non gynea-his(cyto).pptx 2
DESCRIPTION
Non-Gynae SlideTRANSCRIPT
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NON- GYNEA
1) Respiratory tract2) Urine 3) Pleural, pericardial, and peritoneal fluids4) Peritoneal washings5) Cerebrospinal fluid6) Gastrointestinal tract7) Breast8) Thyroid9) Salivary gland10)Lymph nodes11)Liver12)Pancreas13)Kidney and adrenal gland14)Ovary15)Soft tissue
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1) RESPIRATORY TRACT
NORMAL BENIGN MALIGNANT
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Cytomorphology :
Upper respiratory tract
Ciliated columnar cells Squamous cells
Lower respiratory tract
• Trachea and bronchi
Ciliated columnar cells
Goblet cells
Basal/reserve cells
Neuroendocrine cells
• Terminal bronchioles
Non ciliated cuboidal/columnar cells (Clara cells)
Alveoli Type I and II pneumocytes
Alveolar macrophages
Title: Ciliated columnar cell Source: http://www.czytelniamedyczna.pl/img/ryciny/newmed/2007/04/images/20070411.jpg
Title: Goblet cell Source: http://www.siumed.edu/~dking2/erg/images/GI125a1.jpg
NORMAL
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Cytomorphology
Pulmonary hematoma Bland spindle cells Immature fibromyxoid matrix Mature cartilage with chondrocytes in lacunae Benign glandular cells Adipocytes
Inflammatory myofibroblastic tumor Spindle cells Storiform pattern Polymorphous inflammatory cells Minimal to no necrosis
Endobronchial granular cell tumor Small clusters of macrohage-like cells Abundant granular cytoplasm Small, uniform, round to oval nuclei
Title: cytomorphology of benign cell in respiratory tractSource:http://www.pathologyoutlines.com/caseofweek/case2007100pap.jpg
BENIGN
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Cytomorphology :
Squamous cell carcinoma Abundant dyshesive cells Polygonal, rounded, or elongated cells Dense cytoplasmic orangeophilia (Papanicolou stain) Tadpole or fiber - like cells Pleomorphic, pyknotic nuclei Obscured nucleoli and chromatin detail Frequent anucleated cells Twisted keratin strands (Herxheimer spirals)
Adenocarcinoma Cohesive sheets – 3D clusters, acini Accentric, irregular nuclei Finely to coarsely granular chromatin Large nucleoli Secretory vacuoles Transparent, foamy cytoplasm
Title : Squamous Cell CarcinomaSource : http://nih.techriver.net/patientImages/5713.jpg
Title: Immunocytochemical positive staining for carcinoembryonic antigen (CEA) on the metastatic pulmonary adenocarcinoma in pleural fluid.Source :http://www.acta-cytol.com/feature/2007/feature022007.php
MALIGNANT
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2) URINE
NORMAL UROTHELIAL CELLS
INFLAMMATION REACTIVE UROTHELIAL NEOPLASM
LOW GRADE UROTHELIAL LESIONSHIGH GRADE UROTHELIAL CARCINOMA
OTHER MALIGNANT LESIONSSQUAMOUS CELL CARCINOMA
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Scanty cellularity in voided sample Cells are usually single in voided urine Clusters or sheets of urothelial cells in cystoscopy urine and bladder washings Umbrella cells, deeper layer cells, squamous cells seen A few polymorphs may be seen Spermatozoa and corpora amylacea may be present in males
Umbrella cells . These are the largest urothelial cells and cover the surface of the urothelium. Normal columnar urothelial
cells are also pesent
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
NORMAL
UROTHELIAL CELLS
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Hazy or turbid urine specimen Numerous polymorphs, histiocytes, occasionally eosinophil
Reactive changes in epithelial cells Organisms may be present, bacteria or parasitic
Evidence of associated pathology may be seen such as debris in the presence of calculi
Polyomavirus infection. The enlarged nucleus is
virtually replaced by a glassy, homogeneous
inclusion.
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
INFLAMMATION
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N/C ratio: mild increase
Cytoplasm: retain cytoplasmic clearing Nuclear borders : - normal Chromatic: finely granular Nucleoli: prominent in all cells Mitosis: few (if any) and normal
Reactive urothelial cells (catheterized urine).
Coarsely vacuolated cytoplasm is characteristic of
benign, reactive changes and uncommon in malignancy
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
REACTIVE
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Cytoplasmic homogeneityHigh nuclear to cytoplamic ratioIrregular bordersPapillary fragments with fibrovascular cores(diagnostic, but rare)Cell clusters without coresIrregular cell clusters ( commonly associated with UC than smooth cell clusters)
cytologic criteria for the diagnosis of a low grade urothelial lesion
(catheterized specimen). Homogeneous cytoplasm, an increased
nuclear to cytoplasmic ratio, and irregular nuclear outline are
associated with low-grade lesions, but are not specific.
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
UROTHELIAL NEOPLASM
LOW GRADE UROTHELIAL LESIONS
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High nuclear to cytoplasmic ratio Marked nuclear hyperchromasia Coarsely granular chromatin Irregular nuclear outline Large nucleoli (some cases)
High-grade urothelial lcarcinoma. Numerous
isolated malignant cells have enlarged, dark nuclei and an increased nuclear to cytoplasmic ratio.
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
HIGH GRADE UROTHELIAL CARCINOMA
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Cytoplasmic keratinization Pearls Bridges Angulated hyperchromatic nuclei
Urothelial carcinoma
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
OTHER MALIGNANT LESIONS
SQUAMOUS CELL CARCINOMA
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3) PLEURAL, PERICARDIAL AND PERITONEAL FLUIDS
(EFFUSIONS)
BENIGN MALIGNANT
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Benign effusions contain mesothelial cells, histiocytes and lymphocytes.
Cytomorphology
Mesothelial cells
Numerous, isolated cells, small cluster with ‘windows’, single nucleolus, dense cytoplasm with clear outer rim (lacy skirt), round cells and nucleus.
Histiocytes
Smaller nuclei than mesothelial cells, folded nuclei, cytoplasm granular/vacuolated, no ‘windows’ between adjacent cells.
BENIGN
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MALIGNANT
Tips for detection: Second population, numerous large clusters and lacunae (cell block sections).
Cytomorphology
Malignant mesothelioma
~Common pattern
Large cluster with scalloped (knobby) edges, cytomegaly, prominent nucleoli, bi/multinucleation, dense cytoplasm with peripheral halo, windows, normal nc ratio, round and center nuclei.
~Uncommon pattern
Predominant isolated tumor cells, lymphocytes only, tumor cells with abundant lymphocytes and histiocytes, psammoma bodies and cytoplasmic vacuolation.
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4) PERITONEAL WASHING
NORMAL MALIGNANT
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- Mesothelial cells in sheets and clusters.- Collagen balls 5%- Histiocytes muscle.- Adipose tissue
NORMAL
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Isolated cells and clusters. Large cells.
Marked variation in nuclear size. Nuclear hyperchromasia.
Prominent nucleoli. Mitoses.
Vacuolated cytoplasm (some cells)
Peritoneal wash: Suspicious for pancreatic carcinoma .Cells in cluster with larger cells and variation in nuclear size.
Vacuoalation cytoplasm seen.http://www.cytologystuff.com/indexnongyn.htm?
section9ng.htm
Peritoneal wash: Suspicious for pancreatic carcinoma.60x .Cells in cluster.
http://www.cytologystuff.com/indexnongyn.htm?section9ng.htm
MALIGNANT
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5) CEREBROSPINAL FLUID
NORMAL BENIGN MALIGNANT
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Common • Lymphocytes • Monocytes Rare • Choroid plexus /ependymal cells • Brain fragment• Germinal matrix • Chondrocytes • Bone marrows
Title : Normal cell in CSF . Dark purple stain is lymphocyte.Source: http://serc.carleton.edu/images/woburn/all_csf_150.jpg
NORMAL
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Abnormal inflammatory cells Plasma cells Macrophage Neutrophils
Non neoplastic disorder Numerous neutrophils Bacteria Viruses Fungi
Title: Cytomorphology of fungal (cryptococcus sp.) infection in cerebrospinal fluid.Source:http://sociedaddecitologia.org.ar/sac/images/stories/galerias/criptococosis/dsc00371.jpg
BENIGN
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Cytomorphology :
Adenocarcinoma Large cells Isolated or small cluster Abundant cytoplasm Accentric nucleus
Small cell carcinoma Small cells Isolated or small cluster Abundant cytoplasm Accentric nucleus
Title: Diff Quick staining of the cerebrospinal fluid reveals adenocarcinomaSource:http://img.medscape.com/fullsize/migrated/507/124/mgm507124.fig2.gif
MALIGNANT
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6) GASTROINTESTINAL TRACT
ESOPHAGUSBarrett’s esophagus , Dysplasia in Barrett’s esophagusLow-grade dysplasia, High-grade dysplasiaAdenocarcinomaSquamous cell carcinomaUncommon tumors
STOMACHAdenocarcinoma
DUODENUMAdenoma and Adenocarcinoma
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Barrett’s esophagus
Cytomorphology:
Epithelial repair
Goblet cells
Differential diagnosis
Intestinal metaplasia of the gastric cardia
Dysplasia in Barrett’s esophagus
Cytomorphology
Background of Barrett’s epithelium
Scattered atypical cells with some but not all features of adenocarcinoma
Barrett’s epithelium with goblet cells. A single large cytoplasmic vacuole expands the apical portion of the cytoplasm and displaces the nucleus and shapes it into a crescent against the basal cell membrane
ESOPHAGUS
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Low-grade dysplasia
Cytomorphology:
Crowded groups with stratification
Mild nuclear atypia and pleomorphism
High-grade dysplasia
Cytomorphology
Crowded groups or isolated cells
Higher degree of nuclear atypia and pleomorphism
Differential diagnosis
Regenerative epithelium
adenocarcinoma
Low-grade dysplasia in Barrett’s epithelium. A fragment of glandular epithelium with stratified elongated nuclei is seen. Although mucin depletion and slight nuclear enlargement are seen, significant nuclear atypia is absent.
High –grade dysplasia in Barrett’s epithelium. A sheet of irregular arranged cell with variable enlarged nuclei is present without evident dyshesion. In spite of the increase nuclear to cytoplasmic ratio, nuclear membrane irregularities, and slight hyperchromasia, the atypia is insufficient for a definitive diagnosis of malignancy.
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Adenocarcinoma
Cytomorphology:
Increased cellularity
Abnormal cellular arrangement
Atypical nuclear features
Various amount of vacuolated cytoplasm
Tumor diathesis
Barrett’s epithelium may or may not be present in the background
Differential diagnosis
Epithelial repair
Dysplasia in Barrett’s epithelium, particularly high grade
Poorly differentiated squamous cell carcinoma
Adenocarcinoma. The nuclei show significant hyperchromasia with chromatin clumping and clearing and large prominent nucleoli.
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Squamous cell carcinoma
Cytomorphology – well differentiated squamous cell carcinoma:
Hyperchromatic / pyknotic nuclei
Completely obscured chromatin
Variable cell shapes (round, oval or spindled)
Irregular, angulated nuclei
Keratinized cytoplasm (‘hard’ or ‘glassy’ orangeophilia)
Sharp cytoplasmic border
Prominent necrosis/ tumor diathesis
Cytomorphology – poorly differentiated squamous cell carcinomas
Less keratinization, nuclear angularity, and pyknosis
Indistinct cell borders
Coarsely textured chromatin
Prominent nucleoli
Well-differentiated squamous cell carcinoma. Two spindled-shaped keratinized malignant-squamous cells with orangeophilic cytoplasm and hyperchromatic nuclei show markedly abnormal chromatin distribution. Degenerated cells with pyknotic nuclei are in the background.
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Uncommon tumorsCytomorphology – uncommon tumors:
Verrucous carcinoma Minimal cytologic atypia Adenosquamous carcinoma
Both malignant squamous and glandular elements Mucoepidermoid carcinoma
Mucinous, squamous, and intermediate cell s in varying proportions
Basaloid carcinoma Tight and loose groups of crowded dark basaloid cells Often misdiagnosed as an adenoid cystic carcinoma
Adenoid cystic carcinoma Cribriform, pseudoacinar, and small duct-like structures
Small cell carcinoma Small or intermediate-sized cells
Scant cytoplasm Prominent molding
Necrosis and nuclear streaking common
Helicobacter pylori (gastric brushings). Numerous faintly basophilic S-shaped rods are entrapped in mucus.
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Adenocarcinoma
Cytomorphology – signet ring cells
Small groups or isolated cells
Vacoulated cytoplasm, often a single large vacuole
Crescent-shaped, angulated, hyperchromatic nuclei
STOMACH
Signet ring cell carcinoma (gastric brushings). A group of malignant signet ring cells is seen. They have characteristic large vacuoles that shape the nucleus into a crescent against the cell membrane. In contrast to benign goblet cells, the nuclei in malignant signet ring cells are hyperchromatic and angulated
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Adenoma and Adenocarcinoma
Cytomorphology:
Cohesive three-dimensional clusters of crowded epithelial cells
Increased nuclear to cytoplasmic ratio
Absent goblet cells
Palisading and molding of elongated nuclei
Fine chromatin and absent or small nucleoli
DUODENUM
Ampullary adenoma (ampullary brushings). A crowded group of glandular cells with mucin depletion and an increased nuclear to cytoplasmic ratio is present. A gland opening is apparent. In spite of the crowding, the arrangement is orderly. The nuclei are enlarged and elongated but significant atypia is present.
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7) BREAST
BENIGN MALIGNANT
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Cytomorphology
~Fibroadenoma
Hypercellular
Large honeycomb sheets, 3D clusters with antler-like configuration, bipolar cells and spindled/oval naked nuclei, fibrillar stromal fragments (bluish gray with Papanicolaou stain/intensely red-purple with Romanowsky type stain), nuclear atypia, some loss of epithelial cohesion, regular nuclear spacing, finely granular chromatin pattern, small and round nuclei.
BENIGN
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Cytomorphology
- Breast cancer
Tubular carcinoma
Hypercellular smear due to dense of fibrosis, predominantly cohesive, often angular clusters(comma-shaped or cornucopia-shaped), some dyshesion, uniform, medium-sized tumor cells with round, uniform nuclei, fine granule chromatin, small nucleoli and occasionally cells have large cytoplasmic vacuole.
-Uncommon breast tumor
Aporine carcinoma
Hypercellular specimen, cluster, sheets and isolated cells, abundant granular cytoplasm with indistinct cell borders, enlarged nuclei with irregular contours, prominent large nucleoli and necrotic debris.
MALIGNANT
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8) THYROID
BENIGN MALIGNANT
Papillary carcinomaAnaplastic carcinomaMedullary carcinomaLymphoma
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Subacute granulomatous (De Quervain’s) thyrioditis
Cytomorphology:
Granulomas
Giant cells
Lymphocytes
Chronic lymphocytic (Hashimoto’s) thyroiditis
Cytomorphology:
Mixed population of lymphocytes
Tingible-body macrophages
Lymphohistiocytic aggregates
BENIGN CONDITIONS
Hashimoto’s thyroiditis. Lymphoid cells are the predominant feature. Most are small, mature lymphocytes.
Hashimoto’s thyroiditis. Hurthle cell with abundant cytoplasm are usually identified in clusters.
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Papillary carcinoma
Cytomorphology:
Sheets, papillae, or microfollicles
Nuclear changes
‘powdery’ chromatin
Grooves
Pseudoinclusions
Nucleoli (small or large)
Membrane irregularity
Nuclear crowding/molding
Variable cytoplasm (scant, squamoid, Hurthle-like, or vacuolated)
Psammoma bodies
Histiocytes, including multinucleated giant cells
MALIGNANT TUMORS
Suspicious for a Hurthle cell neoplasm. These enlarged cells with abundant granular cytoplasm were interpreted as suspicious, but the patient proved to have a multnodular goiter with extensive clear cell change.
Papillary carcinoma. In some cases, papillae are absent, and the neoplastic cells are arranged in crowded sheets. Psammoma bodies are present.
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Anaplastic carcinoma
Cytomorphology:
Mostly single cells
Marked nuclear pleomorphism
Large cells
Epithelioid or spindle shaped
Squamous differentiation (some cases)
Giant cells
Tumor type
Osteoclast type
Anaplastic carcinoma. Tumor cells are dispersed as isolated cells. Nuclei are large, hyperchromatic, and irregular shaped.
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Medullary carcinoma
Cytomorphology:
Numerous single cells
Loose clusters
Epithelioid, plasmacytoid, and/or spindle-shaped cells
Nuclei
Round or elongated
Finely or coarsely granular chromatin
Inconspicious nucleoli
Pseudoinclusion (50% of cases)
multinucleated
Red cytoplasmic granules (70% of cases)
amyloid
Medullary carcinoma. Smears show numerous isolated cells and small blobs of amyloid. (arrows)
Medullary carcinoma. Air-dried Romanowsky-stained preparation show fine red cytoplasmic granules, a helpful diagnostic features.
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Lymphoma
Cytomorphology – MZL type:
Small lymphoid cells
Centrocytes
Plasma cells
Monocytoid B cells
Interspersed large lymphoid cells
Cytomorphology – DLBL type:
Large lymphoid cells
Centroblast
Immunoblasts
Burkitt-like cells
Marginal zone B-cell lymphoma of MALT type. The neoplastic lymphoid cells are uniformly small, with irregularly shaped nuclei a moderate amount of cytoplasm.
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9) SALIVARY GLAND
NORMAL BENIGN MALIGNANT
CARCINOMA & ADENOCARCINOMASMALL CELL CARCINOMA
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Serous and mucinous-type acinar cells Small sheets and tubules of ductal epithelium
Adipose tissue
Title: Major of salivary gland cell Source: http://flylib.com/books/2/953/1/html/2/21%20-%20Serous%20Membranes_files/DA6C21FF4.png
NORMAL
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Epithelial cells Myoepithelial cells
Chondromyxoid matrix
BENIGN
Title: Aspiration from benign salivary gland Source:http://www.nature.com/modpathol/journal/v15/n3/thumbs/3880528f4th.jpg
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Cytomorphology:
Carcinoma Mucus cells ( predominate in low grade tumors)
Intermediate cells Mucinous background
Overt cytology malignancy (high grade tumors)
Adenocarcinoma Cellular aspirate of biphasic cells in 3D cluster
Large clear myoepithelial cells with moderate to abundant cytoplasm and vesicular nuclei Small dark ductal cells with scant cytoplasm
Peripheral homogenous acellular basement membrane material Background naked nuclei
MALIGNANT
CARCINOMA & ADENOCARCINOMA
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Title: Interpretation of suspicious adenoid cystic carcinomaSource: http://www.pathologyimagesinc.com/sgt-cytopath/chronic-inflamm-sialadenitis/cytopathology/diff-diagn/fs-chr-sialad-dd.html
Title: Metastatic squamous cell carcinomaSource:http://pathology2.jhu.edu/cytopath/masterclass/images/salivary/1salp3a.jpg
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Small cell carcinoma
Extranodal marginal zone B-cell lymphoma of MALT type Small to intermediate size lymphocytes
Round to slightly irregular nuclei Occasional immunoblasts
CD 45+, CD20+, CD23-, CD10-,CD5-, cyclin D1-
Folicular lymphoma Mixed population of small and large cleaved and large non-cleaved cells
CD45+, CD20,CD10+,CD5-
Diffuse large B-cell lymphoma Large markedly atypical lymphocytes
CD45+,CD20+, keratin-, S-100-
MALIGNANT
SMALL CELL CARCINOMA
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10) LYMPH NODES
NON – NEOPLASTIC LESIONS NEOPLASMS
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NON – NEOPLASTIC LESIONS
Cytomorphology
- Reactive hyperplasia
~ Polymorphous population, small lymphocytes, centrocytes, centroblast, immunoblast, tingible
– body macrophages, lymphohistiocytic aggregates, capillaries, eosinophils and mast cells.
-Inflammatory/infectious condition
~Sarcoidosis
- Granulomas, epithelioid histiocytes, multinucleated giant cells, lymphocytes and clean background.
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Cytomorphology
Hodgkin LymphomaSmall lymphocytes, eosinophils (especially in mixed cellularity subtype), Reed – Sternberg cells, classic and
mononuclear variants, no lymphohistiocytic aggregates/tingible – body macrophages (exceptions: partial node involvement and lymphocyte predominant Hodgkin lymphoma)
Non-Hodgkin Lymphoma (small lymphocytic lymphoma)Monomorphous small lymphocytes clumped chromatin, smooth/minimally irregular nuclear contour, small
nucleoli, scant cytoplasm, prolymphocytes and paraimmunoblasts, no tingible – body macrophages or lymphohistiocytic aggregates.
NEOPLASMS
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11) LIVER FNAC
NORMAL MALIGNANT
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Hepatocytes Large polygonal cells.
Isolated cells, thin ribbons (trabeculae), or larger tissue fragments. Centrally placed, round to oval and variably sized nuclei.
Commonly binucleated Prominent nucleoli
Intranuclear pseudoinclusions. Abundant granular cytoplasm.
Pigment:
a)Lipofuscin (common:a normal pigment related to cellular aging-golden with the Papanicolaou strain and green-brown with a Romanosky-type strain.
b)Homosiderin: (less common : when present in large quantities it suggests a disoder of iron matabolism)-dark brown with the Papanicolaou strain and blue with with a Ramonowsky-type strain.
c)Bile( not visible under normal conditions but seen in cholestasis) -dark green with both Papanicolaou and Romanosky strain.
NORMAL
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MALIGNANT:
Highly cellular smears with single cells or cords, nests, tubules, or sheets. Spindle-shaped endothelial cells surround thickened cords of neoplastic hepatocytes.
Neoplastic hepatocytes have an increased nuclear to cytoplasmic ratio Granular cytoplasm with bile or hyaline globules( red with Papanicolaou and blue with Romanosky
stains) Large, round nuclei with prominent nucleoli
Intranuclear pseudoinclusions. Large naked nuclei.
MALIGNANT
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Liver FNA - CirrhosisIndividually scattered benign binucleated hepatocytes
from a cirrhotic nodule. 40x http://www.cytologystuff.com/indexnongyn.htm
Liver FNA, Hepatocellular Carcinoma.Loose cluster of malignant hepatocytes from an aspirate of hepatocellular carcinoma. There is uniform atypicality with
increased nuclear-to-cytoplasmic ratios. Some bile pigment is noted between the hepatocytes. 40x
Malignant: liver FNAC
Liver FNA, Hepatocellular Carcinoma.Poorly differentiated hepatocellular carcinoma in which the hepatocytes show marked nuclear enlargement with nuclear irregularity and very prominent nucleoli.60x http://www.cytologystuff.com/indexnongyn.htm
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12) PANCREAS
BENIGN
PANCREATIC ACINAR EPITHELIUM
PANCREATIC DUCTAL EPITHELIUM
REACTIVE NEOPLASM
DUCTAL ADENOCARCINOMAACINAR CELL CARCINOMA
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acinar arrangement or isolated cells eccentrically placed, round nucleus evenly distributed, finely granular chromatin inconspicuous nucleolus abundant granular cytoplasm indistinct cell borders
Normal pancreatic acinar cells (Papanicolaou stain)
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
BENIGN
PANCREATIC ACINAR EPITHELIUM
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Flat, cohesive epithelial sheets (few single cells) Round to oval nuclei Evenly distributed, finely granular chromatin Even nuclear spacing Well defined cytoplasmic boundaries No nuclear crowding or overlapping
Pancreatic ductal epithelial cells. (a) Forming a
honeycomb sheet. (b) Palisading groups with
basally located nuclei
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
PANCREATIC DUCTAL EPITHELIUM
A
B
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Low cellularity Flat, cohesive sheets Uniformly spaced nuclei Round to oval nuclear contours Rare intact single atypical cells
Marked reactive atypia of ductal epithelium in the setting
of chronic pancreatitis. (a)Note the nuclear enlargement
and overlapping, and prominent nucleoli.
(b) The nuclear are basally located, however, with
smooth, round contours and evenly distributed chromatin.
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
REACTIVE
REACTIVE DUCTAL ATYPIA
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Increased cellularity Cohesive epithelial sheets ( with rounded edges) Nuclear crowding and overlapping Increased intracytoplasmic mucin Focally irregular nuclear contours (pyramidal and carrot-shaped nuclei) Nuclear enlargement (particularly marked anisonucleosis within a single
sheet) Irregular chromatin clearing
Pancreatic ductal adenocarcinoma
(a) Compare the appearance of this disordered, crowded
Sheet with the normal ductal epithelium. (b) Irregular nuclear
Contours and marked nuclear enlargement are evident.
(c) Irregular chromatin distribution and hyperchromasia.
a
b
c
NEOPLASMS
DUCTAL ADENOCARCINOMA
(Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)
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Groups of cells in nest, cords, or acini Increased single cells Nuclear irregularity, crowding, overlapping Increased nuclear to cytoplasmic ratio Conspicuous nucleoli Absence of ductal epithelium
Acinar cell carcinoma (http://en.wikipedia.org/wiki/File:Acinic_cell_carcinoma.jpg)
ACINAR CELL CARCINOMA
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13) KIDNEY AND ADRENAL GLAND (FNA)
KIDNEY AND ADRENAL GLAND NORMALMALIGNANT
KIDNEYNORMAL
Glomeruli, Proximal tubular cell & Distal tubular cellOncocytoma
MALIGNATClear cell typechromophobe type
ADRENAL GLANDNORMALMALIGNANT
Adrenal cortical carcinomaPheochromocytoma and Metastatic carcinoma
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Glomeruli: Cytomorphology:
Large papillary structures. Capillary loops.
Differential diagnosis: Papillary RCC ( renal cell carcinoma)
Proximal tubular cells: Cytomorphology:
Rare cells with abundant granular cytoplasm.
Differential diagnosis: Oncocytoma Chromophobe RCC
Distal tubular cells:Cytomorphology: Rare cells with scant cytoplasm and minimal
atypia.Differential diagnosis Low grade clear cell or papillary RCC
NORMAL: KIDNEY AND ADRENAL GLAND
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MALIGNANT:
Clear cell/ conventional renal cell carcinoma
Cytomorphologic:
Large cohessive groups.
Abundant clear and granular cytoplasm.
Large, round, eccentrically placed nucleus with prominent nucleolus.
Differential diagnosis:
Large cohessive groups
Abundant clear and granular cytoplasm.
Large, around, eccentrically placed nucleus with prominent nucleolus
MALIGNANT: KIDNEY AND ADRENAL GLAND (FNA)
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NORMAL: KIDNEY FNAC
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Oncocytoma:
Clean Background Dyshesive Single Cells or Loose Clusters, No Stripped Nuclei
Rarely in Large Groups (Unlike RCC) Small Uniform Nuclei, Smooth Borders (Unlike RCC)
Focal Nuclear Atypia, Binucleation, Inconspicuous Nucleoli Abundant Uniformly Granular Well-defined Cytoplasm
No Vacuoles (Unlike RCC) Sharp Well Defined Cell Border (Unlike PCT Cells)
Hale's Colloidal Iron Negative, or Perinuclear/atypical Staining Present Electron Microscopy: Mitochondria
MIMICS: PCT, Chromophobe RCC, Conventional RCC with Granular Cytoplasm Renal Cell Carcinoma
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Kidney - oncocytoma60x
http://www.cytologystuff.com/indexnongyn.htm
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MALIGNANT: KIDNEY (FNA)
Conventional/common/clear cell type (CRCC):
Clean or necrotic background Cohesive monolayered sheets (unlike oncocytoma)
Prominent branching capillaries rare single cells (low grade) ® more single cells and stripped nuclei (higher grades) (unlike oncocytoma)
Bland nuclei, no nucleoli (low grade) Larger atypical nuclei, some bizarre, nucleoli prominent (higher grade), (unlike oncocytoma, chromophobe
RCC). Eccentric nucleus, extruded from cells
More uniform nuclei than chromophobe rcc Foamy vacuolated cytoplasm (unlike onc and normal)
Clear, or granular (not uniform) abundant cytoplasm (low N/C ratio) Intracytoplasmic mallory-like bodies
Vimentin, cytokeratin positive (use biotin block) Hale's colloidal iron negative
Electron microscopy: glycogen, lipid; mitochondria in some MIMICS: distal convoluted tubule and collecting duct, oncocytoma, chromophobe RCC
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Chromophobe Type:
Clean background Sheets, clusters, single cells (dyshesive, but less than CRCC)
Bare nuclei (unlike oncocytoma) More variation in cell & nuclear size (than oncocytoma, CRCC)
Vesicular nuclei, binucleation, inclusions Irregular nuclear outline (unlike oncocytoma, CRCC)
Prominent nucleoli in some abundant granular cytoplasm Perinuclear clearing, prominent cell borders ("koilocytic")
Fluffy/clear/granular not uniform cytoplasm Vimentin negative, cytokeratin positive (use biotin block) Hale's colloidal iron positive - uniform, dense, cytoplasmic
Electron microscopy: microvesicles; mitochondria if eosinophilic variant MIMICS: oncocytoma, CRCC
http://www.cytologystuff.com/indexnongyn.htm
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Kidney - renal cell carcinomaConventional type. Cluster of foamy vacuolated cells with eosinophilic intracytoplasmic Mallory-
like bodies. 60x
Malignant: Kidney (FNA)
Kidney - renal cell carcinomaConventional type. Monolayered sheets of foamy
vacuolated cells with low N/C ratios, eccentric nuclei, minimal nuclear atypia and small nucleoli. Nuclei appear
uniform. 40x
http://www.cytologystuff.com/indexnongyn.htm
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NORMAL: ADRENAL GLAND (FNA)
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Adrenal gland - normal cortex Clusters of vacuolated cells with bland round smoothly contoured nuclei,
small nucleoli and fragile frayed cytoplasmic edges. 60x
Abundant foamy granular lipid rich background appears in clumps on thin layer. Entrapped vacuolated cells with round bland regular nuclei. Note bare stripped nuclei as well. 40x
http://www.cytologystuff.com/indexnongyn.htm
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MALIGNANT:
Adrenal cortical carcinoma • MIMICS Adenoma Features • Necrosis May be Present • May See Malignant Nuclear Criteria • Histological Assessment Required to Distinguish Larger Adenomas from Carcinomas • Similar Immunoprofile as Adenoma • MIMICS: May be Indistinguishable from Normal Adrenal Gland and Adrenal Cortical Adenoma; Pheochromocytoma, Other Malignancies, if Poorly Differentiated
MALIGNANT: ADRENAL GLAND (FNA)
http://www.cytologystuff.com/indexnongyn.htm
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http://www.cytologystuff.com/indexnongyn.htm
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Adrenal gland, Metastatic small cell carcinoma60x
Adrenal gland, Metastatic small cell carcinoma
60x
Adrenal gland, Metastatic adenocarcinomaProminent 3-D cell ball formation without intercellular
windows indicating glandular differentiation.60x
Adrenal gland, Metastatic adenocarcinoma60x
http://www.cytologystuff.com/indexnongyn.htm
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14) OVARY
BENIGNSerous cystadenoma and cystadenofibroma, Mucinous cystadenoma
MALIGNANT~Papillary serous cystadenoma of low malignant potential and serous
cystadenocarcinoma~Mucinous cystadenoma of low malingnant potential and cystadenocarcinoma~Endometrioid carcinoma
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Serous cystadenoma and cystadenofibroma
Cytomorphology:
Cuboidal cells
Ciliated cells
Detached ciliary tufts
Psammoma bodies (rare)
Mucinous cystadenoma
Cytomorphology:
Mucinous cells
Isolated cells, ribbons, sheets
Macrophages
Extracellular mucin
BENIGN EPITHELIAL NEOPLASMS
Serous cystadenoma. Benign ciliated cells have basally placed nuclei, terminal bars, and cilia.
Mucinous cystadenoma. Among the macrophages are fragments of benign mucinous epithelium endocervial epithelium.
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Papillary serous cystadenoma of low malignant potential and serous cystadenocarcinoma
Cytomorphology: serous tumor of low malignant potential
Twisted sheets and spheres
Branching clusters
Mild to moderate nuclear atypia
Large cytoplasmic vacuoles (some cells)
Psammoma bodies
Stripped fibrovascular cores
Cytomorphology: serous cystadenocarcinoma
Cluster and isolated cells
Large pleomorphic cells
Round nuclei
Prominent nucleoli
Psammoma bodies
MALIGNANT EPITHELIAL NEOPLASMS
Serous of low malignant potential tumor. The cells are arranged in a crowded sheet. There is mild to meoderate atypia.
In this tight spherical aggregate, some cells have large cytoplasmic vacuoles
Psammoma bodies are a common finding
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Mucinous cystadenoma of low malingnant potential and cystadenocarcinoma
Cytomorphology: Mucinous cystadenoma
Columnar mucinous cells with mild atypia and/or groups of pleomorphic large cells with prominent
nucleoli
Cytoplasmic vacuolization
Macrophages
Papillary serous cystadenocarcinoma. The malignant cell often have large, round and pleomorphic nuclei, and nucleoli and prominent
Mucinous cystadenocarcinoma. Some sheets of mucinous cells show only mild atypia
Other cells are markedly atypical and difficult to recognize as mucinous origin
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Endometrioid carcinoma
Cytomorphology: Numerous isolated cells
Strips and/or crowded glands Palisading
Elongated columnar shape Clear cell carcinoma
Endometrioid adenocarcinoma. The cells have elongated nuclei and a narrow columnar shape. Some are arranged in pseudostratified strips and glands.
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15) SOFT TISSUE
SPINDLE CELL NEOPLASMSLEIOMYOSARCOMASCHWANNOMA
ROUND CELL NEOPLASMDESMOPLASTIC SMALL ROUND CELL
TUMORALVEOLAR RHABDOMYOSARCOMA
CONTENTS
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Naked nuclei Loose clusters Spindle-shaped cells ‘cigar-shaped’ nuclei Abundant homogeneous cytoplasm mitoses
Leiomyosarcoma. Nuclei are hyperchromatic with finely or slightly coarsely granular chromatin in lower-grade lesions and more coarsely clumped chromatin in the high-grade lesions.
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
SPINDLE CELL NEOPLASMS
LEIOMYOSARCOMA
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Large, cohesive fragments Wavy, ‘fishlook’ nuclei Pointed nuclear ends Nuclear palisading Filamentous cytoplasm
Schwannoma. The cells of benign schwannoma grow in a
syncytial fashion with indistinct cell borders
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
SCHWANNOMA
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Sheets and clusters of cells Fragments of variably cellular stroma
Uniformly round to oval cells Nuclear molding
Desmoplastic small round cell tumor.
This differs from other round cell lesions in
That its undifferentiated neoplastic cells
retain a loose cohesiveness and are rarely
Singly dispersed.
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
ROUND CELL NEOPLASM
DESMOPLASTIC SMALL ROUND CELL TUMOR
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Larger, uniformly round to polygonal cells Predominantly undifferentiated cells ( early rhabdomyoblasts)
Multinucleated giant tumor cells
Alveolar rhabdomyosarcoma. The cells disperse
individually, but are generally larger and more
uniformly round to polygonal than those seen in
embryonal rhabdomyosarcoma.
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
ALVEOLAR RHABDOMYOSARCOMA
ROUND CELL NEOPLASM