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Difference between revisions of "Cytopathology"
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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''. | ||
=Slide-marking conventions= | |||
Conventions are important for facilitating communication between various team members. | Conventions are important for facilitating communication between various team members. | ||
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**More than 7 marks on slide is generally considered excessive. | **More than 7 marks on slide is generally considered excessive. | ||
=Dictums of cytopathology= | |||
*Malignant cells are malignant because they have malignant features. | *Malignant cells are malignant because they have malignant features. | ||
*Benign cells are benign because they lack malignant features and have benign features. | *Benign cells are benign because they lack malignant features and have benign features. | ||
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*Not all features of malignancy will be present in one cell.<ref>WG. 19 February 2010.</ref> | *Not all features of malignancy will be present in one cell.<ref>WG. 19 February 2010.</ref> | ||
=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" | ||
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**Mesothelioma arises from the mesothelium, a type of epithelium. Carcinomas are epithelial derived malignant tumours (by definition). | **Mesothelioma arises from the mesothelium, a type of epithelium. Carcinomas are epithelial derived malignant tumours (by definition). | ||
=Staining= | |||
There are two standard stains: | There are two standard stains: | ||
#Papanicolaou stain (Pap stain). | #Papanicolaou stain (Pap stain). | ||
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===Pap stain=== | ===Pap stain=== | ||
{{Main|Pap stain}} | |||
Interpretation:<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:<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> | ||
*Blue = nucleus, basophilic cytoplasm. | *Blue = nucleus, basophilic cytoplasm. | ||
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*Cells tend to be larger than on Pap stain. | *Cells tend to be larger than on Pap stain. | ||
=Adequacy of specimens= | |||
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=== | ||
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*Popularized by the Swedes.<ref>{{cite journal |author=Diamantis A, Magiorkinis E, Koutselini H |title=Fine-needle aspiration (FNA) biopsy: historical aspects |journal=Folia Histochem. Cytobiol. |volume=47 |issue=2 |pages=191–7 |year=2009 |pmid=19995703 |doi=10.2478/v10042-009-0027-x |url=http://versita.metapress.com/content/p1p772662w5u373p/}}</ref> | *Popularized by the Swedes.<ref>{{cite journal |author=Diamantis A, Magiorkinis E, Koutselini H |title=Fine-needle aspiration (FNA) biopsy: historical aspects |journal=Folia Histochem. Cytobiol. |volume=47 |issue=2 |pages=191–7 |year=2009 |pmid=19995703 |doi=10.2478/v10042-009-0027-x |url=http://versita.metapress.com/content/p1p772662w5u373p/}}</ref> | ||
=Triage of specimens= | |||
At UHN the specimens are triaged. This is an uncommon practise in the world of cytopathology. | At UHN the specimens are triaged. This is an uncommon practise in the world of cytopathology. | ||
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*'''C'''ytoSpin used for '''C'''SF specimens. | *'''C'''ytoSpin used for '''C'''SF specimens. | ||
=Cytologic features= | |||
===Large clusters=== | ===Large clusters=== | ||
*Large clusters - fibrin (junk) vs. other: | *Large clusters - fibrin (junk) vs. other: | ||
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***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> | ||
=Detail articles= | |||
Details are dealt with in separate articles. | Details are dealt with in separate articles. | ||
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The above article deals with breast cytopathology. | The above article deals with breast cytopathology. | ||
=Grab bag of stuff= | |||
The following is a grab bag of stuff that is: | The following is a grab bag of stuff that is: | ||
*Not covered in the above articles. | *Not covered in the above articles. | ||
*Something that applies to multiple sites (e.g. melanoma). | *Something that applies to multiple sites (e.g. melanoma). | ||
=Mediastinum= | |||
{{Main|Mediastinum}} | {{Main|Mediastinum}} | ||
DDx: | DDx: | ||
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*+/-Granulomas. | *+/-Granulomas. | ||
=Gastrointestinal= | |||
==Liver== | |||
Normal: | Normal: | ||
*Liver cells may be binucleated. | *Liver cells may be binucleated. | ||
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**+/-Yellow granular pigment (bile). | **+/-Yellow granular pigment (bile). | ||
===Hepatocellular carcinoma=== | |||
{{Main|Hepatocellular carcinoma}} | {{Main|Hepatocellular carcinoma}} | ||
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*[http://www.flickr.com/photos/78147607@N00/2331529448 HCC cytology (flickr.com/euthuman)]. | *[http://www.flickr.com/photos/78147607@N00/2331529448 HCC cytology (flickr.com/euthuman)]. | ||
===Cholangiocarcinoma=== | |||
{{Main|Cholangiocarcinoma}} | {{Main|Cholangiocarcinoma}} | ||
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**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. | ||
==Common bile duct== | |||
Normal: | Normal: | ||
*Monolayer of small blue cells. | *Monolayer of small blue cells. | ||
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*Caution is advised when calling malignancy in the setting of a stent or stones. | *Caution is advised when calling malignancy in the setting of a stent or stones. | ||
===Adenocarcinoma=== | |||
Features: | Features: | ||
*Hyperchromasia. | *Hyperchromasia. | ||
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*[http://commons.wikimedia.org/wiki/File:Colorectal_adenocarcinoma_cytology_intermed_mag.jpg Colorectal adenocarcinoma - intermediate mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Colorectal_adenocarcinoma_cytology_intermed_mag.jpg Colorectal adenocarcinoma - intermediate mag. (WC)]. | ||
==Stomach== | |||
*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== | |||
Epithelium:<ref name=Ref_APBR680>{{Ref APBR|680 (Q23)}}</ref> | Epithelium:<ref name=Ref_APBR680>{{Ref APBR|680 (Q23)}}</ref> | ||
*Small blue cells. | *Small blue cells. | ||
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*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> | ||
==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. | ||
==Pancreas== | |||
A short DDx: | A short DDx: | ||
*[[Ductal carcinoma of the pancreas]]. | *[[Ductal carcinoma of the pancreas]]. | ||
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*[[Solid pseudopapillary neoplasm]]. | *[[Solid pseudopapillary neoplasm]]. | ||
===Mucinous tumours=== | |||
Features: | Features: | ||
*Mucin. | *Mucin. | ||
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*[http://moon.ouhsc.edu/kfung/jty1/OPAQ/PNPT/PNPT-Image/PN-NS01-01-01b.gif Mucin (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/OPAQ/PNPT/PN-NS01-Ans.htm http://moon.ouhsc.edu/kfung/jty1/OPAQ/PNPT/PN-NS01-Ans.htm]. Accessed on: 22 February 2012.</ref> | *[http://moon.ouhsc.edu/kfung/jty1/OPAQ/PNPT/PNPT-Image/PN-NS01-01-01b.gif Mucin (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/OPAQ/PNPT/PN-NS01-Ans.htm http://moon.ouhsc.edu/kfung/jty1/OPAQ/PNPT/PN-NS01-Ans.htm]. Accessed on: 22 February 2012.</ref> | ||
=Kidney cytology= | |||
==Renal oncocytoma== | ==Renal oncocytoma== | ||
{{Main|Renal oncocytoma}} | {{Main|Renal oncocytoma}} | ||
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*[http://commons.wikimedia.org/wiki/File:Renal_oncocytoma2.jpg Renal oncoctyoma - resection (WC)]. | *[http://commons.wikimedia.org/wiki/File:Renal_oncocytoma2.jpg Renal oncoctyoma - resection (WC)]. | ||
=Crystals in fluids= | |||
{{main|Crystals in fluids}} | {{main|Crystals in fluids}} | ||
The above article covers gout, pseudogout and urine crystals. | The above article covers gout, pseudogout and urine crystals. | ||
=Skin= | |||
==Malignant melanoma== | |||
Classic features: | Classic features: | ||
#Loosely cohesive cells and single cells. | #Loosely cohesive cells and single cells. | ||
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*[http://commons.wikimedia.org/wiki/File:Pigmented_melanoma_-_cytology.jpg Pigmented melanoma - Pap stain (WC)]. | *[http://commons.wikimedia.org/wiki/File:Pigmented_melanoma_-_cytology.jpg Pigmented melanoma - Pap stain (WC)]. | ||
=Bone marrow/vertebrae= | |||
{{Main|Haematopoiesis}} | {{Main|Haematopoiesis}} | ||
Components:<ref>SB. 25 January 2010.</ref> | Components:<ref>SB. 25 January 2010.</ref> | ||
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*[[Lymphoma]]. | *[[Lymphoma]]. | ||
=See also= | |||
*[[Basics]]. | *[[Basics]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
=External links= | |||
*[http://www.uniklinik-duesseldorf.de/deutsch/Unternehmen/Institute/InstitutfrCytopathologie/page.html Cytopathology Institute Duesseldorf]. | *[http://www.uniklinik-duesseldorf.de/deutsch/Unternehmen/Institute/InstitutfrCytopathologie/page.html Cytopathology Institute Duesseldorf]. | ||
*[http://pathology2.jhu.edu/cytopath/posttest.html Cytopathology test (jhu.edu)]. | *[http://pathology2.jhu.edu/cytopath/posttest.html Cytopathology test (jhu.edu)]. | ||