Gastrointestinal cytopathology

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Gastrointestinal cytopathology is a relatively small part of cytopathology.

This article deals only with gastrointestinal cytopathology. An introduction to cytopathology is in the cytopathology article. Histopathology of the gastrointestinal tract is dealt with in gastrointestinal pathology.

Liver

Normal:

  • Liver cells may be binucleated.
  • Hepatocytes:
    • Abundant cytoplasm, central nucleus.
    • Bile ductules between adjacent cells.
    • +/-Yellow granular pigment (bile).

Hepatocellular carcinoma

Cytology

Features:

  • Clusters of liver cells surrounded by endothelial cells.[1]
  • +/-Nuclear atypia.

Notes:

  • Low grade HCC is composed of cytologically normal appearing cells; the arrangement is what is diagnostic of malignancy.[1]

Image:

Cholangiocarcinoma

Cytology

Features:

  • Looks like an adenocarcinoma:
    • Eccentric nuclei, one nucleolus per cell, abundant cytoplasm, nuclear size var. cell-to-cell, irregular nuclear membrane, irregular/uneven chromatin pattern.

Common bile duct

Normal:

  • Monolayer of small blue cells.

Notes:

  • Caution is advised when calling malignancy in the setting of a stent or stones.

Adenocarcinoma

Features:

  • Hyperchromasia.
  • Pencil-shaped nuclei.
  • Nuclear membrane irregularities.

Images:

Stomach

  • May be difficult to distinguish from pancreas ductal epithelium.[2]

Small bowel

Epithelium:[2]

  • Small blue cells.
  • Goblet cells - key feature.

Notes:

  • May appear to be similar to stomach and pancreatic duct.[2]

Esophagus

  • Cytology may be done to look for candida.
    • Report should comment on the presence of candida - if it is seen.

Pancreas

A short DDx:

Mucinous tumours

Features:

  • Mucin.

Image:

Solid pseudopapillary neoplasm

Cytology

Features:[4]

  • Small cells with:
    • Scant cytoplasm.
    • +/-Nuclear grooves.
  • Papillary formations.

IHC

  • PR +ve.
  • Beta-catenin +ve.
  • CD10 +ve.

Others:

  • Chromogranin A -ve.

Pancreatic neuroendocrine tumour

Cytology

Features:

  • Round nuclei with granular chromatin.
    • typically no nucleolus.
    • Moderate nuclear size variation.

IHC

  • Chromogranin A +ve.
  • Synaptophysin +ve.

See also

References

  1. 1.0 1.1 Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 679. ISBN 978-1416025887.
  2. 2.0 2.1 2.2 Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 680 (Q23). ISBN 978-1416025887.
  3. URL: http://moon.ouhsc.edu/kfung/jty1/OPAQ/PNPT/PN-NS01-Ans.htm. Accessed on: 22 February 2012.
  4. URL: http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-029-M.htm. Accessed on: 9 April 2012.