Cytopathology

Cytopathology

Feb. 21. 2016

Cytopathology

Study of pathological changes at cellular level. Samples are fluid or free cells, Cytopathology = cytology, which means "the study of cells. Cytopathologic tests = smear tests; samples are smeared across glass slide for staining and examination.

Role of cytopathology

Early detection, or confirmation of diseases (malignant or pre-malignant lesions), without surgical trauma. Diagnosis of hormonal imbalance. Useful in flow up the course of disease or monitoring therapy.

Advantages of FNA

Easy “painless” office procedureQuick (dx in minutes)InexpensiveDecreases hospital costsHelps patient plan treatment in case of carcinomaHelps alleviate anxiety in benign diseaseUseful in pregnant patientsDiagnostic and therapeutic in benign cysts

Disadvantages of FNA

False negatives False positives Special training needed to perform and interpret FNA In situ Vs invasive carcinoma Endocrine malignancy, of limited value. Complications


Cytopathology can be subdivided into: Fine Needle Aspiration (FNA): include FNA of breast, FNA of thyroid, LN, soft tissue mass…….etc. Gynecological Cytology, include cervicovaginal cytology (Pap smear, vaginal smear). Non gynecological Cytopathology Include cytological examination of all other organs (e.g. Resp. system cytology, urine, sputum, CSF, & Serous fluid cytology……etc.)


Other classification; TYPES OF CYTOPATHOLOGY: Fine Needle Aspiration (FNA) Exfoliative cytopathology Forcible removed cytopathology

Types of Exfoliated cytopathology

Natural spontaneous exfoliation Natural covering epithelium: skin, urinary tract, vagina, and cervix. Glandular epithelial secretion: Breast (Nipple secretion). Sputum Urine Exudates and transudate: Pleural fluid Peritoneal fluid Pericardial fluid Joint fluid CSF


Artificial enhanced exfoliation: Scrapings from cervix, vagina, oral cavity, & skin Brushing and lavage: bronchi, GIT, and UT Fine needle aspiration (FNA) for: Body cavity fluid: pleural, pericardial & peritoneal fluids Cysts: neck, breast & ovary Solid tissue: body organs, tumors & other swell
Types of Exfoliated cytopathology

Fine Needle Aspiration Cytology (FNAC) e.g FNA of breast, thyroid, LN, Mass.

Cytology technique

Cytology technique

Quick aspiration (avoid blood clot) Quick transfer of material on slides Proper smearing (avoid crush) Immediate fixation (avoid air dry) Papanicoulau stain, H&E stain (alcohol fixed) Romanowsky type stain (air dry) Cell block (Optional)

Smearing on labeled slides

Smears spreading

Fixation - 95% Ethyl Alcohol for 20 -30 Min

Fixatives used in Cytopathology: 95% ethyl alcohol.Spray fixatives (does not result in lysis of RBC & better reserved of nuclear details). Saccomanno's fixative (50% ethyl alcohol + 2% polyethylene glycol).Carnoy’s fixative (lysis of RBC).Other (Formaline, Glutarldehyde). Fixation in 95% alcohol for 20 -30 Min

Types of staining smears

1. Papnicolaou stain (Pap): Good demonstration of nuclear details. 2. Hematoxyline & Eosin (H&E): 3. Leishman & Giemsa stains: Other special stains for the most suspected diseases, to confirm diagnosis. Cell block for remnant sediment and histopathological examination

FNA 0f Breast: FNA is by far the most popular , simple, cost effective, reliable, & diagnostic procedure in cytological diagnosis of breast lesions. FNA is important part in triple screening for early detection of beast carcinoma (physical examination, mammography & FNA).

Fibroadenoma

Staining & L/M Examination
Breast adenocarcinoma

Breast adenocarcinoma

Staining & L/M Examination

Cytopathology

Exfoliative cytology or cytopathology. Sputum Serous effusion Urine & CSF cytopathology.



Sputum Cytology: Highly diagnostic values for centrally located lung cancer. Three to five consecutive daily sputum. Spontaneously coughed or induced. Fixed in 95% ethyl alcohol, or in Saccomanno's fixative (50% ethyl alcohol + 2% polyethylene glycol). Sputum sample is considered satisfactory when it contains alveolar macrophages.

Saccomanno's Cytology Fixative

Widely used fixative in Cytology. For FNA'S, urine, sputums, bronchial washings, pleural and peritoneal fluids. 50% Ethyl alcohol + 2% polyethylene glycol Protect specimens from autolysis, (best for specimens transported or held for some time). for sputum separates mucus from the specimen cells so the cells can be evenly spread onto a microscope slide

Sputum cytology - Inflammatory

Sputum cytology – Sq. C. Ca. Normal epith

Sputum cytology – Adenoca.

Serous effusions Cytology
1ml of heparin + 100ml of effusion fluid to prevent clotting


Gross exam Cytological smears exam; Establish the presence or absence of malignancy (primary or metastatic ca. to these sites) . Other special test (Chemistry, Microbiology (
1ml of heparin + 100ml of effusion fluid to prevent clotting
Serous effusions Cytology

Smears spreading

Fixation - 95% Ethyl Alcohol for 20 -30 Min

Accumulation of fluids in body cavities

Differences Between a Transudate and an Exudate
Feature Transudate Exudate
Gross appearance Watery, clear Cloudy, reddish Specific gravity <1.015 >1.015 Protein <3.0 g/dl >3.0 g/dl Clots No Yes Cells Few; usually benign Many; can be malignant
Exudate Inflammation: Infection, infarction, hemorrhage & tumor
Transudates Increased hydrostatic pressure: Congestive heart failure Decreased oncotic pressure: cirrhosis, nephrosis, and malnutrition. (decreased albumin)
Serous effusions

Reactive mesothelial cells

Malignant cells



“More and bigger cells, in more and bigger clusters” Cell-in-cell pattern Malignant Mesothelioma

Irregular clusters of cells Large and clear vacuoles

Ovarian carcinoma
Signet ring cell pattern
Gastric carcinoma

Squamous cell carcinoma

Keratinized or non-keratinized Tadpoles and bizarre shape

Skin lesion smear