CYTOLOGY

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CYTOLOGY

• A branch of Pathology dealing with
• - clusters of cells
• - Individual cells in smears

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• Obtained from -
• Exfoliated cells
• Scrappings
• Effusions

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Exfoliated cells
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• Classification
• Exfoliative cytology
• FNAC

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Exfoliative Cytology

• Use is made of exfoliated cells from superficial
  squamous cells or forcibly scrapped cells
• example from
• - Cervix
• - Bronchial aspirate (Brushing)
• - Buccal smears (Barr Bodies) in
  genetic councelling

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• - URINE ? Infection
• ? Tumours
• -
• - Sputum ? Infections - specific
• - non-specific
• ? Tumours

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• - Imprints (Touch preparations) malignant
  cells eg. lymphomas
• - Effusions ? Infections - specific
• - Non-Specific ? Tumours -1
• - 2

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• - Skin scrapes - filariasis
• - Onchocerciasis
• - Fungal infections
• - Psoriasis

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• - Cystic aspirations
• - Thyroid
• - Lymphoepithelial
• - Branchial
• - Cystic hygroma

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Cervical Screening

• - Pre-Malignant conditions
• CIN i
• CIN ii
• CIN iii

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• Infections ? Bacterial
• Acute
• - Chronic
• - Granulomatous ? TB
• ? Schisto
• ? Fungal candida
• ? Chlamydial
• ? Viral - Herpes
• - HPV
• - CMV
• -

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• Malignant Cells ? CIS
• ? Invasive Ca
• Hormonal status

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Carcinoma in situ
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Invasive SCC cervix-well differentiated
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Components of Cervical Smear

• 1. Superficial Exfoliated Cells
• ? Superficial
• ? Intermediate
• ? Parabasal
• ? Basal
• 2. Columnar Endocevical Cells

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• 3. Metaplastic Cells from transitional zone
• 4. Endometrial cells - during pregnancy -
  IUCD
• 5. Commensals - Dorderlain bacilli - after
  secretory phase
• - during pregnancy
• strept, staph, candida

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• 6) Other Cells - RBC - Menstral
• - Erosions
• - Ulcerations
• - leukocytes (infection)
• 7) Mucus Strands - Hormonal status
• 8) Contaminants - Spermatozoa

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Effects of Hormones

• Squamous epithelium of Cx and vagina is sensitive
  to ovarian hormones
• Oestrogen? Epihelium is thicker and shows
  maturation towards the surface (mature
  superficial flat cells)

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• Secretory phase, Pregnancy
• ? Navicullar cells
• Pre-puberfal, Post menopause
• ? Scanty parabasal cells
• Intermediate Cells
• ? Decreased oestrogen response
• or effect of progesterone

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• 7) Mucus Strands - Hormonal status
• 8) Contaminants - Spermatozoa

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Cervical Pathology

• Cellular atypia
• CIN i Mild dysplasia
• CIN ii Moderate Dysplasia
• CIN ii-iv Severe Dysplasia

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LGCIL
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HGCIL
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• Carcinoma in situ
• Invasive Carcinoma

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FINE NEEDLE ASPIRATION CYTOLOGY

• FNAC - Screening
• - Diagnosis of benign conditions
• Malignant conditions

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• Requirements
• A needle 23-25 gauge (0.6 mm diameter)
• - Syringe 10cc, 20cc
• - Syringe holder
• - Air dried/Fixed

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Site of Aspiration (Indications)

• 1) Screening purposes
• 2) Definitive Diagnosis

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• Superficial Organs
• - Thyroid
• - Salivary glands (parotid)
• - Lymphnodes
• - Breast
• - Soft tissues

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• Deep seated Organs
• - Liver - Spleen
• - Brain

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• - Kidney
• - prostate
• - Pancreas
• - Abdominal Lymphnodes

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• Deep Organs FNAC
• aided by imaging techniques
• - Ultrasound
• - CT Scan
• - Magnetic image resonance (MRI)

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• Follow up after - Surgery
• - Chemotherapy
• - Radiation therapy
• - Hormonal therapy

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Advantages

• -Minimum trauma
• - Less expensive
• - Simple, fast, safe
• - No anaesthesia needed
• - Results fast obtained
• - Out patient basis

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• Complications Rare - Implant of Tumour
  Cells
• - Infections (prostate)
• - Haemorrhage (Liver,Thyroid)

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Cytopathology in Clinical Use

• 1) SCREENING for pre-cancerous changes
• CIN i to iv (CIL)
• CIS
• Invasive Ca

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CIN - 2
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Invasive cancer
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• 2) Diagnosis of malignant Conditions
• - sputum
• - Bronchial aspirate
• - URINE
• - Skin scrapes
• - Effusions
• - FNAC

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• 3) Evaluation of response to treatment
• - Tumour Excision
• - RT
• - Chemotherapy (cytotoxic drugs)

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• 4) Follow up of patients after
• - Surgery
• - RT
• - Chemotherapy
• - Recurrence
• - Metastasis

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• 5) Screening for high risk groups
• - Workers ? Dye industry
• ? Rubber Industry exposed to chemical
  carcinogens (aniline dyes)
• - Females under hormonal treatment
  (inappropriate hormone secretions)

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• 6) Diagnosis of specific non-malignant conditions
  especially in Immune-compromised individuals
• - PCN
• - Fungi
• - TB ? pulmonary
• ? Extrapulmonary

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Pneumocystis carinii pneumonia
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Pneumocystis carinii
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Aspergillus
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aspergillus
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• - Herpes simplex
• - HPV types 5,6,11,
• 16,18, 31
• - CMV
• - Trichomonas vaginalis
• - strongyloids stercoralis
• - trichuris trichura

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Extrapulmonary TB TB Lymphadenopathy
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Disseminated Mycobacterial Infection
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Sputum examination
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• 7) Hormonal imbalance ? Cx
• - Benign Tumours ? Breast
• ? thyroid
• ? Lymphnodes
• ?Salivary glands

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• 8) Diagnosis of Genetic diseases
• - Barr bodies
• XXY, XO
• - Haemaphrodites
• 9) Research

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Fixatives

• ? 50 ether in alcohol
• 95 alcohol
• Cold acetone (immunohitochemistry)
• - stains papanicolaou stain
• - Nuclear
• - Cytoplasmic ? details especial for
  epithelial cells

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• - May Grunwald Giemsa (MGG)
• - CSF
• - Lymphoid cells (Lymphomas)
• - PAS ? DD Adecarcinoma
• Mesothelial cells
• - Z-N stain (AFB)

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Immunocytochemistry

• - Intermediate filaments
• - vimentin
• - NSE
• - S-100
• - LCA
• - GFAP

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• - Actin, myosin
• - Desmin
• - Hormones
• Eostrogen ? Breast Cancer
• Eostrogen ? Prostate Cancer
• hcg ? Ovarian Cancer
• Trophoblastic diseases

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• Other markers - CEA
• - EMA
• - AFP

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• - Flow Cytometry
• - DNA content
• - Diploid complete mole
• 46 (XX/XY) chromosome
• - Aneuploid
• - Triploid/Tetraploidy partial
  hydatidiform mole(XXY/XYY)

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• ? Advise on further management of pt
• - Malignant
• - suspicious
• - Unsatisfactory smear