1. Cytopathology Feb. 21. 2016

2. Cytopathology at cellular level Study of pathological changes at cellular level. fluid or free cells Samples are fluid or free cells, Cytopathology = cytology, which means "the study of cells. Cytopathologic tests = smear tests; samples are smeared across glass slide for staining and examination.

3. Role of cytopathology Early detection, or confirmation of diseases (malignant or pre-malignant lesions), without surgical trauma. Diagnosis of hormonal imbalance. Useful in flow up the course of disease or monitoring therapy.

4. Advantages of FNA Easy “painless” office procedure Quick (dx in minutes) Inexpensive Decreases hospital costs Helps patient plan treatment in case of carcinoma Helps alleviate anxiety in benign disease Useful in pregnant patients Diagnostic and therapeutic in benign cysts

5. Disadvantages of FNA False negatives False positives Special training needed to perform and interpret FNA In situ Vs invasive carcinoma Endocrine malignancy, of limited value. Complications

6.  Cytopathology can be subdivided into:  Fine Needle Aspiration (FNA): include FNA of breast, FNA of thyroid, LN, soft tissue mass…….etc. Pap smear, vaginal smear)  Gynecological Cytology, include cervicovaginal cytology (Pap smear, vaginal smear).  Non gynecological Cytopathology Include cytological examination of all other organs (e.g. Resp. system cytology, urine, sputum, CSF, & Serous fluid cytology ……etc. )

7. Other classification; TYPES OF CYTOPATHOLOGY :  Fine Needle Aspiration (FNA)  Exfoliative cytopathology  Forcible removed cytopathology

8.  Types of Exfoliated cytopathology  Natural spontaneous exfoliation – Natural covering epithelium: skin, urinary tract, vagina, and cervix. – Glandular epithelial secretion: Breast (Nipple secretion). – Sputum – Urine – Exudates and transudate: – Pleural fluidPeritoneal fluid – Pericardial fluidJoint fluid CSF

9.  Artificial enhanced exfoliation : – Scrapings from cervix, vagina, oral cavity, & skin – Brushing and lavage: bronchi, GIT, and UT – Fine needle aspiration (FNA) for: » Body cavity fluid: pleural, pericardial & peritoneal fluids » Cysts: neck, breast & ovary » Solid tissue: body organs, tumors & other swell  Types of Exfoliated cytopathology

10.  Fine Needle Aspiration Cytology (FNAC) e.g FNA of breast, thyroid, LN, Mass.

11. Cytology technique

12. Quick aspiration (avoid blood clot) Quick transfer of material on slides Proper smearing (avoid crush) Immediate fixation (avoid air dry) Papanicoulau stain, H&E stain (alcohol fixed) Romanowsky type stain (air dry) Cell block (Optional)

13. Smearing on labeled slides

14. Smears spreading

15. Fixation - 95% Ethyl Alcohol for 20 -30 Min

16. Fixatives used in Cytopathology: 1.95% ethyl alcohol. 2.Spray fixatives (does not result in lysis of RBC & better reserved of nuclear details). 3. Saccomanno's fixative (50% ethyl alcohol + 2% polyethylene glycol). 4.Carnoy’s fixative (lysis of RBC). 5.Other (Formaline, Glutarldehyde). Fixation in 95% alcohol for 20 -30 Min

17. Types of staining smears 1. Pap 1. Papnicolaou stain ( Pap) : Good demonstration of nuclear details. 2. Hematoxyline & Eosin (H&E): 3. Leishman & Giemsa stains: Other special stains for the most suspected diseases, to confirm diagnosis. Cell block for remnant sediment and histopathological examination

18. FNA 0f Breast: FNA is by far the most popular, simple, cost effective, reliable, & diagnostic procedure in cytological diagnosis of breast lesions. FNA is important part in triple screening for early detection of beast carcinoma (physical examination, mammography & FNA).

19. Fibroadenoma Staining & L/M Examination Breast adenocarcinoma

21. Staining & L/M Examination

22. Cytopathology  Exfoliative cytology or cytopathology. Sputum Serous effusion Urine & CSF cytopathology.

23. Sputum Cytology: Highly diagnostic values for centrally located lung cancer. Three to five consecutive daily sputum. Spontaneously coughed or induced. Fixed in 95% ethyl alcohol, or in Saccomanno's fixative (50% ethyl alcohol + 2% polyethylene glycol). Sputum sample is considered satisfactory when it contains alveolar macrophages.

24. Saccomanno's Cytology Fixative Widely used fixative in Cytology. For FNA'S, urine, sputums, bronchial washings, pleural and peritoneal fluids. 50% Ethyl alcohol + 2% polyethylene glycol Protect specimens from autolysis, (best for specimens transported or held for some time). for sputum separates mucus from the specimen cells so the cells can be evenly spread onto a microscope slide

25. Sputum cytology - Inflammatory

26. Sputum cytology – Sq. C. Ca. Normal epith

27. Sputum cytology – Adenoca.

28. Serous effusions Cytology 1ml of heparin + 100ml of effusion fluid to prevent clotting

29. Gross exam Cytological smears exam; Establish the presence or absence of malignancy (primary or metastatic ca. to these sites). Other special test (Chemistry, Microbiology ( 1ml of heparin + 100ml of effusion fluid to prevent clotting Serous effusions Cytology

30. Smears spreading

31. Fixation - 95% Ethyl Alcohol for 20 -30 Min

32. Accumulation of fluids in body cavities 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 Clots No Yes Cells Few; usually benign Many; can be malignant Exudate Inflammation: Infection, infarction, hemorrhage & tumor Transudates Increased hydrostatic pressure: Congestive heart failure Decreased oncotic pressure: cirrhosis, nephrosis, and malnutrition. (decreased albumin) Serous effusions

33. Reactive mesothelial cells

34. Malignant cells

35. “More and bigger cells, in more and bigger clusters” Cell-in-cell pattern Malignant Mesothelioma

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

37. Squamous cell carcinoma Keratinized or non-keratinized Tadpoles and bizarre shape

38. Skin lesion smear