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Diagnostic Cytology
of Cancer Cases
Somporn TechangamsuwanCompanion Animal Cancer Research Unit (CAC-RU)
Department of Pathology, Faculty of Veterinary Science,
Chulalongkorn University
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Tumor or Non-tumor
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•Infectious agents?
•Fluid?
•Tumor cells?
•Inflammatory cells?
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Cytology >>> Fastest!
Some tumors are diagnosed by
cytology better than biopsy, eg.;
round cell tumor.
Is that final conclusion ?
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Tumor cell
interpretation
Step-by-Step
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At First Glance on Slide1. Significant tumor cells: presence or absence (fluid, blood)
>> DIY: Prepare 2-3 slides
2. Size and shape of tumor cell
>> Easy way to compare tumor size
3. Cellular arrangement
>> clump, sheet, glandular, individual
4. Nuclei and cytoplasm of tumor cell
>> criteria of malignancy
>> intracytoplasmic granules (black, metachromatic)
5. Extracellular matrix (keratin, mucin, osteoid), Foreign bodies, Pathogen6
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Interpretation: First Step Approach
Inflammatory cells
Differentiate cell type
Inflammatory cells+
Tissue cells
- Differentiate cell type
- History taking
Tissue cells
Differentiate cell type and
origin
Which cell type??
• Neutrophils>85% = suppurative (pus)• Neutrophils, Macrophages, pus cells
= pyogranulomatous• Macropahges, Lymphocytes, fibroblasts, plasma cells, low neutrophils
= granulomatous• Many Eosinophils >10% = eosinophilic plaques (granuloma) or allergic reaction
•Epithelium•Mesenchymal•Round cell•Mixed, pleomorphic
>> difficult for diagnosisMost malignant tumor 7
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Epithelial
Mesenchymal
Discrete round cell
Size Shape Cellularity Cluster
Large Round to Usually high Yescaudate
Small to Spindle to Usually low Nomedium stellate
Small to Round Usually high NomediumMast cell Lymphoma
TVT Histocytoma
3 basic tumor cell types
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Anisokaryosis
Pleomorphism
Anisocytosis
Macrocytosis
Multinucleation
Abnormal mitosis
General criteria
Nuclear criteria
HypercellularityIncrease cell no.
Normal Abnormal
Coarse chromatin
Nuclear molding
Angular nucleoli
AnisonucleosisRBC
Criteria of Malignancy
Macrokaryosis &Increased N:C ratio
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Cell Arrangement
Single,solitary Chain, row Sheet Cluster
Glandular Clump
VG
Mal. histiocytosis
Hepatoid cell Mesothelial cell
MG adenocarcinoma
Fibrosarcoma
Basal cell
Cellular Arrangement
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Anisocytosis
PleomorphismVG
Cellular morphology
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Cell Arrangement
VG
Mal. histiocytosis
Hepatoid cell Mesothelial cell
MG adenocarcinoma
Fibrosarcoma
Basal cell
Cytoplasm
Abundant pale, Multiple vacuoles
Scant cytoplasm, basophilic Abundant pale blue cyto. Abundant pale cyto.,
eccentric vacuole
Abundant basophilic cytoplasm Low to moderate pale blue cytoplasmAbundant pale blue cyto. with multiple vacuoles12
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Cell Arrangement
VG
Mal. histiocytosis
Hepatoid cell Mesothelial cell
MG adenocarcinoma
Fibrosarcoma
Basal cell
Nuclear pattern
Heterochromatin, non-prominent nucleoli
Homogeneous, non-obvious nucleoli
Vesicular-prominent large nucleoli
Heterochromatin Prominent large nucleoli
Homogeneous, prominent large nucleoli Heterochromatin, non-obvious small nucleoli
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Abnormal mitosis
Multinucleation
Abnormal Nuclei
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Extracellular Matrix
Intracytoplasmic Granules
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Cluster/single + scant cytoplasm
Cluster/single+ abundant cytoplasm vacuoles
vacuoles
Cluster/sheet/row
glands
Squamous cell tumor group
Basal cell tumor group
Glandular cell tumor group
• Adenoma• Adenocarcinoma• Site of mass
• Epidermal inclusion cyst• Squamous papilloma• Squamous cell carcinoma• Carcinoma
• Sebaceous adenoma• Sebaceous epithelioma
Sebaceous cell tumor group
Epithelial Cell Tumor
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Epithelial Cell Tumor
Trichoblastoma
= Epidermal basal cells (eg ; basal cell tumor,
trichoblastoma, basal cell carcinoma) = Benign hair follicular cells
(eg; trichoepithelioma, pilomatricoma)
Cluster/single + scant cytoplasm Basal cell tumor group
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Cluster/single+ abundant cytoplasm
vacuoles
Squamous cell tumor group
• Epidermal inclusion cyst• Squamous papilloma• Squamous cell carcinoma• Carcinoma
Epithelial Cell Tumor
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Epidermal inclusion cyst
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Cluster/single+ abundant cytoplasm
vacuoles
Squamous cell tumor group
• Epidermal inclusion cyst• Squamous papilloma• Squamous cell carcinoma• Carcinoma
Epithelial Cell Tumor
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SCC
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Cluster/single+ abundant cytoplasm vacuoles Cluster/sheet/row
• Sebaceous adenoma• Sebaceous epithelioma
Sebaceous cell tumor group
Epithelial Cell Tumor
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Cluster/single+ abundant cytoplasm vacuoles
glands
Glandular cell tumor group
• Adenoma
• Adenocarcinoma
• Site of mass:
mammary gland
Epithelial Cell
Tumor
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Cluster/single+ abundant cytoplasm vacuoles
glands
Glandular cell tumor group
• Adenoma
• Adenocarcinoma
• Site of mass:
Perianal gland
Epithelial Cell
Tumor
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Sheet/ Solitary /ClusterTumor involving superficial squamous epithelial cells
= Benign - squamous epithelium (eg; papilloma)
= Squamous cell carcinoma
= Basal cells group
= Epidermal basal cells (eg ; basal cell tumor, trichoblastoma, basal cell
carcinoma)
= benign hair follicular cells (eg; trichoepithelioma, pilomatricoma)
Sebaceous cell group: -adenoma,-epithelioma,-carcinoma
Glandular PatternPerianal gland adenoma/adenocarcinoma
Apocrine gland adenoma/adenocarcinoma
Tumor of the subcutaneous glandular tissues (salivary, mammary, thyroid etc)
Tumor of internal organs; pancreas, adrenal gl., lung etc.
Un-differentiated carcinoma
Conclusion: Epithelial Cell Tumor
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Granules (brown, black, green)
Melanoma
Vacuoles Lipoma/-sarcoma
Secretion (Mucin)
Myxoma/-sarcoma
Extracellular matrix
Chondrosarcoma, Osteosarcoma
Fibroma/-sarcomaHemangioma/-sarcomaHemangiopericytoma
NeurofibrosarcomaMalignant Fibrous Histiocytoma
Spindle Cell Tumor (Mesenchymal Origin)
+--
- + Giant cells
+ Whorls
+ Giant cells
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Granules (brown, black, green) Melanoma
Spindle Cell Tumor (Mesenchymal Origin)
+
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Granules (brown, black, green)
Vacuoles Lipoma/-sarcoma
Spindle Cell Tumor (Mesenchymal Origin)
-
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Granules (brown, black, green)
Extracellular matrix
Chondrosarcoma, Osteosarcoma
Spindle Cell Tumor (Mesenchymal Origin)
-
Chondrosarcoma
Osteosarcoma
+ Giant cells
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Granules (brown, black, green)
Extracellular matrix
Fibroma/-sarcomaHemangioma/-sarcomaHemangiopericytoma
Spindle Cell Tumor (Mesenchymal Origin)
-
Fibrosarcoma
+ Whorls
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Granules (brown, black, green)
Extracellular matrix
Fibroma/-sarcomaHemangioma/-sarcomaHemangiopericytoma
Spindle Cell Tumor (Mesenchymal Origin)
-+ Whorls
Hemangiosarcoma 29
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Granules (brown, black, green)
Extracellular matrix
Fibroma/-sarcomaHemangioma/-sarcomaHemangiopericytoma
Spindle Cell Tumor (Mesenchymal Origin)
-+ Whorls
Hemangiopericytoma 30
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Conclusion: Spindle Cell TumorGranulation tissue?
Malignant melanoma melanin
Lipoma/Liposarcoma fat
Osteoma/osteosarcoma bone matrix, giant cells
Chondrosarcoma chondroid matrix
Myxoma & myxosarcoma mucin production
Fibroma/Fibrosarcoma spindle cell
Hemangiopericytoma whorl
Hemangioma/Hemangiosarcoma endothelial, RBC
Neurofibroma/neurofibrosarcoma
Malignant fibrous histiocytoma giant cells, macrophage
Undifferentiated sarcoma = “Malignant mesenchymal cell tumor” 31
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Round Cell Tumor
Granules (+)Red / purple Mastocytoma
Black Melanocytoma
Granules (-)
DIP QUIK Toluidine blue32
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Round Cell Tumor
Granules (+)Red / purple Mastocytoma
Black Melanocytoma
Granules (-)
Melanocytoma
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Granule(-)
Dense nuclear chromatin
Scant cytoplasm Lymphoid cell
< 50 % with plasma cells, neutrophils= Hyperplasia / Reactive Lymph node
>50%, blast cells, multiple nucleoli = lymphoma
Coarse nuclear chromatin Deep blue cytoplasm
Vacuole(+/-)
TVT
Histiocyte, Basal cell
Large sizeAbundant cytoplasm
With giant cells
Histiocyticlymphoma
Malignant histiocytosis
Medium sizeModerate amount of cytoplasm
Eccentric nucleiCell-rich FNA
Histiocytoma(young dog)
Small sizeScant cytoplasm
Ribbon arrangement
Basal cell tumor (middle-aged dog)
Round Cell Tumor
+
-
Granules (+)
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Mixed breed dog, 12 Y Lymphoma
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Lymphoglandular bodies
Reactive lymph node
Abnormal mitosis
Ruptured cells
Clinical signs– gross• lymphadenopathy (swollen LN)
Cytology• Lymphocytes (main)• Plasma cells (found)• Low lymphoblasts (normal)• Low neutrophils• Lymphoglandular bodies +/-
Lymphoma
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TVT (VG) / ETVT 37
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TVT (VG) / ETVT
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Histiocytoma 39
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Histiocytoma
Histiocytoma
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Malignant Histiocytosis
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Malignant Histiocytosis
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