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=Liver= | =Liver= | ||
Brief DDx: | |||
* | *Metastatic adenocarcinoma, usu. colorectal adenocarcinoma. | ||
*Hepatocellular carcinoma. | |||
Others: | |||
*[[Cholangiocarcinoma]] - usu. adenocarcinoma NOS, i.e. non-specific. | |||
*[[Epithelioid hemangioendothelioma]]. | |||
*[[Angiomyolipoma]]. | |||
==Normal liver== | |||
===Cytology=== | |||
Features: | |||
*Hepatocytes: | *Hepatocytes: | ||
**Abundant cytoplasm | **Abundant cytoplasm | ||
** | **central nucleus +/- binucleation. | ||
**+/-Yellow granular pigment (bile). | **+/-Yellow granular pigment (bile). | ||
*Bile ductules between adjacent cells. | |||
==Hepatocellular carcinoma== | ==Hepatocellular carcinoma== | ||
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===Cytology=== | ===Cytology=== | ||
Features: | Features: | ||
*Cohesive clusters of ( | *Architecture - single cells and large clusters: | ||
* | **Cohesive clusters of cells (hepatocytes) surrounded by endothelial cells - '''diagnostic'''.<ref name=Ref_APBR679>{{Ref APBR|679}}</ref> | ||
*+/- | **Capillaries traversing the fragments. | ||
*Cells: | |||
**Central nucleus +/-prominent nucleoli,<ref name=ouhsc_34/> +/-nuclear inclusions. | |||
**+/-Multinucleation. | |||
**+/-Yellow cytoplasmic pigment (bile). | |||
**+/-Nuclear atypia. | |||
**+/-High NC ratio. | |||
Notes: | Notes: | ||
*Low grade [[HCC]] is composed of cytologically normal appearing cells; the arrangement is what is diagnostic of malignancy.<ref name=Ref_APBR679>{{Ref APBR|679}}</ref> | *Low grade [[HCC]] is composed of cytologically normal appearing cells; the arrangement is what is diagnostic of malignancy.<ref name=Ref_APBR679>{{Ref APBR|679}}</ref> | ||
*[[Fibrolamellar HCC]] has very large cells. | |||
Images: | Images: | ||
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==Cholangiocarcinoma== | ==Cholangiocarcinoma== | ||
{{Main|Cholangiocarcinoma}} | {{Main|Cholangiocarcinoma}} | ||
===Cytology=== | ===Cytology=== | ||
Features: | Features: | ||
*Looks like an adenocarcinoma: | *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. | **Eccentric nuclei, one [[nucleolus]] per cell, abundant cytoplasm, nuclear size var. cell-to-cell, irregular nuclear membrane, irregular/uneven chromatin pattern. | ||
==Epithelioid hemangioendothelioma== | |||
{{Main|Epithelioid hemangioendothelioma}} | |||
===General=== | |||
*Rare. | |||
===Cytology=== | |||
Features: | |||
*Large atypical cells with: | |||
**Nuclear inclusions | |||
**Moderate cytoplasm. | |||
**+/-Multinucleation. | |||
===IHC=== | |||
*Factor VIII +ve. | |||
=Common bile duct= | =Common bile duct= | ||
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*Nuclear membrane irregularities. | *Nuclear membrane irregularities. | ||
Images | ===Images=== | ||
<gallery> | |||
*[http:// | Image:Colorectal_adenocarcinoma_cytology_low_mag.jpg | Colorectal adenocarcinoma - low mag. (WC) | ||
Image:Colorectal_adenocarcinoma_cytology_intermed_mag.jpg | Colorectal adenocarcinoma - intermediate mag. (WC) | |||
</gallery> | |||
====www==== | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3418535/figure/f16/ Colonic carcinoma (nlm.nih.gov)].<ref name=pmid22943018>{{Cite journal | last1 = Conrad | first1 = R. | last2 = Cobb | first2 = C. | last3 = Raza | first3 = A. | title = Role of cytopathology in the diagnosis and management of gastrointestinal tract cancers. | journal = J Gastrointest Oncol | volume = 3 | issue = 3 | pages = 285-98 | month = Sep | year = 2012 | doi = 10.3978/j.issn.2078-6891.2012.023 | PMID = 22943018 }}</ref> | |||
=Stomach= | =Stomach= | ||
==Normal stomach== | |||
===General=== | |||
*Important as it may be a contaminant in a pancreatic FNA. | |||
===Cytology=== | |||
Features: | |||
*Bland cells with round nuclei. | |||
*Granular cells with red cytoplasm (on Pap stain) - parietal cells - distinctive. | |||
Note: | |||
*May be difficult to distinguish from pancreas ductal epithelium.<ref name=Ref_APBR680>{{Ref APBR|680 (Q23)}}</ref> | *May be difficult to distinguish from pancreas ductal epithelium.<ref name=Ref_APBR680>{{Ref APBR|680 (Q23)}}</ref> | ||
=Small bowel= | =Small bowel= | ||
Epithelium:<ref name=Ref_APBR680>{{Ref APBR|680 (Q23)}}</ref> | Epithelium:<ref name=Ref_APBR680>{{Ref APBR|680 (Q23)}}</ref> | ||
* | *Orderly flat sheets of smaller (blue) cells without atypia.<ref name=pmid22943018/> | ||
**"Orderly" = nuclei do not overlapped. | |||
*Goblet cells - '''key feature'''. | *Goblet cells - '''key feature'''. | ||
Notes: | Notes: | ||
*May appear to be similar to stomach and pancreatic duct.<ref name=Ref_APBR680>{{Ref APBR|680 (Q23)}}</ref> | *May appear to be similar to stomach and pancreatic duct.<ref name=Ref_APBR680>{{Ref APBR|680 (Q23)}}</ref> | ||
===Images=== | |||
====www==== | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3418535/figure/f15/ Normal duodenal mucosa and duodenal adenocarcinoma (nlm.nih.gov)].<ref name=pmid22943018>{{Cite journal | last1 = Conrad | first1 = R. | last2 = Cobb | first2 = C. | last3 = Raza | first3 = A. | title = Role of cytopathology in the diagnosis and management of gastrointestinal tract cancers. | journal = J Gastrointest Oncol | volume = 3 | issue = 3 | pages = 285-98 | month = Sep | year = 2012 | doi = 10.3978/j.issn.2078-6891.2012.023 | PMID = 22943018 }}</ref> | |||
=Esophagus= | =Esophagus= | ||
*Cytology may be done to look for candida. | *Cytology may be done to look for candida. | ||
**Report should comment on the presence of candida - if it is seen. | **Report should comment on the presence of candida - if it is seen. | ||
A short DDx: | |||
*Barrett's esophagus. | |||
*Candida. | |||
*[[HSV]]. | |||
*[[GIST]]. | |||
=Pancreas= | =Pancreas= | ||
A short DDx: | A short DDx: | ||
* | *Normal: | ||
*[[Serous cystadenoma of the pancreas]]. | **Duct. | ||
*[[IPMN]]. | **Acini. | ||
*[[Mucinous cystadenoma of the pancreas]]. | *Cystic lesions: | ||
*[[Solid pseudopapillary neoplasm]]. | **[[Serous cystadenoma of the pancreas]]. | ||
*[[Pancreatic neuroendocrine tumour]]. | **[[IPMN]]. | ||
**[[Mucinous cystadenoma of the pancreas]]. | |||
**[[Solid pseudopapillary neoplasm]]. | |||
*Others: | |||
**[[Ductal carcinoma of the pancreas]]. | |||
**[[Pancreatic neuroendocrine tumour]]. | |||
==Normal pancreas== | |||
===Cytology=== | |||
Features - duct: | |||
*2-D sheet of cells - equally spaced. | |||
*Moderate-to-abundant cytoplasm. | |||
Features - acini: | |||
*Clustered cells +/- nuclear overlap. | |||
*Round bland nuclei. | |||
**Small nucleoli. | |||
*Moderate cytoplasm. | |||
==Pancreatic pseudocyst== | |||
===General=== | |||
*Symptomatic, e.g. abdominal pain. | |||
**Asymptomatic pseudocysts are typically observed, as a large number resolve spontaneously.<ref name=pmid20142757>{{Cite journal | last1 = Gumaste | first1 = VV. | last2 = Aron | first2 = J. | title = Pseudocyst management: endoscopic drainage and other emerging techniques. | journal = J Clin Gastroenterol | volume = 44 | issue = 5 | pages = 326-31 | month = | year = | doi = 10.1097/MCG.0b013e3181cd9d2f | PMID = 20142757 }}</ref> | |||
*Classically associated with [[pancreatitis]] secondary to [[alcohol]].<ref name=pmid14730118>{{Cite journal | last1 = Andrén-Sandberg | first1 = A. | last2 = Dervenis | first2 = C. | title = Pancreatic pseudocysts in the 21st century. Part I: classification, pathophysiology, anatomic considerations and treatment. | journal = JOP | volume = 5 | issue = 1 | pages = 8-24 | month = Jan | year = 2004 | doi = | PMID = 14730118 |URL = http://www.joplink.net/prev/200401/08.html }}</ref> | |||
*Pathologic diagnosis of exclusion. | |||
===Cytology=== | |||
Features: | |||
*Histiocytes. | |||
**Should be paucicellular otherwise. | |||
*Necrotic debris - granular. | |||
Note: | |||
*Pseudocysts, by definition, do '''not''' have an epithelial lining. | |||
*Luminal GI tract contamination - may lead to confusion with mucinous neoplasm. | |||
DDx: | |||
*Mucinous neoplasm. | |||
*Serous neoplasm. | |||
==Serous neoplasm== | |||
===General=== | |||
*May be associated with [[von Hippel-Lindau syndrome]]. | |||
*Usu. body or tail. | |||
*Classically have a central stellate scar - seen radiologically. | |||
== | ===Cytology=== | ||
Features: | Features: | ||
* | *Cuboidal/flat cells in clusters or sheets. | ||
*+/-Nuclear grooves. | |||
===Stains=== | |||
*PAS +ve. | |||
*PASD -ve. | |||
==Mucinous neoplasm== | |||
===General=== | |||
*Pancreatic head: classically IPMN. | |||
**IPMN assoc. with colloid carcinoma. | |||
*Pancreatic body & tail: mucinous tumour. | |||
===Cytology=== | |||
Features: | |||
*Clusters or sheets of mucinous cells. | |||
*+/-Nuclear atypia. | |||
*+/-Thick mucin. | |||
**Suggestive of IPMN. | |||
Notes: | |||
*In the body & tail mucinous cells may be contamination from the [[stomach]]. | |||
**Lesions in the pancreatic head are approached from the duodenum - do not have this problem. | |||
*Ovarian stroma is '''not''' seen on cytology. | |||
*Thick mucin may be from stomach. | |||
Image: | Image: | ||
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==Solid pseudopapillary neoplasm== | ==Solid pseudopapillary neoplasm== | ||
{{Main|Solid pseudopapillary neoplasm}} | {{Main|Solid pseudopapillary neoplasm}} | ||
*Abbreviated ''SPN''. | |||
===General=== | |||
*Young women. | |||
*Tail of pancreas. | |||
===Cytology=== | ===Cytology=== | ||
Features:<ref name=ouhsc_26>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-029-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-029-M.htm]. Accessed on: 9 April 2012.</ref> | Features:<ref name=ouhsc_26>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-029-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-029-M.htm]. Accessed on: 9 April 2012.</ref> | ||
* | *Papillary formations - composed of small cells with: | ||
**Scant cytoplasm. | **Scant cytoplasm. | ||
**+/-Nuclear grooves. | **+/-Nuclear grooves. | ||
* | *+/-Cholesterol clefts. | ||
Note: | |||
*There are no '''true''' papillae in [[SPN]]. | |||
DDx: | |||
*[[Pancreatic pseudocyst]]. | |||
*[[Pancreatic neuroendocrine tumour]] - single cells, classically plasmacytoid. | |||
===IHC=== | ===IHC=== | ||
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==Pancreatic neuroendocrine tumour== | ==Pancreatic neuroendocrine tumour== | ||
{{Main|Pancreatic neuroendocrine tumour}} | {{Main|Pancreatic neuroendocrine tumour}} | ||
*Previously known as ''islet cell tumour of the pancreas''. | |||
===General=== | |||
*Classically solid. | |||
**May be cystic. | |||
===Cytology=== | ===Cytology=== | ||
Features: | Features: | ||
*Round nuclei with | *Round nuclei with salt and pepper chromatin. | ||
**Moderate nuclear size variation. | **Moderate nuclear size variation. | ||
*Classically single cells with [[plasma cell|plasmacytoid]] morphology. | |||
DDx: | |||
*[[Solid pseudopapillary neoplasm]]. | |||
===IHC=== | ===IHC=== | ||
*Chromogranin A +ve. | *Chromogranin A +ve. | ||
*Synaptophysin +ve. | *Synaptophysin +ve. | ||
==Pancreatic adenocarcinoma== | |||
{{Main|Invasive ductal carcinoma of the pancreas}} | |||
*[[AKA]] ''ductal carcinoma''. | |||
===Cytology=== | |||
Features: | |||
*Single cells. | |||
**Should be present. | |||
*Monolayer of irregularly spaced cells - described as "drunken honeycomb". | |||
*Nuclear atypia +/-grooves, +/-chromatin clearing. | |||
**Significant atypia: >=4:1 ratio between the nuclear diameter of cells. | |||
Image: | |||
*[http://www.flickr.com/photos/euthman/322383640/ Pancreatic adenocarcinoma - marked nuclear atypia - low mag. (flickr.com/euthman)]. | |||
*[http://www.flickr.com/photos/euthman/322383635/ Pancreatic adenocarcinoma - marked nuclear atypia - high mag. (flickr.com/euthman)]. | |||
*[http://www.flickr.com/photos/euthman/5558060009/ Pancreatic adenocarcinoma - drunken honeycomb - low mag. (flickr.com/euthman)]. | |||
*[http://www.flickr.com/photos/euthman/5558642608/ Pancreatic adenocarcinoma - drunken honeycomb - high mag. (flickr.com/euthman)]. | |||
==Acinar cell carcinoma== | |||
{{Main|Acinar cell carcinoma of the pancreas}} | |||
===General=== | |||
*Very rare. | |||
===Cytology=== | |||
Features: | |||
*High cellularity - '''important feature'''. | |||
*Lack of ducts. | |||
*Single cells and small cell clusters with abundant granular (metachromatic) cytoplasm - similar to normal pancreatic acini. | |||
*Naked nuclei. | |||
Note: | |||
*Considered to be a difficult diagnosis. | |||
=See also= | =See also= | ||
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=References= | =References= | ||
{{Reflist|2}} | {{Reflist|2}} | ||
=External links= | |||
*[http://www.thejgo.org/article/view/438/html Cytopathology of the GI tract (thejgo.org)]. | |||
[[Category:Cytopathology]] | [[Category:Cytopathology]] |
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