Cytology of Body Fluid

1
Cytology of Body Fluid
Edmund S, Cytology, Chapter 4 Pleural,
pericardial, and peritoneal fluid Richard M
DeMay, The art science of cytopathology,
Chapter 8 Fluid Leopold G.Koss, Koss diagnostic
cytology, Chapter 26 Effusion in the presence of
cancer

• Speaker ???
• Advisor ?? ?? ??? ??
• Date 3.15.2006

2
Outline

• Representation of the three body cavities
• Collection and preparation of specimen
• Benign elements
• Non-neoplastic conditions
• Malignant effusions---primary tumors
• ---metastatic
  tumors
• Differences Between Adenocarcinoma and
  Mesothelioma

3
Schematic representation of the three body
cavities
4
Accumulation of fluids in body cavities
Differences Between a Transudate and an Exudate
Feature Transudate Exudate
Gross appearance Watery, clear Cloudy, reddish Specific gravity lt1.015 gt1.015 Protein lt3.0 g/dl gt3.0 g/dl Clots No Yes Cells Few usually benign Many can be malignant
5
Collection and preparation of specimen
6
Benign elements
Mesothelial cells
7
Benign Mesothelial cells that mimic cancer cells
Benign Formation Mimics
Three Dimensional cells balls, or rosettes Adenocarcinoma Papillae Papillary adenocarcinoma Indian files Breast, small cell carcinoma Cell in cell Squamous cell carcinoma Signet ring Breast, stomach cancer Single cell Lymphoma
8
(No Transcript)
9
Non-neoplastic conditions
Eosinophilic pleural fluid
10
Tuberculous pleuritis
Multinucleated macrophages
11
Systemic lupus erythematosus

• Cytology preparation Lupus erythematosus cell
  (LE cell)

LE cell
12
Malignant effusions---primary tumors
Malignant Mesothelioma Malignant Mesothelioma
More and bigger cells, in more and bigger clusters Group Irregular papillae and Knobby three-dimensional clusters Cell-in-cell arrangements Indian files Nuclei Increased bi/multinucleation Nuclear enlargement and pleomorphism Macronucleoli Cytoplasm Windows, skirts (lacy appearance) Dense, many two-tone staining Fine vacuoles (lipid, glycogen)
13
Cell-in-cell pattern
More and bigger cells, in more and bigger
clusters
14
Malignant effusions---metastatic tumors
The Most Common Tumor that Cause Malignant Effusion, by Site and Sex
Type of Malignant Men Women
Pleural Lung Breast Gastrointestinal tract Lung Pancreas Ovary Peritoneal Intestinal Ovary (includes gastric and pancreatic) Pancreas Breast Prostate Uterus
15
The patterns of Adenocarcinoma The patterns of Adenocarcinoma
Breast cancer Ovarian cancer Stomach cancer Kidney cancer Thyroid cancer Cannonball (no vacuole) Indian files Signet ring cells (small) Psammoma bodies Cannonball (vacuole) Signet ring cells (large) Clear cells Psammoma bodies
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
F4.27
F4.28
20
Non-Hodginkin lymphoma

• Large cell lymphoma
• Nuclei large than histiocyte
• Eccentric nuclei
• Abundant blue cytoplasm
• Best appreciated in Diff-Quik

• Follicular lymphoma
• Irregular nuclear contours
• Scant cytoplasm

21

• lymphoblastic lymphoma
• Small to medium sized lymphocytes
• Fine powdery chromatin
• Scant cytoplasm

22
(No Transcript)
23
(No Transcript)
24
Differences Between Adenocarcinoma and
Mesothelioma
Cytologic Differences Between Adenocarcinoma and Mesothelioma
Adenocarcinoma Mesothelioma
Groupings Community borders irregular knobby outline Windows unusual Windows common Cells Columnar shape Blebs, skirts Nucleus Usually eccentric Usually central Pleomorphic and bizarre Less pleomorphic and not bizarre Cytoplasm Delicate, homogeneous Dense with lacy edges Uniform stain Two-tone staining Vacuoles Secretory Degenerative Multinucleated Rare Common Giant cells
25
Distinguishing Between Mesothelioma and Metastatic Adenocarcinoma with Immunocytochemistry
Stain Staining patterns Adenicarcinoma Mesothelioma
Mucicarmine C Carcinoembryonic antigen C CA19-9 C Leu M-1 CM E-cadherin CM BerEP4 CM B27.3 M Thyroid transcription factor-1 N (TTF-1) Keratin protein M (peripheral) (perinuclear) Calretinin CN Vimentin C Wilms tumor(WT1) protein N
-


-

-

-

-
-


-

-



-
-


-
C cytoplasm M membrane N nuclear
26
THE END
Thank you for your attention
27
E-cadherin
28
BerEP4
29
B72.3
30
Calretinin