Histopathology and Cytology (1)(MLHC-201)

SupervisionProf.Dr.Noha Ragab

1-To know the meaning of cytology and cytopathology2-Differentiate between transudate and exudate3-To know examination of body fluid and sample collection4-Understand types of staining smears5-Study types of different body fluids

Cytopathology:is a branch of pathology that studies and diagnoses diseases on the cellular level.

The most common use of cytopathology is the Pap smear, used

to detect cervical cancer at an early treatable stage. Two methods of collecting cells for analysis are:

1) Cells are extracted from fluid shed into the body cavities. For example, in pleural fluid, ascitic fluid, or in the case of the Pap smear, cells scraped from the cervix. 2) Fine Needle Aspiration Cytology

Schematic representation of the three body cavities

Accumulation of fluids in body cavities

Transudates

• Increased hydrostatic pressure: Congestive heart failure

• Decreased oncotic pressure (decreased albumin) : liver cirrhosis, nephrosis, and malnutrition

Exudate

• Inflammation: Infection, infarction, hemorrhage

• Tumor

Feature Transudate Exudate

Gross appearance Watery, clear Turbid or cloudy

Specific gravity Less than 1015 More than 1015

Protein Less than 3mg/dl More than 3mg/dl

Clots No Yes

cells Usually benign:

Few mesothelial

cells, few histocytes

and lymphocytes

More mesothelial cells,

acute or chronic

inflammatory cells,

RBCs, malignant cells

It is very useful for diagnosis of premalignant and

malignant tumors, especially metastatic tumors.

It is very useful for diagnosis of inflammatory

conditions (septic effusion, or chronic specific

inflammation e.g. TB

Respiratory Tract

Urinary Tract

Oral Cavity

Gastrointestinal Tract

Effusions (pleural, pericardial, joint)

Cerebral Spinal Fluid

Amniotic fluid

Many other body sites

Non-Gynecological Specimen Collection

Gross exam

Total cell count

Microscopic exam

Any other special test (Chemistry, Microbiology,

cytology (

Test are performed in various areas of lab based on what

the physician orders.

Body fluids sterile vs. non-sterile

FNA of effusion fluids

Tapping

Collection and preparation of specimen

PAP

Gram Stain

Hx & E

Cell block for remnant sediment and

histopathological examination.

Other special stains for the most suspected diseases,

to confirm diagnosis.

Heparinized bottles (3 units heparin/ml) Unfixed

Alcohol-fixed

Papanicolaou-stained

Cytocentrifuge preparationCell block

Adding plasma and thrombin solution

Wrapped in filter paper

Placed in a cassette

Embedded in paraffin

Cut and H&E stain

Air-dried cytocentrifuge preparation

(Hematologic malignancy is suspected)

Fluid surrounding brain and spinal cord

Sterile

Specimen collection: by Lumbar puncture

Collect 3-5 vials, each tube has a designated department.

Gross exam: Turbidity, Color, microscopic exam, cell

count

Enumerate and differentiate cells seen

Lymphocytes: usually are few; increased with viral,

fungal, bacterial meningitis, or nervous system disease

Monocytes: Less than 2% of normal CSF, increased

with TB meningitis, viral encephalitis, subarachnoid

haemorrhage.

PMN: are few, associated with viral and acute bacterial

inflammation.

Macrophages: are few in number associated with

malignancy, hemorrhage, inflammation

Eosinophils/Basophils: not normally seen in CSF

Plasma cells: not normally present; associated with viral

disorders, and Hodgkin's diseases.

Red Blood Cells: Few to none present

Mesothelial cells: not present

Malignant cells: will see with malignant disease and

infiltrate.

• Effusion:

• Transudate

• Exudates

• Lab analysis: Gross exam, cell count, etc.

• Differential: PMN, Lymph, Mono, etc.

2- Pleural Fluid: Lung fluid

• Cells unique to the lungs: Mesothelial cells

• RBCs and WBCs: are limited, if increased without

traumatic tap ----- indicates infarction

• Cytology exam: useful in identifying malignancy or

abnormal morphological cells.

Abnormal accumulation of fluid (effusion) in peritoneal

cavity: Ascites

Ascites: a condition in which fluid accumulates within

the peritoneal space.

◦ Must have an accumulation of > 100 ml (several 100) before

effusion can be detected on physical exam.

Peritoneal Fluid Appearance: Color and clarity.

◦ Color and clarity can indicate certain infections and

diseases.

Total Cell Count: Assist in diagnosis of certain

diseases by determining total RBC and WBC

number.

Lymphocytes: CHF, liver cirrhosis, nephrotic syndrome

Mesothelial Cells: Associated with TB effusions

Malignant cells: seen with malignancy

Pericardial Fluid: accumulation of fluid of the lining of

the heart (effusion)

Cause: neoplasm, infections, collagen disease, renal

disease, Cardiovascular disease.

Gross Exam: Report appearance (bloody, clear, cloudy)

4- Pericardial Fluid

Measure pH: pH less than 7.0 associated with

infection or rheumatoid disorder.

Cell count: see limited RBCs and WBCs

Evaluate sediment

• Joint Fluid: normally clear, viscous

• Functions as a lubricate and transports nutrient

• Arthrocentesis: aspirate of the joint fluid, aseptic

technique

• Lab Assay: Gross exam, microscopic exam, Gram

stain, cultures,...

5- Synovial Fluid:

• Appearance: clear, transparent, viscous

• Viscosity test

• Mucin Clot test

• Note crystals (intracellular vs. extra cellular)

• Slide exam: usually performed on concentration of the

fluid using Giemsa or Papnicolaou

Cellular pleural cytology; lymphocytes, reactive mesothelial cells

Cellular ascitic fluid; lymphocytes, PNL and metastatic carcinoma cells

1-Cytopathologyis………………………………………………2-Sample collection is made by……….and…………..3-Types of staining smears are………………….4-……………..acts as a lubricate and transports nutrient5-Pericardial Fluid is accumulation of fluid of the…………………6-………………. Fluid surrounding brain and spinal cord

الغنى عبد السيد محروس أميرة عاشور القادر عبد خلود مرسى أحمد محمد دنيا الديب سالم عطية دينا الله عبد رضا رانيا اللطيف عبد رزق روان فريد رجب ابراهيم ريوان