy’s fluid
72
Composition of Carnoy’s fluid
Equal parts of tertiary butyl alcohol and 1 part of 95% ethanol
73
Other fixatives for exfoliative cytology
Carnoy’s fluid
Schaudinn’s fluid
74
Purpose of PAP smear
screening test for cervical CA
hormonal evaluation
75
Gold standard stain for cytology
PAPANICOLAU STAIN
76
PAP STAIN COMPONENTS
Harris Hematoxylin
OG6
EA 50
77
Nuclear stain of PAP stain
Harris Hematoxylin
78
Counterstains of PAP stain
OG6
EA50
79
PAP counterstain
Stains the cytoplasm of superficial cells
OG6
80
PAP counterstain
Stains the cytoplasm of both parabasal and intermediate cells
EA 50
81
Stain for routine tissue processing
H&E
82
H&E COMPONENTS – for routine tissue processing
Hematoxylin - Nuclear dye
Eosin - Cytoplasmic dye
83
PAP stain result:
Vesicular nucleus
blue
84
PAP stain result:
Pyknotic nucleus
dark blue to black
85
PAP stain result:
Cytoplasm (superficial)
orange + hint of green
*using OG6
86
PAP stain result:
Cytoplasm (parabasal and intermediate)
olive green + hint of brown and red
*using EA36-50
87
PAP stain result:
Bacteria
dark blue
88
PAP stain result:
Mycelia
violet
89
PAP stain result:
T. vaginalis
pale greenish blue
90
PAP SMEAR METHODS
Conventional PAP’s
Liquid Based PAP’s
91
Ob-gyne collects specimen from the patient directly smeared using an Ayre’s spatula on to the slide; spread in disorderly manner
Disadvantage: Difficult for pathologist to view individual cells microscopically (crowded/overlapping cells)
Conventional PAP’s
92
Use of spatula or brush/broom to collect specimen → vial with preservative. Thin cell layer is placed on a slide.
Liquid Based PAP’s
93
COLLECTION SITES FOR PAP SMEAR
T-zone (Transformation zone)
Endocervix (simple columnar epithelium)
Ectocervix (stratified squamous non-keratinized epithelium)
Upper third of the vaginal wall
94
Collection site for PAP smear; junction between the endocervix and ectocervix
T-zone (Transformation zone)
95
Collection site for evaluation of endocervical or intrauterine lesions
Endocervix (simple columnar epithelium)
96
Most common site for cancer screening
Ectocervix (stratified squamous non-keratinized epithelium)
97
Collection site for evaluation of inflammatory conditions
Upper third of the vaginal wall
98
Based on the specific response of vaginal epithelium to steroid hormones
HORMONAL CYTOLOGY
99
4 MAIN VAGINAL CELLS (presence of these cells in PAP smear are based on the steroid hormones)
1. Superficial
2. Intermediate
3. Parabasal
4. Basal
100
Vaginal cell NOT NORMALLY SHED
Basal
101
STEROID HORMONES
ESTROGEN
PROGESTERONE
102
Steroid hormones that influence desquamation of superficial cells
ESTROGEN
103
Steroid hormones that influence desquamation of intermediate cells
PROGESTERONE
104
most predominant steroid hormone in menopause
E1 (Estrone)
105
most predominant steroid hormone in reproductive years
E2 (Estradiol)
106
most plenty steroid hormone, but least potent
E3 (Estriol)
107
✓ Performed regularly even in pregnant women without undue risk (especially when sexually active)
✓ Inexpensive
✓ No lubricant or vaginal wash must be used
✓ Smears are taken from the upper lateral third of vaginal wall
PAP smear for hormonal cytology
108
Largest; most mature cells in PAP smear with pyknotic (smallest) nuclei
SUPERFICIAL CELLS
109
Size of superficial cells
30-60 u
110
Polyhedral flat cells and cytoplasm may be acidophilic or basophilic
SUPERFICIAL CELLS
111
Medium sized cells in PAP smear
INTERMEDIATE CELLS
112
INTERMEDIATE CELL size
20-30 u
113
Polyhedral cells; basophilic cytoplasm with vacuoles
INTERMEDIATE CELLS
114
Types of intermediate cells
Navicular cells
Pregnancy cells
115
Intermediate cell, boat-shaped cells with a tendency to fold or curl on edges
Navicular cells
116
Navicular cells are seen during these conditions
* Latter half of menstrual cycle, during pregnancy or menopause
* Progesterone-estrogen effect
* Abnormal androgen stimulation
117
Round to oval with translucent basophilic cytoplasm observed greatest at the center of the cell due to glycogen accumulation
Pregnancy cells
118
Round to oval cells in PAP smear with strongly basophilic cytoplasm
PARABASAL CELLS
119
PARABASAL CELLS are found in
– 2 weeks of age to puberty
– after childbirth
– abortion
– after menopause
120
Smallest cells in PAP smear; NOT normally shed (shed traumatically)
BASAL CELLS
121
Size of PARABASAL CELLS
15-30 u
122
Size of BASAL CELLS
13-20 u
123
Round to slightly oval cells with large nucleus occupying half or more of cell volume, with strongly basophilic cytoplasm
BASAL CELLS
124
Found only before pregnancy and ff> menopause
BASAL CELLS
125
Cells found during and 1-4 days after menstruation
ENDOMETRIAL CELLS
126
Occurring in groups of >3, shed in response to ovarian hormone
ENDOMETRIAL CELLS
127
If seen in post-menopausal women, it may indicate possible endometrial carcinoma or endometrial hyperplasia
ENDOMETRIAL CELLS
128
Indicated when endometrial cells are seen in post-menopausal women
Endometrial carcinoma
Endometrial hyperplasia
129
Cells occurring in large groups or sheets
ENDOCERVICAL GLANDULAR CELL
130
Cells forming honeycomb appearance
ENDOCERVICAL GLANDULAR CELL
131
ABNORMAL CELLULAR COMPONENTS IN PAP’S
Yeast (Candida albicans)
Trichomonas vaginalis
Clue cells
Koilocytes
Doderlain bacillus
132
Yeast (Candida albicans) are seen in these conditions:
Diabetic patients
Oral contraceptives
Prolonged steroid therapy
Immunocompromised patients
133
Pear shaped parasite causing trichomoniasis
Trichomonas vaginalis
134
squamous cells with attached bacilli – gram variable Gardnerella vaginalis
Clue cells
135
indicative of bacterial vaginosis
clue cells
136
abnormal squamous with atypical nucleus surrounded by non-staining halo, indicative of HPV infection
Koilocytes
137
Normal flora; but abnormal if increased in last trimester of pregnancy, infection, estrogen deficiency, and DM
Doderlain bacillus
138
Doderlain bacillus is INCREASED in:
▪ Last trimester of pregnancy
▪ Infection
▪ Estrogen deficiency
▪ DM
139
Involves evaluation of hormonal status based on the distribution of cells
CYTOHORMONAL MATURATION INDEX (CHMI)
140
Cells included in CHMI
Parabasal, Intermediate, Superficial cells (total of 100)
141
T/F
In CHMI, result should be correlated with age and LMP of the patient
T
142
CHMI in Newborns
0 / 90 / 10
143
CHMI in Menopause
0 / 80 / 20
144
CHMI in Post ovulatory
0 / 70 / 30
145
Old method, obsolete manner of reporting PAP’s
Class System
146
In Class system, this indicates negative for malignancy
Class I
147
In Class system, this indicates conclusive for malignancy
Class V
148
New system of reporting cervical, vaginal cytologic smears
Bethesda System
149
Developed at national Cancer Institute December 1988
Bethesda System
150
REPORT FORMAT OF PAP SMEAR
A) Specimen Adequacy
B) General Categorization
C) Descriptive Diagnosis
