Download - Lab Diagnosis of Neoplasia
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Lab Diagnosis of Neoplasia
By Sarah Iqbal Ahmed
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These are the different methods used for diagnosis and staging of Neoplasia:
1. Histological methods.2. Cytological methods3. Histochemistry and Cytochemistry4. Immunohistochemistry5. Tumour markers6. Flow Cytometry7. Newer methods
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1.Histological Methods
Microscopic examination of properly fixed tissue.
Tissue sample taken by:
Selection of site is very important.Samples are fixed in alcohol or glutaraldehyde
and then stained.
Needle Aspiration Cytologic Smears Excision or Biopsy
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The samples are stained then examined
under microscope.
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2.Cytological Methods
There are two methods:
1)Exfoliative Cytology/PAP smear: Study of cells shed off into body cavities. Used for gyneac & non gyneac purposes. Used for examination of :
1)Sputum 2)Bronchial washings 3)Pleural,Peritoneal & Pericardial effusions 4)Urine 5)Gastric secretions 6)CSF.
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FNAC(fine needle aspiration cytology)
Aspiration of cells and fluid under vacuum
Followed by Cytologic examination of smear. It is most commonly used method with a
reliability of 75-80% It cannot be substituted for clinical judgment.
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Frozen Section and Cryostatic Methods
Method of freezing and immediate examination of samples. Eg:Surgeon sends margins of excised tumour to make sure if entire malignancy has been removed.
Special staining methods to. identify composition of cells, constituents and products.
3.Histochemistry and Cytochemistry
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4.Immunohistochemistry
Identifies specific components of cell by specific monoclonal antibodies.
Antigen antibody complex is made visible by fluorescent dyes or enzyme systems.
Melanoma stained by 3 antibodies(1)HMB-45 (2)CD-3.(3)CD-20
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Uses of Immunohistochemistry
1. Categorisation of undifferentiated tumours.Eg:Presence of keratin indicates epithelial cell tumour whereas desmin presence indicates neoplasia of muscle.
2. Determination of site of origin of metastasis spread.
3. Detection of molecules of prognostic importance.Eg: hormone receptors
4. Categorisation of Leukemia's and lymphomas
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5.Tumour MarkersThey are biochemical indicators of tumours in
blood or body fluids. Products of tumour cells –also produced by normal
cells.They may be - cell surface antigens,enzymes,
cytoplasmic proteins and hormones.Measurement of these in serum is done by
bioassays.They help in identification of tumour and in
measurement of prognosis.
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TUMOUR MARKERS
TUMOURS
1. CEA
2. Alkaline phosphatase
3. Alpha fetoprotein
4. HCG
5. PSA
6. CA-125
Colorectal and pancreatic neoplasm's
Neoplasms of bone
Hepatocellular carcinoma,germ cell tumour of testis
Choriocarcinoma
Prostatic adenocarcinoma
Ovarian tumours
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6.Flow Cytometry
It is a Computerised technique by which detailed characters of individual cells are
recognized and stored In-situ Hybridization:DNA/RNA sequences are localized by specifically labeled probe in the intact cellUsed for detection of oncogenes and viruses
HPV
Cytokeratin
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7.Other Methods
DNA Microarray Analysis:Conventional Molecular profiling of tumour
by gene chip technology.DNA probes substituted by silicon chip.Molecular Diagnostic techniques: DNA/RNA extracted from cell and analyzed.Eg:Southern blot,Northern blot and
PCR(Polymerase Chain Reaction).
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