Download Cytological Examination: Part II

Cytological Examination:
Part II
Clinical Pathology
Microscopic Evaluation
• Scan at 10x
– Determine if stained adequately
– Any localized or increased cellular areas
– Scan for any large objects: parasites, foreign
bodies, etc.
– Look at what type of cells are found
• Examine at 40x
– Evaluate individual cells
• Examine at 100x (oil immersion)
– Cell morphology, nucleus, chromatin, cytoplasm
Interpretation
• Inflammatory vs. Non-inflammatory
– Most important judgement
– May not get a definitive diagnosis, but may be
able to get a general idea/general process.
– Cytology may be helpful on what’s the next
diagnostic step to take
• Culture
• Biopsy
• Rads
• Serology
Inflammatory cells found in
Cytology
• Neutrophils
– May resemble same as blood neutrophils.
– Be degenerative
– Hypersegmented
• Lymphocytes
• Plasma cells
– Active lymphocytes that have a very basophilic cytoplasm
• Eosinophils
– Mast cells- allergic inflammation
• Macrophages
– Large tissue monocytes.
– Have abundant blue cytoplasm with vacoules that may contain
phagocytized cells or debris
– Oval to pleomorphic nucleus
– Mesothelial cells
• Cells that line the pleural, peritoneal,a nd visceral surfaces.
• A type of macrophage
Neutrophils in Tissue
Lymphocytes and Plasma cells in
tissue
Eosinophils in tissue
Mast cells in tissue
Macrophages in Tissue
Mesothelial Cells in Tissue
Classifications of Inflammation
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Purulent
Pyogranulomatous
Granulomatous
Eosinophilic
• May also be classified as duration:
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Acute
Subacute
Chronic-active
Chronic
Purulent Inflammation (Abscess)
• Most common type of
inflammation
• Usually caused by
bacteria
• Also called
suppurative
inflammation
• Over 70% neutrophils
with a few
macrophages and
lymphocytes
Pyogranulomatous inflammation
• Also referred to as chronic/active
• Consists of macrophages and 50-75%
neutrophils
Granulomatous Inflammation
• Greater than 50-70% of cells are
mononuclear (monocytes, macrophage,
giant cells).
• Few neutrophils
• Also called chronic inflammation.
Eosinophilic Inflammation
• Consists of greater than 10% eosinophils
• Allergic related
• May see a few mast cells, plasma cells
and lymphocytes
Selected Infectious agents of
Cutaneous lesions
• Bacterial agents
– Tend to produce lesions characterized by >85%
neutrophils, few macrophages, lymphocytes, and
plasma cells.
– Rods, cocci
– Cytology is helpful in determining what kind of culture
or stain is needed.
• Fungal agents
– Tend to have more macrophages than bacterial
lesions, but may be mixed (pyogranulomatous). Low
numbers of lymphocytes.
• Sporothrix schenkii
• Histoplasma capsulatum
• Blastomyces dermatidis
• Crytococcus neoformans
• Coccidiodes immitis
Sporiotrichosis: Sporothrix
schenkii
• Organisms are round to oval or cigar
shaped
• Stain pale to medium-blue cytoplasm with
a slightly eccentric pink or purple nucleus.
• Dimorphic fungus found in the
environment worldwide
• Inoculated into tissue via puncture wounds
• Suppurative to pyogranulamatous
• Skin lesions are characterized by multiple,
non-painful, nonpruritic nodules that may
ulcerate and drain purulent exudate.
• Dissemination is rare
Sporotricosis continued
• Diagnose via cytology, biopsy, fungal
culture
• Easier to diagnose in cats, tend to have
more organisms
• Infected cats are highly contagious to
humans
• Treatment includes long term antifungals
– Ketoconazole
– Itraconazole
• Prognosis is fair to good, but relapse is
possible.
Histoplasma Capuslatum
• Round to oval- yeast-like
• Dark blue/purple staining nucleus
surrounded by a thin halo
• Causes systemic disease
• Cutanous lesions are rare, causes lungs or
GI tract infections
• Most common in termperate and
subtropical areas.
• Diagnosed through cytology,
histopathology, fungal cultures, rads
Blastomyces dermatidis:
Blatomycosis
• Caused by inhaling the conidia
• Causes a disseminated infection
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Lymph nodes
Skin
Bones
Other organs
• Found in mostly acidic soils
• Diagnosed by cytology, histopathology,
serology and fungal cultures.
• Most are single, blue, spherical and thick
walled.
• Pyogranulamatous
Cyptococcus Neoformans:
Cryptococcosis
• Found worldwide
• Organism is inhaled and establishes
infections in the nasal cavity, sinuses, skin
and other organs
• Spherical, yeast-like organisms
• Thick, clear mucoid capsule
• May be budding or non-budding
• Cats: URI signs, SQ swelling over bridge
of nose, non-painful, may have CNS signs
• Dogs: CNS signs and ophthalmic signs
usually occur. Nodules on lips and nose.
Coicidiodes Immitis:
Coccidiomycosis
• Dimorphic fungus and soil saprophyte
endemic to desert areas
• Organisms are inhaled and disseminate in
body
• Skin lesions are nodular, abscesses and
draining tracts
• Painful lameness
Coccidiomycosis Continued
• Spherical with thick deeply
stained wall.
• Diagnosis thought cytology,
pyogranulamatous,
histopathology, serology and
fungal culture.
• Treated by long term systemic
antifungals (8-12 months)
• Prognosis is unpredictable
• Relapses are common
• Fungal cultures are contagious
• Infected animals are not
considered contagious
Leishmania donovani:
Leishamaniasis
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Protozoa transmitted by blood-sucking sandflies
Endemic to Central and South America
Sporadic infections in the US
A visceral and cutaneous disease that develops
over months-years
Lesions are dark and small to large and ulcerated.
Diagnose by imprints, scraping and FNA
Organism usually found in macrophages
Small, round to oval
Has a very light blue cytoplasm, an oval nucleus,
and a small dark kinetoplast
Usually numerous organisms found
Not curable
Contagious to other dogs through vector
Non-inflammatory Lesions
• Neoplastic
– Epithelial
– Mesenchymal (spindle cell)
– Discrete Round cell tumor
• Non-Neoplastic
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Cysts (sebaceous)
Hyperplasia (prostatic hyperplasia)
Dysplasia
Hematomas
Seromas
Salivary Mucocele
Epithelial Neoplasms
• Tend to exfoliate cells in sheets or clumps
• Cells tend to be large with moderate to
abundant cytoplasm
• Benign epithelial tumors
– Papilloma
– Epidermal inclusion cyst (epithelioma)
– Perianal gland adenomas
• Malignant epithelial tumors
– Perianal gland adenocarcinoma
– Squamous cell carcinoma
Mesenchymal tumors: Spindle
cell tumors
• Tend to exfoliate individual cells instead of clusters
• May be difficult to differentiate from normal
granulation tissue (spindle cells are plump).
• Difficult to differentiate from the different types of
tumors on cytology.
• Benign forms:
– Fibromas
– Lipomas
– Hemangioma
• Malignant forms:
– Fibrosarcoma
– Liposarcoma
– Hemangiosarcoma
Discrete Round Cell Tumors
• Tend to exfoliate small to medium sized
cells.
• Also called cutaneous round cell tumors
• Types:
– Mast cell tumors
– Cutaneous lymphosarcoma
– Histioctyomas Transmissable venereal tumor
Evaluation of Malignant Potential
(Criteria of Malignancy)
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Variation of cell size
Variation in nuclear size
Multinucleated
Increased nucleus: cytoplams ratio
Mitotic figures
Variation in nucleolar size/shape
Coarse Chromatin pattern
If more than 3 criteria are recognized in a high
percentage of cells, this is strong evidenc for
malignancy
• If 1-3 criteria are present, may be either benign or
malignant and should be sent to pathologist or
biopsied.
Submission of Cytologic Slides
• Send 2-3 air-dried unfixed smears and 2-3 stained
smears
• Fluid samples should have smears prepared from
them immediately
• Also send EDTA and red top tubes filled with fluid
• Mail in protective containers
• Timely transportation service
• Easy accesible and easy to collect cytology
• Tranquilization/anesthesia seldome needed for
sample collection
• Quick-sample can be prepared, stained, and
microscopically evaluated in minutes.