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Cytological%20Examination:%20Part%20II

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Cytological Examination: Part II Clinical Pathology Microscopic Evaluation Scan at 10x Determine if stained adequately Any localized or increased cellular areas Scan ... – PowerPoint PPT presentation

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Title: 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.

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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

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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

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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.

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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

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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

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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

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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

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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.
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