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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

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cytology of body fluid

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 : 3.15.2006

outline
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
slide4

Transudates

Exudate

  • Increased hydrostatic pressure: Congestive heart failure
  • Decreased oncotic pressure: cirrhosis, nephrosis, and malnutrition
  • (decreased albumin)
  • Inflammation: Infection, infarction, hemorrhage
  • Tumor

Accumulation of fluids in body cavities

slide5

Cytocentrifuge preparation

Cell block

Heparinized bottles

(3 units heparin/ml)

Unfixed

Alcohol-fixed

Adding plasma and thrombin solution

Papanicolaou-stained

Wrapped in filter paper

Air-dried cytocentrifuge preparation

Placed in a cassette

Diff-Quik

(Hematologic malignancy is suspected)

Embedded in paraffin

Cut and H&E stain

Collection and preparation of specimen

slide6

Mesothelial cells

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

Benign elements

Mesothelial cells

slide7

Reactive mesothelial cell

  • Pleomorphic and enlarged nuclei
  • Hyperchromasia
  • Prominent nucleoli
  • Mitotic figures
slide8

Histiocytes

Other blood cells

  • Nuclei often kidney shape
  • Cytoplasm granular and vacuolated
  • No window between cells
  • CD68 positive
  • Lymphocytes
  • Eosinophils
  • Neutrophils
  • Plasma cells
  • Red blood cells
slide9

Acute serositis

Eosinophilic effusions

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

Non-neoplastic conditions

Eosinophilic pleural fluid

slide10

Tuberculous pleuritis

Rheumatoid 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
  • Necrotizing granulomatous inflammation (joint disease)
  • Cytology preparation: clumps of granular debris
  • multinucleated macrophages

Tuberculous pleuritis

Multinucleated macrophages

slide11

Systemic lupus erythematosus

  • Cytology preparation: Lupus erythematosus cell (LE cell)

LE cell

slide12

Malignant mesothelioma

  • Clinical history: asbestos exposure, persistent pleural effusions, chest pain
  • Epithelial (carcinomatous) pattern

Malignant effusions---primary tumors

slide13

Cell-in-cell pattern

“More and bigger cells,

in more and bigger clusters”

slide15

Adenocarcinoma

  • Large nucleoli
  • Secretory vacuoles
  • Three dimensional aggregates
  • Increased N/C ratio
  • Irregular nuclear membranes
slide16

Breast cancer

Lung cancer

  • Cannonballs:
  • Tight packed large balls of cells
  • Smooth borders
  • Indian files
slide17

Ovarian carcinoma

  • Irregular clusters of cells
  • Large and clear vacuoles

Gastric carcinoma

  • Signet ring cell pattern
slide18

Clear cell carcinoma of kidney cancer

  • Clear or granular and
  • vacuolated cytoplasm

Papillary carcinoma of the thyroid

  • Psammoma bodies
slide19

Squamous cell carcinoma

Small cell carcinoma

  • Keratinized or non-keratinized
  • Tadpoles and bizarre shape
  • Isolated and molded cells
  • Scant cytoplasm, inconspicuous nucleoli

F4.27

F4.28

slide20

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
slide21

Small lymphocytic lymphoma

  • Differential diagnosis:
  • chronic inflammation (tuberculosis)
  • lymphoblastic lymphoma
  • Small to medium sized lymphocytes
  • Fine powdery chromatin
  • Scant cytoplasm
slide22

Hodgkin lymphoma

Multiple myeloma

  • Reed-Sternbery cells:
  • Multinucleated cell with
  • huge inclusion-like nucleoli
  • Single, lack cohesive aggregate
  • Numerous malignant plasma cells
  • Immunocytochemistry stain:
  • kappa and lambda light chain (+)
  • CD138 (+)
slide23

Melanoma

Sarcomas

  • Isolated round cells with prominent nucleoli
  • Fine brown cytoplasmic pigmentation
  • Intranuclear pseudoinclusions
  • Immunocytochemistry stain: S-100(+), HMB-45(+)
  • 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

slide25

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C: cytoplasm; M: membrane; N: nuclear

slide26

THE END

Thank you for your attention