Cytological%20Examination:%20Part%20II

1
Cytological Examination Part II

• Clinical Pathology

2
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

3
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 whats the next
  diagnostic step to take
• Culture
• Biopsy
• Rads
• Serology

4
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

5
Neutrophils in Tissue
6
Lymphocytes and Plasma cells in tissue
7
Eosinophils in tissue
8
Mast cells in tissue
9
Macrophages in Tissue
10
Mesothelial Cells in Tissue
11
Classifications of Inflammation

• Purulent
• Pyogranulomatous
• Granulomatous
• Eosinophilic
• May also be classified as duration
• Acute
• Subacute
• Chronic-active
• Chronic

12
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

13
Pyogranulomatous inflammation

• Also referred to as chronic/active
• Consists of macrophages and 50-75 neutrophils

14
Granulomatous Inflammation

• Greater than 50-70 of cells are mononuclear
  (monocytes, macrophage, giant cells).
• Few neutrophils
• Also called chronic inflammation.

15
Eosinophilic Inflammation

• Consists of greater than 10 eosinophils
• Allergic related
• May see a few mast cells, plasma cells and
  lymphocytes

16
Selected Infectious agents of Cutaneous lesions

• Bacterial agents
• Tend to produce lesions characterized by gt85
  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

17
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

18
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.

19
(No Transcript)
20
(No Transcript)
21
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

22
(No Transcript)
23
Blastomyces dermatidis Blatomycosis

• Caused by inhaling the conidia
• Causes a disseminated infection
• 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

24
(No Transcript)
25
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.

26
(No Transcript)
27
(No Transcript)
28
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

29
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

30
Leishmania donovani Leishamaniasis

• 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

31
(No Transcript)
32
Non-inflammatory Lesions

• Neoplastic
• Epithelial
• Mesenchymal (spindle cell)
• Discrete Round cell tumor
• Non-Neoplastic
• Cysts (sebaceous)
• Hyperplasia (prostatic hyperplasia)
• Dysplasia
• Hematomas
• Seromas
• Salivary Mucocele

33
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

34
(No Transcript)
35
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

36
(No Transcript)
37
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

38
(No Transcript)
39
(No Transcript)
40
Evaluation of Malignant Potential (Criteria of
Malignancy)

• 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.

41
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.