Difference between revisions of "Gastrointestinal cytopathology"

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Gastrointestinal cytopathology (view source)

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=Liver=
=Liver=
Normal:
Brief DDx:
*Liver cells may be binucleated.
*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, central nucleus.
**Abundant cytoplasm
**Bile ductules between adjacent cells.
**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 (liver) cells surrounded by endothelial cells - '''diagnostic'''.<ref name=Ref_APBR679>{{Ref APBR|679}}</ref>
*Architecture - single cells and large clusters:
*+/-Nuclear atypia.
**Cohesive clusters of cells (hepatocytes) surrounded by endothelial cells - '''diagnostic'''.<ref name=Ref_APBR679>{{Ref APBR|679}}</ref>
*+/-Prominent nucleoli.<ref name=ouhsc_34/>
**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===
*[http://commons.wikimedia.org/wiki/File:Colorectal_adenocarcinoma_cytology_low_mag.jpg Colorectal adenocarcinoma - low mag. (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Colorectal_adenocarcinoma_cytology_intermed_mag.jpg Colorectal adenocarcinoma - intermediate mag. (WC)].
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>
*Small blue cells.
*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=
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=Pancreas=
=Pancreas=
A short DDx:
A short DDx:
*Normal:
**Duct.
**Acini.
*Cystic lesions:
*Cystic lesions:
**[[Serous cystadenoma of the pancreas]].
**[[Serous cystadenoma of the pancreas]].
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**[[Pancreatic neuroendocrine tumour]].
**[[Pancreatic neuroendocrine tumour]].


==Mucinous tumours==
==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:
Features:
*Mucin.
*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:
*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>
*Small cells with:
*Papillary formations - composed of small cells with:
**Scant cytoplasm.
**Scant cytoplasm.
**+/-Nuclear grooves.
**+/-Nuclear grooves.
*Papillary formations.
*+/-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 granular chromatin.
*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]]
Michael
48,470

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