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Current Use of LBC in Non-Gynae Cytology

Current Use of LBC in Non-Gynae Cytology. Christine Payne Thames Valley Cytology Society March 2005. Liquid Based Cytology. What is it? Nothing new in cytology; eg FNA into saline urine into alcohol fixative This has facilitated maximising the sample and partial fixation .

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Current Use of LBC in Non-Gynae Cytology

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  1. Current Use of LBC in Non-Gynae Cytology Christine Payne Thames Valley Cytology Society March 2005

  2. Liquid Based Cytology • What is it? • Nothing new in cytology; eg FNA into saline urine into alcohol fixative This has facilitated maximising the sample and partial fixation

  3. Liquid Based Cytology • Why is it different? • At present there are two major commercial companies offering LBC for use in the NHSCSP. • Both procedures can also be used for preparation of non-gynae.

  4. Advantages • The advantages are • Maximising the cellularity of the sample • Removal of excess blood • Excellent fixation • 1 representative slide • Extra material available for further testing

  5. Disadvantages • Cost is the major factor. • Hardware may become available through the Cervical Screening Programme • The cost must be weighed against the benefits for medical and BMS time • Also the reduction of inadequate or non diagnostic samples. • Personal preference

  6. Exfoliative samples Urines Sputa Bronchial washings Bronchial brushings Body fluids Aspiration samples FNA Head and neck FNA Lymph nodes FNA Lung FNA Liver FNA Breast Samples to Process

  7. Thyroid FNA • Need special mention • Most other samples can be diagnosed purely on the ThinPrep sample, but colloid is difficult to evaluate ( ? The same in Surepath), and LBC only is not recommended in our laboratory.

  8. Normal female urine

  9. Urine – high grade TCC

  10. Urine – high grade TCC - HP

  11. Sputum – squamous carcinoma

  12. Bronchial Washings BronchialWashings

  13. Bronchial brushings and washings

  14. Bronchial washings Bronchial washings

  15. Bronchial brushings

  16. Bronchial brushings

  17. Squamous cancer in bronchial brush

  18. Poorly differentiated squamous carcinoma

  19. Bronchial brush small cell x 400

  20. Bronchial Brushings with Small Cell Undifferentiated Carcinoma

  21. Bronchial Brush Adenocarcinoma

  22. Bronchial Brush

  23. Bronchial Brush

  24. Leiomyosarcoma

  25. Transbronchial FNA Small Cell Carcinoma

  26. LBC in Aspiration Cytology • ENT routinely use LBC only with the exception of Thyroid Aspirates • Other FNA sites usually both air dried and LBC are taken

  27. Ductal Carcinoma Breast

  28. Lymph Node Metastatic Melanoma

  29. Metastatic Melanoma

  30. Neck Node Mets from the Lung

  31. Pleomorphic Adenoma

  32. Pleomorphic Adenoma

  33. ? Branchial Cyst

  34. Case Study • An 82 year old man presented to ENT OPD with a large skin lesion behind the ear. • Biopsy and FNA were performed on the lesion and an adjacent lymph node • LBC preps made from the PreservCyt solution using T2000, and stained using Papanicolaou technique.

  35. Lymph Node (1)

  36. Washing from Lymph Node (2)

  37. Diagnostic Dilemma • The material from the lymph node was difficult to evaluate with certainty, as the population of small hyperchromatic cells could have been lymphoid or small cell carcinoma. • The aspirate from the lesion was helpful in forming the provisional diagnosis

  38. Washing from Lesion (1)

  39. Diagnostic Confidence • The fact that the same cells were present in the lesion as in the lymph node added confidence to the probable diagnosis of small cell (neuroendocrine) carcinoma. • The biopsy result was correlated with the cytology

  40. Histology of Biopsy

  41. Small Cell Neuroendocrine Tumour • The differential diagnosis lies between a metastatic small cell carcinoma, most likely from lung and a primary Merkel Cell Tumour of the dermis. • As the chest x-ray is reported clear, then a Merkel Cell tumour is probable.

  42. Merkel Cell Tumour • Merkel cell carcinoma is a rare tumour; locally aggressive and frequently metastatic. Classically difficult to distinguish from metastatic bronchogenic small cell carcinoma and non-Hodgkin’s Lymphoma. • Cells may be less pleomorphic with uniform rounded rather than “oat” shaped nuclei, although “oat like” type can occur.

  43. Epilogue • Double entry on the computer system. • FNA of the Lymph Node one week previous. • Reported as “probably reactive”

  44. FNA (1)

  45. Images for this presentation were sourced at the Royal Gwent Hospital, Wales

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