细针吸取细胞学检查 ( fine needle aspiration cytology)

1. 细针吸取细胞学检查(fine needle aspiration cytology) • 使用细针穿刺病灶吸取出少量细胞成分作涂片来观察病灶部位肿瘤或非肿瘤性细胞的形态，从而作出诊断。 • 细针吸取活检( fine needle aspiration biopsy ) • 细针细胞病理(fine needle aspiration cytopathology)

3. 细针吸取细胞学检查(fine needle aspiration cytology) • Advantages • The advantages of FNA biopsy can be summed up in the acronym SAFE. • It is Simple, Accurate, Fast, and Economic, as well as safe.

4. 细针吸取细胞学检查(fine needle aspiration cytology) • Deep-Seated Organ Aspirations • FNA biopsy of deep-seated organs, such as lung, liver, pancreas, kidney, or adrenal, is in many ways similar to, but in some ways different from, FNA biopsy of superficial targets. • Ultrasound, Computered Tomography Guiding the Needle

5. 细针吸取细胞学检查(fine needle aspiration cytology) • Disadvantages • 样本采集 • 涂片制作 • 细胞学诊断

6. 淋巴结针吸细胞学检查 淋巴结针吸细胞学检查：操作简便，快速安全，对于明确淋巴结良恶性病变的性质、快速诊断淋巴结疾病，包括各类反应性增生和淋巴结转移癌及恶性淋巴瘤，具有临床实用价值。

7. 正常淋巴结细胞学 正常淋巴结穿刺涂片标本淋巴细胞占95%以上，以成熟小淋巴细胞为主，其余5%为幼淋巴细胞、原淋巴细胞、网状细胞和浆细胞等。

8. 正常淋巴结细胞学 • Lymphocytes. • Benign, reactive pattern, with predominance of small, mature lymphocytes, a range of maturation of immature lymphocytes, and a fully differentiated plasma cell. (Diff-Quik)

9. 正常淋巴结细胞学 • Lymphocytes. • The benign pattern showing a range of maturation of lymphocytes, including mature plasma cells. (Pap)

10. 正常淋巴结细胞学 • Tingible body macrophages. • Specialized histiocyte that engulfs dead (necrobiotic) cells. Associated with germinal center formation and benign lymphadenopathy, but can be seen in any high-grade lymphoma. (Pap)

11. 淋巴结良性病变针吸细胞检查 • 慢性淋巴结炎： • 本病常见，多由局部慢性感染引起，好发于颈部、颌下和腹股沟等处； • 涂片内有大量小淋巴细胞，夹有少量转化的淋巴细胞及组织细胞，有吞噬现象；

12. 慢性淋巴结炎

13. 慢性淋巴结炎 Chronic lymphadenitis • Chronic lymphadenitisis probably the most common diagnosis in aspiration of enlarged lymph nodes. • A cellular smearwith numerous immature, or follicular center cells, but an overall predominance of small, mature lymphocytes. • Tingible body macrophages and lymphohistio-cytic aggregates also present. • Mitotic figures may be seen. (Diff-Quik).

14. 慢性淋巴结炎 Chronic lymphadenitis • Follicular hyperplasia, with large, immature lymphocytes and predominance of small, mature lymphocytes resulting in characteristic full range of maturation of the lymphoid cells. • Note immunoblast with prominent nucleolus and plasmacytoid cytoplasm. Histiocytes, tingible body macrophages, lymphohistiocytic aggregates, and mitotic figures would also be easily found in the smear.

15. 淋巴结良性病变针吸细胞检查 • 急性淋巴结炎： • 早期病变涂片内有大量小淋巴细胞，及少量转化的淋巴细胞及组织细胞； • 炎症转为急性化脓性时，见大量中性粒细胞及其退化、坏死。

16. 淋巴结良性病变针吸细胞检查 • 结核性淋巴结炎： • 涂片内见到具有诊断意义的类上皮细胞、郎罕巨细胞及干酪样坏死。 • 抗酸染色可找到结核杆菌。

17. 结核性淋巴结炎 Granulomatous lymphadenitis • Granulomas are characterized by nodular collections of epithelioid histiocytes; giant cells are optional. In Diff-Quik, the epithelioid histiocytes have elongated nuclei and abundant, dense, slightly fibrillar cytoplasm.

18. 结核性淋巴结炎

19. 淋巴瘤针吸细胞检查 • 恶性淋巴瘤：是原发于淋巴组织或淋巴结的恶性肿瘤，临床表现为无痛性淋巴结肿大，以颈部为主，其次是纵隔和腋窝，伴有发热、夜汗、皮肤瘙痒、体乏和体重下降等表现，晚期可出现后腹膜淋巴结、肝脾和（或）骨髓受累。

20. 霍奇金淋巴瘤（Hodgkin’s Disease, HD） • 细胞学诊断主要依据是出现典型的R-S细胞 (Reed-Sternberg cell, R-S cell) 及其变异型R-S细胞，背景是各种反应性增生样淋巴细胞。 • R-S细胞形态特点

21. 霍奇金淋巴瘤（Hodgkin’s Disease, HD） • Classic Reed-Sternberg cells • Benign, reactive inflammatory background

22. 霍奇金淋巴瘤（Hodgkin’s Disease, HD）

23. 霍奇金淋巴瘤（Hodgkin’s Disease, HD） • Hodgkin's disease. The diagnostic cell is the Reed-Sternberg cell, but it must be present in the proper milieu, ie, a benign, reactive chronic inflammatory background. (Diff-Quik)

24. 霍奇金淋巴瘤（Hodgkin’s Disease, HD） • Hodgkin's disease. Malignant Reed-Sternberg cell and benign chronic inflammatory infiltrate. (Pap)

25. 非霍奇金淋巴瘤（ Non-Hodgkin’s Lymphoma NHL ） • 细胞学特征是肿瘤细胞形态单一,多以一种细胞为主．细胞丰富，多弥散分布，细胞核有异型性，可见核膜皱褶，核沟深浅不一．

26. 非霍奇金淋巴瘤Non-Hodgkin’s Lymphoma

27. 非霍奇金淋巴瘤Non-Hodgkin’s Lymphoma • Small (well-differentiated) lymphocytic lymphoma. A cellular aspirate in which most, if not all, of the cells resemble ordinary small, mature lymphocytes. Tingible body macrophages, lymphohistiocytic aggregates, and mitotic figures are not seen. (Diff-Quik)

28. 非霍奇金淋巴瘤Non-Hodgkin’s Lymphoma • Small (well-differentiated) lymphocytic lymphoma. • Small, mature lymphocytes. Cleaved cells are not present. (Pap, oil)

29. 非霍奇金淋巴瘤Non-Hodgkin’s Lymphoma • Small (well-differentiated) lymphocytic lymphoma. Small, mature lymphocytes. The same cells may be circulating in the blood (chronic lymphocytic leukemia)--an important diagnostic clue. (Diff-Quik, oil)

30. 非霍奇金淋巴瘤Non-Hodgkin’s Lymphoma • Small (well-differentiated) lymphocytic lymphoma. In many cases, the malignant cells are slightly larger, with slightly less dense chromatin, compared with normal mature lymphocytes, but nuclear membranes remain smooth. (Diff-Quik, oil)

31. 非霍奇金淋巴瘤Non-Hodgkin’s Lymphoma • Plasmacytoid small lymphocytic lymphoma. Also known as lymphoplasmacytic lymphoma, a variant that is morphologically and clinically similar to small lymphocytic lymphoma, except for the presence of plasmacytoid lymphocytes and a few plasma cells. (Diff-Quik, oil)

32. 非霍奇金淋巴瘤Non-Hodgkin’s Lymphoma • Lymphoblastic lymphoma. Young patient with mediastinal mass is classic presentation. Cytologic finding is medium-sized cells with smooth or convoluted (illustrated, Diff-Quik, oil) nuclei and scant cytoplasm.

33. 淋巴结转移癌针吸细胞检查 • 淋巴结针吸细胞学有助于判断是否有癌转移，还可根据细胞学形态及临床表现，判断原发肿瘤的来源；有的原发肿瘤小而隐蔽，常借针吸细胞学而获诊，并可推断其原发部位。

34. 鳞状细胞癌淋巴结转移

35. 腺癌淋巴结转移

36. 甲状腺癌淋巴结转移

37. 小细胞未分化癌淋巴结转移

38. 白血病淋巴结浸润 • 确诊白血病，一般依据骨髓和血像检查。有时骨髓检查不能肯定诊断时，而肿大的淋巴结穿刺细胞学检查对白血病的诊断和细胞类型的鉴别则有一定参考价值。

39. 恶性黑色素瘤淋巴结转移 • 本瘤恶性程度较高，好发于足底、下肢、头颈及外阴部，可为黑痣受刺激恶变而来，可早期发生血道或淋巴结转移。涂片所见细胞形态除有一般恶性肿瘤的特征外，唯一的特点是胞浆内出现大小不等、弥散分布的棕色黑色素颗粒。

40. 乳腺针吸细胞学检查(fine needle aspiration cytology of breast) • 乳腺针吸细胞学检查操作简便、安全迅速，几乎没有创伤，主要用于判断乳腺良恶性病变的性质，快速诊断早期乳腺癌，具有临床实用价值。

41. 乳腺正常细胞学 • 在一般情况下，涂片见到的脱落细胞成分很少，一张涂片只见几个细胞。常见细胞有乳腺导管上皮细胞、双极裸核细胞、泡沫细胞、吞噬细胞和脂肪细胞。

42. Breast (tissue) • Duct and lobule of normal breast. • In the nonlactating breast, the lobule is composed of terminal ducts and ductules.

43. Breast (tissue) • The normal duct is formed by a double-layered epithelium, consisting of an inner lining of epithelial cells and an outer lining of myoepithelial cells. • Benign disease of the breast. • In contrast, cancer is characterized by loss of the myoepithelial layer.

44. 乳腺导管上皮细胞Ductal cells • Benign ductal cells are usually seen in breast aspirates as highly cohesive, small epithelial cells, often in flat, "honeycombed" sheets, reminiscent of endocervical cells. (Pap)

45. 乳腺导管上皮细胞Ductal cells • Small sheet of ductal cells. • Single, intact epithelial cells are usually sparse in benign aspirates. • The nuclei are uniform and have smooth nuclear membranes. The chromatin is fine; nucleoli are inconspicuous. (Diff-Quik)

46. 肌上皮细胞Myoepithelial cells • Myoepithelial cells are represented by naked, bipolar nuclei in FNA biopsy. Naked, bipolar nuclei are oval to elongated, dark but bland, and stripped of their cytoplasm. • The presence of myoepithelial cells or their "sentinel" nuclei is a hallmark of a benign breast aspirate.

47. 肌上皮细胞Myoepithelial cells • Represented by naked, bipolar nuclei in background of smear. • Be cautious diagnosing malignancy in the presence of these sentinel nuclei. (Diff-Quik, oil)

48. 肌上皮细胞Myoepithelial cells • Myoepithelial cells. • Naked, bipolar nuclei in Pap. (Oil)

49. 乳腺正常细胞学

50. 泡沫细胞Foam cells • Foam cells. • Probably bone marrow-derived histiocytes, these cells have abundant, foamy cytoplasm and are associated with cysts. (Diff-Quik)