Faculty of Allied Medical Sciences

1. Faculty of Allied Medical Sciences Histopathology and Cytology (1) (MLHC-201)

2. Cytolopathology Supervision Prof.Dr.Noha Ragab

3. Outcomes 1-To know the meaning of cytology and cytopathology 2-Differentiate between transudate and exudate 3-To know examination of body fluid and sample collection 4-Understand types of staining smears 5-Study types of different body fluids

4. GENERAL ASPECTS OF CYTOLOGY 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

5. Schematic representation of the three body cavities

6. Transudates Exudate • Inflammation: Infection, infarction, hemorrhage • Tumor • Increased hydrostatic pressure: Congestive heart failure • Decreased oncotic pressure(decreased albumin) : liver cirrhosis, nephrosis, and malnutrition Accumulation of fluids in body cavities

7. differences between transudate and exudate

8. Diagnostic role of effusion cytology • 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

9. Non-Gynecological Specimen Collection • Respiratory Tract • Urinary Tract • Oral Cavity • Gastrointestinal Tract • Effusions (pleural, pericardial, joint) • Cerebral Spinal Fluid • Amniotic fluid • Many other body sites

10. Examination of body fluid • 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

11. Sample collection • FNA of effusion fluids • Tapping

12. Collection and preparation of specimen

13. Types of staining smears • PAP • Gram Stain • Hx & E • Cell block for remnant sediment and histopathological examination. • Other special stains for the most suspected diseases, to confirm diagnosis.

14. Cytocentrifuge preparation Cell block Heparinized bottles (3 units heparin/ml) Unfixed Alcohol-fixed Adding plasma and thrombin solution Papanicolaou-stained Wrapped in filter paper Air-dried cytocentrifuge preparation Placed in a cassette (Hematologic malignancy is suspected) Embedded in paraffin Cut and H&E stain

15. 1- Cerebrospinal Fluid • 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

16. CSF cell differential • 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.

17. PMN: are few, associated with viral and acute bacterial inflammation. • Macrophages: arefew in number associated with malignancy, hemorrhage, inflammation • Eosinophils/Basophils: not normally seen in CSF

18. 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.

19. 2- Pleural Fluid: Lung fluid • Effusion: • Transudate • Exudates • Lab analysis: Gross exam, cell count, etc. • Differential: PMN, Lymph, Mono, etc.

20. 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.

21. 3- Peritoneal Fluid • 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.

22. Physical Characteristics • 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.

23. Lymphocytes: CHF, liver cirrhosis, nephrotic syndrome • Mesothelial Cells: Associated with TB effusions • Malignant cells: seen with malignancy

24. 4- Pericardial Fluid • 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)

25. Measure pH: pH less than 7.0 associated with infection or rheumatoid disorder. • Cell count: see limited RBCs and WBCs Evaluate sediment

26. 5- Synovial Fluid: • 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,...

27. 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

28. Cellular pleural cytology; lymphocytes, reactive mesothelial cells Cellular ascitic fluid; lymphocytes, PNL and metastatic carcinoma cells CELLULAR BODY FLUIDS

29. Questions: 1-Cytopathologyis……………………………………………… 2-Sample collection is made by……….and………….. 3-Types of staining smears are…………………. 4-……………..acts as a lubricate and transports nutrient 5-Pericardial Fluid is accumulation of fluid of the………………… 6-………………. Fluid surrounding brain and spinal cord

30. AssignmentsMalignant Tumors of the Upper Respiratory Tract • أميرة محروس السيد عبد الغنى • خلود عبد القادر عاشور • دنيا محمد أحمد مرسى • دينا عطية سالم الديب • رانيا رضا عبد الله • روان رزق عبد اللطيف • ريوان ابراهيم رجب فريد