faculty of allied medical sciences
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Faculty of Allied Medical Sciences. Histopathology and Cytology (1) (MLHC-201). Cytolopathology. Supervision Prof.Dr.Noha Ragab. Outcomes. 1-To know the meaning of cytology and cytopathology 2-Differentiate between transudate and exudate - PowerPoint PPT PresentationTRANSCRIPT
Histopathology and Cytology (1)(MLHC-201)
SupervisionProf.Dr.Noha Ragab
1-To know the meaning of cytology and cytopathology2-Differentiate between transudate and exudate3-To know examination of body fluid and sample collection4-Understand types of staining smears5-Study types of different body fluids
Cytopathology:is a branch of pathology that studies and diagnoses diseases on the cellular level.
The most common use of cytopathology is the Pap smear, used
to detect cervical cancer at an early treatable stage. Two methods of collecting cells for analysis are:
1) Cells are extracted from fluid shed into the body cavities. For example, in pleural fluid, ascitic fluid, or in the case of the Pap smear, cells scraped from the cervix. 2) Fine Needle Aspiration Cytology
Schematic representation of the three body cavities
Accumulation of fluids in body cavities
Transudates
• Increased hydrostatic pressure: Congestive heart failure
• Decreased oncotic pressure (decreased albumin) : liver cirrhosis, nephrosis, and malnutrition
Exudate
• Inflammation: Infection, infarction, hemorrhage
• Tumor
Feature Transudate Exudate
Gross appearance Watery, clear Turbid or cloudy
Specific gravity Less than 1015 More than 1015
Protein Less than 3mg/dl More than 3mg/dl
Clots No Yes
cells Usually benign:
Few mesothelial
cells, few histocytes
and lymphocytes
More mesothelial cells,
acute or chronic
inflammatory cells,
RBCs, malignant cells
It is very useful for diagnosis of premalignant and
malignant tumors, especially metastatic tumors.
It is very useful for diagnosis of inflammatory
conditions (septic effusion, or chronic specific
inflammation e.g. TB
Respiratory Tract
Urinary Tract
Oral Cavity
Gastrointestinal Tract
Effusions (pleural, pericardial, joint)
Cerebral Spinal Fluid
Amniotic fluid
Many other body sites
Non-Gynecological Specimen Collection
Gross exam
Total cell count
Microscopic exam
Any other special test (Chemistry, Microbiology,
cytology (
Test are performed in various areas of lab based on what
the physician orders.
Body fluids sterile vs. non-sterile
FNA of effusion fluids
Tapping
Collection and preparation of specimen
PAP
Gram Stain
Hx & E
Cell block for remnant sediment and
histopathological examination.
Other special stains for the most suspected diseases,
to confirm diagnosis.
Heparinized bottles (3 units heparin/ml) Unfixed
Alcohol-fixed
Papanicolaou-stained
Cytocentrifuge preparationCell block
Adding plasma and thrombin solution
Wrapped in filter paper
Placed in a cassette
Embedded in paraffin
Cut and H&E stain
Air-dried cytocentrifuge preparation
(Hematologic malignancy is suspected)
Fluid surrounding brain and spinal cord
Sterile
Specimen collection: by Lumbar puncture
Collect 3-5 vials, each tube has a designated department.
Gross exam: Turbidity, Color, microscopic exam, cell
count
Enumerate and differentiate cells seen
Lymphocytes: usually are few; increased with viral,
fungal, bacterial meningitis, or nervous system disease
Monocytes: Less than 2% of normal CSF, increased
with TB meningitis, viral encephalitis, subarachnoid
haemorrhage.
PMN: are few, associated with viral and acute bacterial
inflammation.
Macrophages: are few in number associated with
malignancy, hemorrhage, inflammation
Eosinophils/Basophils: not normally seen in CSF
Plasma cells: not normally present; associated with viral
disorders, and Hodgkin's diseases.
Red Blood Cells: Few to none present
Mesothelial cells: not present
Malignant cells: will see with malignant disease and
infiltrate.
• Effusion:
• Transudate
• Exudates
• Lab analysis: Gross exam, cell count, etc.
• Differential: PMN, Lymph, Mono, etc.
2- Pleural Fluid: Lung fluid
• Cells unique to the lungs: Mesothelial cells
• RBCs and WBCs: are limited, if increased without
traumatic tap ----- indicates infarction
• Cytology exam: useful in identifying malignancy or
abnormal morphological cells.
Abnormal accumulation of fluid (effusion) in peritoneal
cavity: Ascites
Ascites: a condition in which fluid accumulates within
the peritoneal space.
◦ Must have an accumulation of > 100 ml (several 100) before
effusion can be detected on physical exam.
Peritoneal Fluid Appearance: Color and clarity.
◦ Color and clarity can indicate certain infections and
diseases.
Total Cell Count: Assist in diagnosis of certain
diseases by determining total RBC and WBC
number.
Lymphocytes: CHF, liver cirrhosis, nephrotic syndrome
Mesothelial Cells: Associated with TB effusions
Malignant cells: seen with malignancy
Pericardial Fluid: accumulation of fluid of the lining of
the heart (effusion)
Cause: neoplasm, infections, collagen disease, renal
disease, Cardiovascular disease.
Gross Exam: Report appearance (bloody, clear, cloudy)
4- Pericardial Fluid
Measure pH: pH less than 7.0 associated with
infection or rheumatoid disorder.
Cell count: see limited RBCs and WBCs
Evaluate sediment
• Joint Fluid: normally clear, viscous
• Functions as a lubricate and transports nutrient
• Arthrocentesis: aspirate of the joint fluid, aseptic
technique
• Lab Assay: Gross exam, microscopic exam, Gram
stain, cultures,...
5- Synovial Fluid:
• Appearance: clear, transparent, viscous
• Viscosity test
• Mucin Clot test
• Note crystals (intracellular vs. extra cellular)
• Slide exam: usually performed on concentration of the
fluid using Giemsa or Papnicolaou
Cellular pleural cytology; lymphocytes, reactive mesothelial cells
Cellular ascitic fluid; lymphocytes, PNL and metastatic carcinoma cells
1-Cytopathologyis………………………………………………2-Sample collection is made by……….and…………..3-Types of staining smears are………………….4-……………..acts as a lubricate and transports nutrient5-Pericardial Fluid is accumulation of fluid of the…………………6-………………. Fluid surrounding brain and spinal cord
الغنى عبد السيد محروس أميرة عاشور القادر عبد خلود مرسى أحمد محمد دنيا الديب سالم عطية دينا الله عبد رضا رانيا اللطيف عبد رزق روان فريد رجب ابراهيم ريوان