CytopathologyDr. Nada Al-ALwan (Prof. of Pathology)

Prof. Nada Alwan

Prof. Nada Alwan

Prof. Nada Alwan

Prof. Nada Alwan

Histopathology Cytopathology

1. Deals with the form and the structure of the tissue.

2. Evaluation with a tissue biopsy.

3. More invasive traumatic procedure is needed; utilizing surgical instrumentation such as foreceps, scissors, etc..)

4. Needles if used should have a large gauge (i.e., Tru-cut needles measuring 14, 16 ) .

5. Diagnosis obtained after days.

6. Basic stain is H&E

7. Paraffin blocks are needed

8. Difficult to identify specific causative inflammatory pathogen

1. Deals with the structural changes within the nucleus and cytoplasm of individual cells

2. Evaluation requires cells only.

3. Inexpensive simple means of diagnosis which allows frequent repetition of cellular sampling (since it causes no tissue injury).

4. Fine needles with 22, 23 or 24 gauge are usually preferred.

5. Rapid diagnosis that could be obtained within minutes.

6. Basic stain is Pap stain (however H&E could be used as well)

7. Mainly slides are needed

8. Smears permit better evaluation of the nature of the inflammatory process. Fungi and parasites are usually easier to be diagnosed.

Prof. Nada Alwan

Prof. Nada Alwan

Prof. Nada Alwan

Prof. Nada Alwan

Pap Smear

Prof. Nada Alwan

Prof. Nada Alwan

Cervix cytology-normal

superficial cells

parabasal cells

immature sq. cells

endocervical cells en face

endocervical cells-profile

Prof. Nada Alwan

HPV

Prof. Nada Alwan

Prof. Nada Alwan

HPV

Prof. Nada Alwan

Prof. Nada AlwanCIN I or LSIL

Prof. Nada AlwanCIN II or HSIL

Prof. Nada Alwan

CIN III or HSIL

Prof. Nada Alwan

SQUAMOUS CELL CARCINOMA

ADENOCARCINOMA

SMALL CELL CARCINOMA

LARGE CELL CARCINOMA

Prof. Nada Alwan

Prof. Nada Alwan

Fine Needle aspiration Cytology

In general, the definitive diagnosis of any mass can be established by:

Open biopsy,

Tissue core needle (Tru-cut) biopsy,

Fine needle aspiration biopsy.

Compared to FNA, Tru-cut biopsy is a more traumatic procedure which should be performed under local anaesthesia. It requires more time and special equipment that are more expensive. Pain, discomfort and bleeding are common complications.

Prof. Nada Alwan

Fine Needle aspiration Cytology

FNAC, on the other hand, provides many advantages to the surgeons:

It is an easy, reliable, cost effective diagnostictechnique which can give rapid results.

The procedure could be performed in an office setting without anaesthesia. It is usually notmore painful than a venipuncture and can be repeated immediately if the acquired material is inadequate.

Prof. Nada Alwan

Equipments and Procedure of FNAC:

When reduced to its simplest terms, FNA

consists of:

- Using a needle and syringe to remove

material from a mass.

- Smearing it on a glass slide.

- Applying a routine stain.

- Examining it under the microscope.

Prof. Nada Alwan

Prof. Nada Alwann

Malignant epithelial cells

Prof. Nada Alwan

Indications for Cytopathology

1. Differentiation between benign and malignant lesions

2. Diagnosis of the type of Malignancy

3. Diagnosis of premalignant diseases

4. Detection of inflammation and certain types of pathogenic agents

5. Study of hormonal patterns

6. Monitoring of response to therapy and Follow-up of irradiation

7. Study of tumour markers

Prof. Nada Alwan

Criteria of MalignancyHow can we detect the presence of malignant cells

cytologically?

Nuclear Changes

Nuclear Hypertrophy

Nuclear Size Variation

Nuclear Shape Variation

Hyperchromatism and Chromatin Irregularity

Multinucleation

Irregularity of Nuclear Membrane

Irregular and Prominent Nucleoli

Prof. Nada Alwan

in Malignant CellsCytoplasmic Changes

Scantiness of Cytoplasm

Cytoplasmic Boundries (sharp & distinct in Squamous cell

ca & indistibnct in undifferentiated ca)

Variation in Size

Variation in Shape

Cytoplasmic Staining ( deep orange in keratinizing

squamous ca or basophoilic in immature poorly differentiated

ca)

Cytoplasmic Inclusions (melanin pigments in melanoma)

Cytoplasmic & Nuclear membrane relationship

Prof. Nada Alwan

Changes in Cells as a Group in Malignancy

Cellular Phagocytosis or Cannibalism (indicating

rapid growth of cells within a narrow cavity)

Lack of Cellular Adhesion (due to abnormalities in

desmosomes)

Abnormal Mitosis

Bloody Background (fresh blood is meaningless, but

when RBCs are ingested by histeocytes or blood obtained

without trauma)

Foreign Cellular Structures (ex. psammoma Bodies)

Degeneration and Inflammation (Tumour Diathesis)

Prof. Nada Alwan