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Cytopathology (view source)

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[[Image:Serous carcinoma 2c - cytology.gif | thumb| right|An animation showing two [[micrograph]]s in different planes of focus of a cytopathology specimen with [[serous carcinoma]]. (WC)]]
[[Image:Granulomatous inflammation - alt -- high mag.jpg|thumb|right|Granulomatous inflammation in the hilum of lung. [[Diff-Quik stain]].]]
'''Cytopathology''', often called ''cytology'', is the study of pathologic changes in cells.
'''Cytopathology''', often called ''cytology'', is the study of pathologic changes in cells.
Specimen types include exfoliated [[cervical cytology]] (Pap tests), [[urine cytology|urine]], [[mesothelial cytopathology|body cavity fluids]] (pleural, pericardial, and peritoneal), [[CNS cytopathology|cerebrospinal fluid]], and fine needle aspirations from any body site, among others (see ''[[Cytopathology#Detail_articles|detail articles section]]''). These are often collected by minimally invasive means.
Cytologic preparation methods usually include viewing single cells or small clusters of cells on slides, in contrast to surgical biopsy specimens that usually include larger pieces of tissue, with tissue architecture. In some institutions, small tissue biopsies such as core needle biopsies may also be assigned to the cytology service.


It is often divided into ''[[gynecologic cytology|gynecologic]]'' and ''non-gynecologic''.  ''Gynecologic'' in this context usually refers to Pap test specimens, i.e. uterine cervix, vaginal vault; other gynecologic specimens are considered ''non-gynecologic''.
It is often divided into ''[[gynecologic cytology|gynecologic]]'' and ''non-gynecologic''.  ''Gynecologic'' in this context usually refers to Pap test specimens, i.e. uterine cervix, vaginal vault; other gynecologic specimens are considered ''non-gynecologic''.
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=Cell types=
=Cell types=
WG's cell typing guide:<ref>WG. 6 January 2010.</ref>
WG's cell typing guide:<ref>WG. 6 January 2010.</ref>
{| class="wikitable"
{| class="wikitable sortable"
|-
|-
!
! Cell type
! Nucleus location
! Nucleus location
! Nucleus shape
! Nucleus shape
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#Hydropic.
#Hydropic.


The last two are the most important.
Notes:
 
*The last two are the most important.
<!-- *Way to remember? ''Gay fat philosophers have much g___''  -->
====Vacuoles====
====Vacuoles====
''Hydropic vacuoles'' and ''secretory vacuoles'':<ref>SM. 5 January 2010.</ref>
''Hydropic vacuoles'' and ''secretory vacuoles'':<ref>SM. 5 January 2010.</ref>
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| -
| -
|-
|-
| Mesothelioma (see ''Note 1'')
| [[Malignant mesothelioma|Mesothelioma]] (see ''Note 1'')
| Clusters (usu. large), single cells
| Clusters (usu. large), single cells
| Knobby border
| Knobby border
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===Romanowsky stains===
===Romanowsky stains===
Variants:
Variants:
*Diff-Quik.
*[[Diff-Quik]].
*Field's stain.
*Field's stain.
*May-Grünwald-Giemsa.
*May-Grünwald-Giemsa.
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Interpretation (Romanowsky stain):<ref>{{cite journal |author=Horobin RW, Walter KJ |title=Understanding Romanowsky staining. I: The Romanowsky-Giemsa effect in blood smears |journal=Histochemistry |volume=86 |issue=3 |pages=331–6 |year=1987 |pmid=2437082 |doi= |url=http://www.springerlink.com/content/r81x25451m841866/}}</ref>
Interpretation (Romanowsky stain):<ref>{{cite journal |author=Horobin RW, Walter KJ |title=Understanding Romanowsky staining. I: The Romanowsky-Giemsa effect in blood smears |journal=Histochemistry |volume=86 |issue=3 |pages=331–6 |year=1987 |pmid=2437082 |doi= |url=http://www.springerlink.com/content/r81x25451m841866/}}</ref>
*Red - RBCs, eosinophil granules, neuroendocrine granules.<ref name=pmid9769124>{{cite journal |author=Sapino A, Papotti M, Pietribiasi F, Bussolati G |title=Diagnostic cytological features of neuroendocrine differentiated carcinoma of the breast |journal=Virchows Arch. |volume=433 |issue=3 |pages=217–22 |year=1998 |month=September |pmid= |doi= |url=}}</ref>
*Red - [[RBC]]s, [[eosinophil]] granules, neuroendocrine granules.<ref name=pmid9769124>{{cite journal |author=Sapino A, Papotti M, Pietribiasi F, Bussolati G |title=Diagnostic cytological features of neuroendocrine differentiated carcinoma of the breast |journal=Virchows Arch. |volume=433 |issue=3 |pages=217–22 |year=1998 |month=September |pmid= |doi= |url=}}</ref>
*Blue (basophilic) - lymphocyte cytoplasm.
*Blue (basophilic) - lymphocyte cytoplasm.
*Purple - nuclear chromatin, neutrophil granules, platelets.
*Purple - nuclear chromatin, neutrophil granules, platelets.
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Standards are lacking for most types of specimens.  A generally accepted standard is established only for cervical cytology specimens.
Standards are lacking for most types of specimens.  A generally accepted standard is established only for cervical cytology specimens.
===Non-gynecologic===
===Non-gynecologic===
Standards (UHN) for non-gyne specimens:<ref>UHN PCY50001.08 P.11.</ref>
Standards at one large centre for non-gyne specimens:<ref>UHN PCY50001.08 P.11.</ref>
*Breast: >= 6 cell groups (6 cells/cluster).
*Breast: >= 6 cell groups (6 cells/cluster).
*Thyroid: >= 20 cell cluster (20 cells/cluster).
*Thyroid: >= 20 cell cluster (20 cells/cluster).
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==Principles of FNA==
==Principles of FNA==
General:
General:
*Fine needle aspiration of superficial lesions may be performed by pathologists or other clinicians
*Fine needle aspiration of deep-seated lesions may be performed by interventional radiologists under imaging guidance
*Endobronchial ultrasound may be used by pulmonologists and thoracic surgeons to access pulmonary lesions, while endoscopic ultrasound may be used by gastroenterologists to access GI tract or pancreatic lesions
*Fine needle aspiration is an oxymoron.<ref>SB. 11 January 2010.</ref>
*Fine needle aspiration is an oxymoron.<ref>SB. 11 January 2010.</ref>
**One does not really aspirate.
**One does not really aspirate.


Principles:<ref>SB. 11 January 2010.</ref>
Principles:<ref>SB. 11 January 2010.</ref>
*Use a small needle - 22 gauge.
*Use a small needle - 22-25 gauge.
*Use minimal suction - aspiration per se is not the key; the sample is obtained by coring.
*Use minimal suction - aspiration per se is not the key; the sample is obtained by coring.
*Use minimal back and forth angulation - it destroys blood vessels
*Use minimal back and forth angulation - it destroys blood vessels
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=Triage of specimens=
=Triage of specimens=
At UHN the specimens are triaged.  This is an uncommon practise in the world of cytopathology.
At some large centres the specimens are triaged.  This is an uncommon practise in the world of cytopathology.


Options:
Options:
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Note 1:
Note 1:
*''Sure-Path'' (from TriPath) is not used at many teaching centres as it has some short coming for non-gyne specimens vis-a-vis ''ThinPrep'' (from Cytyc).<ref>SM. January 2010.</ref>   
*''Sure-Path'' (from TriPath) is not used at many teaching centres (in Ontario) as it has some short coming for non-gyne specimens vis-a-vis ''ThinPrep'' (from Cytyc).<ref>SM. January 2010.</ref>   
**It is used by the private labs in Ontario and seems to be better for Pap tests.
**It is used by the private labs in Ontario and seems to be better for Pap tests.
*A comparison between ''SurePath'' and ''ThinPrep''/experience from one lab in the USA is here: [http://www.palpath.com/MedicalTestPages/papthin1.htm http://www.palpath.com/MedicalTestPages/papthin1.htm].
*A comparison between ''SurePath'' and ''ThinPrep''/experience from one lab in the USA is here: [http://www.palpath.com/MedicalTestPages/papthin1.htm http://www.palpath.com/MedicalTestPages/papthin1.htm].
Note 2 - see ''[[lymphoma]]'' article for detailed description of markers:
Note 2 - see ''[[lymphoma]]'' article for detailed description of markers:
*The typical "full" panel is:  
*The typical "full" panel is:  
**B-cell markers: CD10, CD19, CD20, CD23, FMC7, Kappa, Lambda.
**B-cell markers: CD10, CD19, [[CD20]], [[CD23]], FMC7, Kappa, Lambda.
**T-Cell markers: CD3, CD5, CD4, CD8, CD7, CD2.
**T-Cell markers: CD3, CD5, CD4, CD8, CD7, CD2.
**NK-Cell markers: CD56, CD16.
**NK-Cell markers: [[CD56]], CD16.
**Miscellaneous markers: CD11c, CD14.
**Miscellaneous markers: CD11c, CD14.
Notes (general):
Notes (general):
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Notes:
Notes:
*Granulomas are ''not'' always nice and round, as in non-cytology specimens.
*Granulomas are ''not'' always nice and round, as in non-cytology specimens.
Images:
*[http://commons.wikimedia.org/w/index.php?title=File:Granuloma_cytology.jpg Granuloma - cytology (WC)].
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CI-Image-0803/FQ-051a.gif Granuloma (ouhsc.edu)].<ref name=ouhsc_31>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-031-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-031-M.htm]. Accessed on: 9 April 2012.</ref>
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CI-Image-0803/FQ-051b.gif Granuloma (ouhsc.edu)].<ref name=ouhsc_31>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-031-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-031-M.htm]. Accessed on: 9 April 2012.</ref>


DDx:
DDx:
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**Bacterial:
**Bacterial:
***Bartonella (gram -ve) ([[Cat-scratch disease]]).<ref>[http://emedicine.medscape.com/article/781320-overview http://emedicine.medscape.com/article/781320-overview]</ref>
***Bartonella (gram -ve) ([[Cat-scratch disease]]).<ref>[http://emedicine.medscape.com/article/781320-overview http://emedicine.medscape.com/article/781320-overview]</ref>
====Images====
<gallery>
Image:Granuloma_cytology.jpg | Granuloma - cytology. (WC)
</gallery>
<gallery>
Image: Granulomatous inflammation -- intermed mag.jpg | GI - intermed. mag. (WC)
Image: Granulomatous inflammation -- high mag.jpg | GI - high mag. (WC)
Image: Granulomatous inflammation - alt -- high mag.jpg | GI - high mag. (WC)
Image: Granulomatous inflammation -- very high mag.jpg | GI - very high mag. (WC)
</gallery>
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CI-Image-0803/FQ-051a.gif Granuloma (ouhsc.edu)].<ref name=ouhsc_31>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-031-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-031-M.htm]. Accessed on: 9 April 2012.</ref>
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CI-Image-0803/FQ-051b.gif Granuloma (ouhsc.edu)].<ref name=ouhsc_31>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-031-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-031-M.htm]. Accessed on: 9 April 2012.</ref>


=Detail articles=
=Detail articles=
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{{Main|Gastrointestinal cytopathology}}
{{Main|Gastrointestinal cytopathology}}
The above article deals with gastrointestinal cytopathology.
The above article deals with gastrointestinal cytopathology.
===Kidney cytopathology===
{{Main|Kidney cytopathology}}


=Grab bag of stuff=
=Grab bag of stuff=
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*Should not mistake for granuloma... as nuclei of epithelial cells round ''not'' oval.
*Should not mistake for granuloma... as nuclei of epithelial cells round ''not'' oval.


Image:
====Image====
*[http://commons.wikimedia.org/wiki/File:Thymoma_-_cytology_high_mag.jpg Thymoma - Field stain (WC)].
<gallery>
Image:Thymoma_-_cytology_high_mag.jpg | Thymoma - Field stain. (WC)
</gallery>
 
==Benign ovarian cyst==
====General====
*Common - typically ''[[serous cystadenoma of the ovary|serous cystadenoma]]''.
 
====Cytology====
Features:
*Benign epithelial cells - often ciliated.
*Macrophages.
*+/-Rare squamous cells.
 
DDx:
*[[Serous carcinoma]].
*[[Adenocarcinoma]].
 
====Sign out====
<pre>
Ovarian Cyst, Left, Fine Needle Aspiration:
- Compatible with cyst contents; consisting of macrophages, small groups of ciliated cells and rare squamous cells.
- Low cellularity.
- NEGATIVE for atypia and NEGATIVE for malignancy.
</pre>


==Germ cell tumours==
==Germ cell tumours==
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*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040-Ans/CI-Image-0803/FQ-060b.gif Seminoma - Diff-Quik - high mag. (ouhsc.edu)].
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040-Ans/CI-Image-0803/FQ-060b.gif Seminoma - Diff-Quik - high mag. (ouhsc.edu)].
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040-Ans/CI-Image-0803/FQ-060d.gif Seminoma - Pap stain - high mag. (ouhsc.edu)].
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040-Ans/CI-Image-0803/FQ-060d.gif Seminoma - Pap stain - high mag. (ouhsc.edu)].
=Kidney cytology=
==Angiomyolipoma==
{{Main|Angiomyolipoma}}
===General===
*May be associated with [[tuberous sclerosis]].
===Cytology===
Features:
*Blood vessels.
*Fat - usu. scant.
*Muscle - ovoid, bent cigar-shaped nuclei.
==Renal oncocytoma==
{{Main|Renal oncocytoma}}
===Cytology===
Features:<ref name=Ref_APBR683>{{Ref APBR|683}}</ref>
*Moderate granular cytoplasm.
*Distinct cell borders.
*Round nuclei.
Oncocytoma vs chromophobe RCC:<ref name=Ref_APBR683>{{Ref APBR|683}}</ref>
*ChRCC:
**Thicker cell borders.
**Perinuclear clearing/quasi koilocytic appearance.
Image:
*[http://commons.wikimedia.org/wiki/File:Renal_oncocytoma2.jpg Renal oncoctyoma - resection (WC)].
==Clear cell renal cell carcinoma==
{{Main|Clear cell renal cell carcinoma}}
===Cytology===
Features - classically:
*Prominent [[nucleoli]].
*Abundant vacuolated, delicate cytoplasm.
*Small blood vessels (chicken-wire vasculature).
Note:
*Cytoplasm not clear.
DDx:
*[[Xanthogranulomatous pyelonephritis]] - histiocytes, typically single cells - may be in small groups.
Images:
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040-Ans/CI-Image-0803/FQ-045d.gif RCC - prominent nucleoli (ouhsc.edu)].<ref name=ouhsc_nine>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-025-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-025-M.htm]. Accessed on: 9 April 2012.</ref>
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040-Ans/CI-Image-0803/FQ-045c.gif RCC - small blood vessel (ouhsc.edu)].<ref name=ouhsc_nine>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-025-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-025-M.htm]. Accessed on: 9 April 2012.</ref>
==Chromophobe renal cell carcinoma==
{{Main|Chromophobe renal cell carcinoma}}
===Cytology===
Features:
*Thick appearing cell membrane - vegetable matter-like appearance.
==Papillary renal cell carcinoma==
{{Main|Papillary renal cell carcinoma}}
===Cytology===
Features:
*Papillary structures - typically have a smooth contour.
**Contain foamy macrophages.
*Tumour cells have small nucleoli +/- nuclear grooves.
*+/-[[Psammoma bodies]].


=Crystals in fluids=
=Crystals in fluids=
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=Skin=
=Skin=
==Malignant melanoma==
==Malignant melanoma==
{{Main|Malignant melanoma}}
Classic features:
Classic features:
#Loosely cohesive cells and single cells.
#Loosely cohesive cells and single cells.
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Notes:
Notes:
#Large nucleolus - may vaguely resemble adenocarcinoma.
#[[Large nucleolus]] - may vaguely resemble adenocarcinoma.
#*Prominent red nucleolus common in: serous carcinoma.
#*Prominent red nucleolus common in: serous carcinoma.
#The classic appearance of melanoma without pigment is closest to adenocarcinoma (which may have red nucleoli, large cells, abundant cytoplasm, occasional binucleation).
#The classic appearance of melanoma without pigment is closest to adenocarcinoma (which may have red nucleoli, large cells, abundant cytoplasm, occasional binucleation).
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#*Background of melanoma different than HL.
#*Background of melanoma different than HL.


Images:
===Images===
*[http://commons.wikimedia.org/wiki/File:Melanoma_-_cytology_field_stain.jpg Bug-eyed monster cell in melanoma - Field stain (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Pigmented_melanoma_-_cytology.jpg Pigmented melanoma - Pap stain (WC)].
Image:Melanoma_-_cytology_field_stain.jpg | Bug-eyed monster cell in melanoma - Field stain. (WC)
Image:Pigmented_melanoma_-_cytology.jpg | Pigmented melanoma - Pap stain. (WC)
</gallery>


=Bone marrow/vertebrae=
=Bone marrow/vertebrae=
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*[[Lymphoma]].
*[[Lymphoma]].


=Soft tissue=
=Soft tissue lesions=
==Nodular fasciitis==
==Nodular fasciitis==
{{Main|Nodular fasciitis}}
{{Main|Nodular fasciitis}}
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*Myxoid background.
*Myxoid background.
*Moderate nuclear pleomorphism.
*Moderate nuclear pleomorphism.
==Schwannoma==
{{Main|Schwannoma}}
===Cytology===
Features:
*Bent fish hook-like nuclei - '''key feature'''.
*Variable cellularity (Antoni A = cellular, Antoni B = paucicellular).
==Solitary fibrous tumour==
{{Main|Solitary fibrous tumour}}
===Cytology===
Features:
*Spindle cells with oval nuclei.
*Wire-like lamellar collagen.
===IHC===
*CD34 +ve.
*BCL2 +ve.
*CD99 +ve.


=See also=
=See also=
Michael
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