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يؤتي الحكمة من يشآء

يؤتي الحكمة من يشآء . DIAGNOSIS OF NEOPLASM Depend on triple test. CLINICAL. LABORATORY & PATHOLOGY data. IMAGING. ROLE OF PATHOLOGY. PRE- operative intra operative POST oprative SURGERY CYTOLOGY FROZEN SECTION PARAFFIN

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يؤتي الحكمة من يشآء

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  1. يؤتي الحكمة من يشآء

  2. DIAGNOSIS OF NEOPLASM Depend on triple test CLINICAL LABORATORY &PATHOLOGY data IMAGING

  3. ROLE OF PATHOLOGY • PRE- operative intra operative POST oprative SURGERY • CYTOLOGY FROZEN SECTION PARAFFIN • CNP CYTOLOGY IHC • ISH • SCREENING PRELIMINARY DEFINITIVE • DIAGNOSIS DIAGNOSISDIAGNOSIS

  4. CYTOLOGY • MINIMALY INVASIVE • CHEAP • RAPID • SCREENING - DIAGNOSIS • HIGH ACCURACY • LIMITATION : NO ARCHITECTURE

  5. Important Role Of Cytology

  6. Cytology Speciments Exfoliative Cytology • Sputum • Urine • Effusion Fluid : pleural fluid. pericard, ascites • Gastric Lavage ; Joint Fluid; Cerebrospinal Fluid • Female’s Genital Discharge/Secret : vagina, cervix • Scrapping : Sex Chromatine Examination, hormonal feature. Superficial Malignancy • Aspiration Cytology • -- Tissue Aspiration : on Localized Nodule -Superfisial mass (lymph node, thyroid, soft tissue, head & neck) - Deep mass (liver, ovary, lung, bone)

  7. FIX IN ALCOHOL 96%

  8. IMAGING GUIDED FNAB

  9. Specimen Delivery Requirement, : 1. The specimen should be representative and be fixed with appropriate fixation. 2. Brief and clear description about clinical imaging and other lab data. 3. Send as soon as possible to the laboratory

  10. Cytology examination steps : Acknowledge/Confirmation : B I O P S Y

  11. Result INTERPRETATION (Papaniculaou system):Class I : Normal smearClass II : Infection by bacteria, Fungus, paracytes etc Class III : Cytologic atypical cell either with or without inflammationClass IV : Suspicious malignant cells. Refer to perform biopsy.Class V : Malignant cells. Refer to perform biopsy

  12. EXFOLATIVE CYTOLOGYSPUTUM Requirement Specimens: • Gathering from deep cough • It should be Fresh,the best is morning sputum If sputum < : - Collecting within 12-24 hours in a bottle + alcohol 70% - Add expectorant 2-3 days before sputum collection Better in 3x Delivery, with 3 days interval 1x Collection  Accuracy 37 % 5x Collection  Accuracy 88 %

  13. SPUTUM DELIVERY and SMEAR PREPARATION: Without FIXATION : - It has life span about 3 hours - Smear it on object glass  alcohol 95% fixation ( 15 mnts) ISOLATED PLACE / LONG DISTANCE : - sputum + alcohol 70% smear on object glass air drying (without fire heating)

  14. SPUTUM

  15. SPUTUM False Positif: - Lung Abcess - Bronkhiektasis - TBC False Negatif : - tumor unreliable with bronchus - bronchial stenosis - Tumor Localization : pheripher/superior - Tumor Structure : oat cell Ca THE DIAGNOSIS OF LUNG CELL CARCINOMA IS BEST BASED ON COMBINATION OF CYTOLOGY RADIOLOGY AND BRONCHOSCOPY EXAMINATION, .

  16. URINE Best Source : Morning Urine 50 CC Delivery and Smear Preparation : Protective Materials (-)  DELIVER AS SOON AS POSSIBLE / Alcohol fixation 50% aa 18

  17. Clean Catch

  18. Speciment collection: Suprapubic Needle Aspiration

  19. Attention Dry Preparation:

  20. URINE Frequent Abnormality Will be Founded: • Inflammation • Staghorn/Stone: squamousmetaplasia • Benign Tumor : papilloma • 4.Malignant Tumor : intra epithelial neoplasia. Carcinoma , TCC

  21. Squamous Cells Transitional Cells

  22. Effusion fluid Gathering , Delivery and Smear Preparation : Changing position of Patient Punctie 100-200 CC Fixation with alcohol 50% aa Sentrifuge 2500 rpm (10 mnts) Smear on object glass(+egg albumin) Alcohol 95% (10 mnts) Examination Trait : Inflammation Cells >> Mesothel with hiperchromatic nucleus Histiocyte mimics malignant cells

  23. Fixation 1ml of heparin + 100ml of effusion fluid to prevent clotting N.B.: do not use alcohol in fixation of fluid before spread cytological smear on glass slides

  24. 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 (Hematologic malignancy is suspected) Embedded in paraffin Cut and H&E stain

  25. Female Genital Cytology Location to get the specimens :

  26. Female Genital Cytology Specimen Gathering Requirements : Outside menstrual period No Irrigation Smear is the first step of examination Tx. Local : stop 1 week before Post partum / uterine surgery /radiation : specimen taking 6 weeks afterward Patient in lithotomy position 28

  27. PAP SMEAR EXAMINATION

  28. Introduction METHODS INTREPRETATION 30

  29. Introduction METHODS INTREPRETATION Patient Preparation Examiner Preparation Cultivation Method Fixation Coloring 31 HOME

  30. Introduction METHODS INTREPRETATION Patient Preparation Examiner Preparation Cultivation Method Fixation Coloring Cultivation/Gathering Methods : • Do not forget to fulfill and numbering examination forms completely. • Sign the same number on object glass. • Prepare patient in lithotomy position, clean up the vulva with cotton and antiseptic solution. • Apply the speculum and gently perform the portion of the cervix. • Clean up if there are any blood or mucous. • Pay attention if there are any leukoplakia or erosion. 32 HOME

  31. Introduction METHODS INTREPRETATION Patient Preparation Examiner Preparation Cultivation Method Fixation Coloring Cultivation/Gathering Methods (cont’d) : Insert Ayre spatula to the vagina, make sure that the longest edge of the spatula entering the canal of cervix and rotate 360o with a little bit pressure. Insert cytobrush to the canal of cervix 1-2 cm in depth, and then rotate ¼ or ½. Smear gently the edge of the device (spatula/cytobrush) in one way and once move on object glass. Do Fixation properly. Keep the preparation slides on safe placement and send them with the examination form. 33 HOME

  32. Introduction METHODS INTREPRETATION Patient Preparation Examiner Preparation Cultivation Method Fixation 34

  33. PAP SMEAR

  34. Result INTERPRETATION and Management :Class I : Normal smear next year visit to reapply examination.Class II : Infection by bacteria, Fungus, paracites etc followed by light dischariotic. Treat and control 1-6 months later.Class III : Mild Dischariotic cell with severe inflammation.Treat and control a month later.Class IV : Suspicious malignant cells. Refer to perform kolposcopy biopsy.Class V : Malignant cells. Refer to perform kolposcopy biopsy Introduction METHODS INTREPRETATION Adequacy Evaluation Cultivation Method Report System 36 HOME

  35. NORMAL CERVICAL SQUAMOUS EPITHELIUM

  36. SUPERFISIAL, INTERMEDIATE & PARABASAL CELL

  37. CELL ENDOSERVIX

  38. Introduction METHODS INTREPRETATION Adequacy Evaluation Report System 40 HOME

  39. Introduction METHODS INTREPRETATION HPV Infection 41

  40. HPV INFECTION KOILOCYTOSIS & NIS

  41. CIN Image from Kolposcopy View 43

  42. Introduction METHODS INTREPRETATION CIN I LSIL 44

  43. Introduction METHODS INTREPRETATION CIN II HSIL CIN II 45

  44. Introduction METHODS INTREPRETATION CIN III 46

  45. Introduction METHODS INTREPRETATION SQUAMOUS CELL Ca 47

  46. MILD MODERATE SEVERE CA INVASIVE

  47. Introduction METHODS INTREPRETATION ADENO Ca 49

  48. Tissue Acquisition Devices - Types and Indications • FNA ( Fine –needle aspiration) • Core biopsy • Vacuum assisted core biopsy • Fine needle localization devices

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