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Speaker : 黃筱琪 Advisor : 聶鑫 主任 李修南 學姊 Date :

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Presentation on theme: "Speaker : 黃筱琪 Advisor : 聶鑫 主任 李修南 學姊 Date :"— Presentation transcript:

1 Speaker : 黃筱琪 Advisor : 聶鑫 主任 李修南 學姊 Date : 3.15.2006
Cytology of Body Fluid Edmund S, Cytology, Chapter 4: Pleural, pericardial, and peritoneal fluid Richard M DeMay, The art & science of cytopathology, Chapter 8: Fluid Leopold G.Koss, Koss’ diagnostic cytology, Chapter 26: Effusion in the presence of cancer Speaker : 黃筱琪 Advisor : 聶鑫 主任 李修南 學姊 Date :

2 Outline Representation of the three body cavities
Collection and preparation of specimen Benign elements Non-neoplastic conditions Malignant effusions---primary tumors ---metastatic tumors Differences Between Adenocarcinoma and Mesothelioma

3 Schematic representation of the three body cavities

4 Accumulation of fluids in body cavities
Transudates Increased hydrostatic pressure: Congestive heart failure Decreased oncotic pressure: cirrhosis, nephrosis, and malnutrition (decreased albumin) Exudate Inflammation: Infection, infarction, hemorrhage Tumor Differences Between a Transudate and an Exudate Feature Transudate Exudate Gross appearance Watery, clear Cloudy, reddish Specific gravity < >1.015 Protein <3.0 g/dl >3.0 g/dl Clots No Yes Cells Few; usually benign Many; can be malignant

5 Collection and preparation of specimen
Heparinized bottles (3 units heparin/ml) Unfixed Cell block Adding plasma and thrombin solution Wrapped in filter paper Placed in a cassette Embedded in paraffin Cut and H&E stain Alcohol-fixed Papanicolaou-stained Cytocentrifuge preparation Air-dried cytocentrifuge preparation Diff-Quik (Hematologic malignancy is suspected)

6 Benign elements Mesothelial cells Usually dispersed as isolated cells
Binucleation and multinucleation Occasional small clusters with “windows” Dense cytoplasm with clear outer rim (lacy skirt) Mesothelial cells

7 Reactive mesothelial cell
Pleomorphic and enlarged nuclei Hyperchromasia Prominent nucleoli Mitotic figures Benign Mesothelial cells that mimic cancer cells Benign Formation Mimics Three Dimensional cells balls, or rosettes Adenocarcinoma Papillae Papillary adenocarcinoma Indian files Breast, small cell carcinoma Cell in cell Squamous cell carcinoma Signet ring Breast, stomach cancer Single cell Lymphoma

8 Histiocytes Nuclei often kidney shape Cytoplasm granular and vacuolated No window between cells CD68 positive Other blood cells Lymphocytes Eosinophils Neutrophils Plasma cells Red blood cells

9 Non-neoplastic conditions
Acute serositis Bacterial infection: pleural empyema, bacterial peritoneal Color of the fluid: creamy pale yellow (purulent) Cytology preparation: high cellular and polymorphonuclear leukocytes Eosinophilic effusions Thoracic trauma, pneumothorax, hemothorax, pulmonary infarcts Cytology preparation: high number of eosinophils Eosinophilic pleural effusions more common Charcot-Leyden crystals Eosinophilic pleural fluid

10 Tuberculous pleuritis
Color of the fluid: turbid and greenish-yellow Cytology preparation: high cellular of lymphocytes (T cells) Differential diagnosis: inflammatory effusion of non-tuberculous origin Tuberculous pleuritis Rheumatoid pleuritis Necrotizing granulomatous inflammation (joint disease) Cytology preparation: clumps of granular debris multinucleated macrophages Multinucleated macrophages

11 Systemic lupus erythematosus
Cytology preparation: Lupus erythematosus cell (LE cell) LE cell

12 Malignant effusions---primary tumors
Malignant mesothelioma Clinical history: asbestos exposure, persistent pleural effusions, chest pain Epithelial (carcinomatous) pattern Malignant Mesothelioma “More and bigger cells, in more and bigger clusters” Group Irregular papillae and Knobby three-dimensional clusters Cell-in-cell arrangements Indian files Nuclei Increased bi/multinucleation Nuclear enlargement and pleomorphism Macronucleoli Cytoplasm Windows, skirts (lacy appearance) Dense, many two-tone staining Fine vacuoles (lipid, glycogen)

13 Cell-in-cell pattern “More and bigger cells, in more and bigger clusters”

14 Malignant effusions---metastatic tumors
The Most Common Tumor that Cause Malignant Effusion, by Site and Sex Type of Malignant Men Women Pleural Lung Breast Gastrointestinal tract Lung Pancreas Ovary Peritoneal Intestinal Ovary (includes gastric and pancreatic) Pancreas Breast Prostate Uterus

15 Adenocarcinoma Increased N/C ratio Irregular nuclear membranes
Large nucleoli Secretory vacuoles Three dimensional aggregates The patterns of Adenocarcinoma Breast cancer Ovarian cancer Stomach cancer Kidney cancer Thyroid cancer Cannonball (no vacuole) Indian files Signet ring cells (small) Psammoma bodies Cannonball (vacuole) Signet ring cells (large) Clear cells

16 Cannonballs: Tight packed large balls of cells Smooth borders Indian files Breast cancer Lung cancer

17 Irregular clusters of cells
Large and clear vacuoles Ovarian carcinoma Signet ring cell pattern Gastric carcinoma

18 Clear cell carcinoma of kidney cancer
Clear or granular and vacuolated cytoplasm Papillary carcinoma of the thyroid Psammoma bodies

19 Squamous cell carcinoma
Keratinized or non-keratinized Tadpoles and bizarre shape F4.27 Small cell carcinoma Isolated and molded cells Scant cytoplasm, inconspicuous nucleoli F4.28

20 Non-Hodginkin lymphoma
Large cell lymphoma Nuclei large than histiocyte Eccentric nuclei Abundant blue cytoplasm Best appreciated in Diff-Quik Follicular lymphoma Irregular nuclear contours Scant cytoplasm

21 lymphoblastic lymphoma
Small to medium sized lymphocytes Fine powdery chromatin Scant cytoplasm Small lymphocytic lymphoma Differential diagnosis: chronic inflammation (tuberculosis)

22 Hodgkin lymphoma Multiple myeloma Reed-Sternbery cells:
Multinucleated cell with huge inclusion-like nucleoli Multiple myeloma Single, lack cohesive aggregate Numerous malignant plasma cells Immunocytochemistry stain: kappa and lambda light chain (+) CD138 (+)

23 Melanoma Sarcomas Isolated round cells with prominent nucleoli
Fine brown cytoplasmic pigmentation Intranuclear pseudoinclusions Immunocytochemistry stain: S-100(+), HMB-45(+) Sarcomas Isolated cells Pleomorphic sarcoma Osteosarcoma Liposarcoma Large and bizarre shaped Round cell sarcoma Rhabdomyosarcoma Neuroblastoma Small and uniform shaped Spindle cell sarcoma Fibrosarcoma Leiomyosarcoma Spindle shaped

24 Differences Between Adenocarcinoma and Mesothelioma
Cytologic Differences Between Adenocarcinoma and Mesothelioma Adenocarcinoma Mesothelioma Groupings Community borders irregular knobby outline Windows unusual Windows common Cells Columnar shape Blebs, skirts Nucleus Usually eccentric Usually central Pleomorphic and bizarre Less pleomorphic and not bizarre Cytoplasm Delicate, homogeneous Dense with lacy edges Uniform stain Two-tone staining Vacuoles Secretory Degenerative Multinucleated Rare Common Giant cells

25 - + + - + - + - + - + - + - + - + + - + - + - +
Distinguishing Between Mesothelioma and Metastatic Adenocarcinoma with Immunocytochemistry Stain Staining patterns Adenicarcinoma Mesothelioma Mucicarmine C Carcinoembryonic antigen C CA C Leu M C+M E-cadherin C+M BerEP C+M B M Thyroid transcription factor N (TTF-1) Keratin protein M (peripheral) (perinuclear) Calretinin C+N Vimentin C Wilms’ tumor(WT1) protein N - + + - + - + - + - + - + - + - + + - + - + - + C: cytoplasm; M: membrane; N: nuclear

26 Thank you for your attention
THE END Thank you for your attention

27 E-cadherin

28 BerEP4

29 B72.3

30 Calretinin

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