an analysis on cytology diagnoses of the effusion using lbc technology
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An Analysis on Cytology Diagnoses of the Effusion
using LBC Technology
Jong Yull Kim, Prof.,PMIACEulji University
Cellntech Bio.,Co.,Research Institute
Zhanar Yeleubayeva, MD.,MIAC
1
Kinds of Effusion using LBC Technology
Pleural fluid
Ascitic fluid
Cardiac fluid
Synovial fluid
2
Specimen shows varied and different kinds of features of solutions
3
Conventional methods are considered as difficult to effectively smear
-Bloody effusion -Mucous effusion -Clear effusion
4
Conventional methods are sometimes caus-ing false negative and false positive.
Bloody smear Dirty background& overlaping
Degeneration
5
Main purpose of LBC technology
-Thin smear -Clean background -Less degeneration than conventional method
use specially-designated equipment for smear. specially-designated filtering membrane. specially-designated reagent solution.
6
Process for specimen of effusion
• Step 1. Sampling from patient by physician
• Step 2. Transfer to cytopathologic laboratory -Effusion derived from patients should immediately be transferred to cytology rooms to prevent cellular degeneration -Cellular degeneration starts 30 minutes after sampling of effusion -More delay means increased intensity of degeneration -We should prepare the sample immediately to block cellular degeneration in labs
7
Step 3. Classify specimen according to feature of effusion for pre-treatment
8
Step 4. Treatment of specimen according to feature of effusion
1. In case of non-bloody effusion & clear effusion (generally common method : non-treatment of background) - after centrifuge at 1500~2500 rpm / 5 mins
- move sediment to preserve solution
- smear cells on slide by divice
- staining
9
2. In case of bloody effusion
- centrifuge
- add “hemolysin” solution for hemolysis
- centrifuge - move sediment to preserve solution
- smear cells on slide by divice
- staining
10
3. In case of mucous effusion - centrifuge
- add “mucosin” solution for discarding mucus
- moving sediment to preserve solution
- smearing cells on slide by device
- pap staining
11
Increasing diagnostic rate
Percentage of increasing diagnostic rate
More than mean 22% of diag-noses among the each inadequate specimen are diagnosed to suf-ficient specimenas either benign or malignant.
10 20 40 60 80
100Percentage of increasing diagnostic rate Among the Inadequate specimen
Blood Mucus Clear
24% 19% 21%
Percen
tage
Source: Cellnatech bio, research institute.
Inadequate diagnosisLBC con LBC LBCcon con
12
In conclusion
1. Slide smear using the LBC technologies have advantages com-pared to two conventional methods. -The strengths follow: Eliminating backgrounds around diagnostic cells effectively makes easy microscopic work. -As LBC technology enables to manufacture thin smear, a deep and thorough reviews of morphological features in diagnostic cells are guaranteed. -As the LBC technology enables to allow samples to have proper substance of background, identification for details of malignant cells like mucus producing adenocarcinoma and signet ring cell type adenocarcinoma is useful.
2. Based on different status of specimen, -the LBC technology could produce a series of slides. Meanwhile, re-examination and special stain are also posible. -As diagnostic cells exit in a slide by forming groups, it's also possible to find the origin of malignant details in metastasis.
13
Diagnosis
14
Body Cavity: potential space lined by mesothelium
Mesothelium : Single layer of mesothelial cells
Supporting vascular connective tissue
15
Condition with Neutrophils in effusion(Abscess)
dirty background with neutrophils clean background with neutrophils
16
Condition with RBC In Effusion(Traumatic hemorrhage)
bloody background with lymphocytes clean background with lymphocytes
17
Condition with Eosinophils in Effusion (parasitic infestation)
portein background with Eosinophils clean background with Eosinophils
18
Parasitic Infestation
Parasitic Ova with Inflammatory and necrotic debris
Parasitic Ova with clean background
19
Tuberculous Effusion(Caseous necrosis)
amorphous necrotic materials with lymphoid small particle.
“Caseous necrosis”20
Lymphocytes & epithelioid cells
Low power feature
21
Langhans giant multinucleated histiocyte
22
Rheumatoid Arthritis
Elongated histiocytes(carrot cells)
MacrophagesAmorphous proteinaceous debris
23
Multinucleated giant cells(MGH)
Abundant clumps of granular debris
Monolobular or polylobular neutrophils (degenerating neutrophils)
24
Systemic Lupus Erythematosus
LE cells ; enlarged neutrophil nucleus + pink to purplish amorphous round intracytoplasmic mass
Degenerating cells(atypical plasmacytoid cells) Nuclear debris
25
Mesothelial Reaction
dirty background and degenerative change of mesothelial cells
clean background and well preserved chromatin pattern.
26
Malignant mesothelioma & Mesothelial reaction
many mesothelial cells with thick cytoplasmWe can find different morphology of nuclear between both slides
27
Pseudomyxoma peritonei
Viscous and thick mucinous materialBenign looking columnar cells
Well-differentiated columnar and over dis-tended by large mucinous
containing vacuoles28
Serous cystadenocarcinoma of ovary
dirty background and degenerated malignant cluster
clean background and well preserved malignant cluster
Papillary or rosette formationOften intracytoplasmic large vacuoles
29
Mucious cystadenocarcinoma of Ovary
Gray to deep purple colored mucus & abun-dant, well defined cytoplasm
Irregular shape in nuclear border with coarse chromatin, large & bizarre nucleoli
30
• Cellular group• Glandular structure
• Indibidual pattern• Similar histiocyte• Eccentric nucleus• Macronucleoli• Individual cells
Signetic ring cell type adenocarcinoma from stomach
mucicarmine Stain positive intracytoplasmic mucus in signet ring cell carcinoma.
Pap stain. Macronucleoi & eccentric nucleus
31
Signetic ring cell type adenocarcinoma from stomach
dirty background with degenerated cancer cells
clean background with well preserved cancer cells
32
Metastatic Adenocarcinoma From colon
Tall columnar, multi-layer, tubular formation
Necrotic tumor cells with necrotic background
33
Adenoid cystic carcinoma
Refractive spherules have three-dimensional cancer cells with benign looking.
34
Giemsa stain pattern as intracystic pinkish materials
Pap stain pattern as refractive three-dimensional appearance
35
Ductal carcinoma, metastatic
cannibalism in Ductal carcinoma, metastatic.
structure of ball form in Ductal carcinoma, metastatic
36
Mucinous carcinoma from Breast
so much mucus background small amount of mucus background
37
Breast-Lobular carcinoma
String of small mlignant cells with internuclear space.
We called it as “Indian file appearance”.
38
Lobular ca. vs. Small cell ca.
indian file appearancewith internclear spaces.
indian file appearance with scanty or abscent internclear spaces
39
Small cell carcinoma
Pap stain pattern including nuclear moulding & scanty cytoplasm
Giemsa stain pattern including nuclear moulding & scanty cytoplasm
40
Small cell carcinoma, metastatic
clustes of small cell carcinoma, metastatic.compact & tight clusters with scanty cytoplasm are remarkable.
41
Large cell carcinoma, metastatic
marked nuclear pleomorphism & nuclear nippling in large cytoplasm.
42
Squamous cell carcinma, metastatic
necrotic background with degenerated cancer cells
well preserved cancer cells with small amount of necrosis
43
Lymphocytes vs. Malignant lymphoma(Body fluid)
mature lymphocytes including some pseudofiber
cells of lymphoma includingopen chromatin & nucleoli
44
Hodgkin’s lymphoma
Reed-Sternberg cell
Single prominent nucleoli
Variable amounts of immature lymphocytes
and plasma cells in background 45
Plasmocytoma
Dysplastic plasma cell(myelocytes)with accentric nucleus including macronucleoli in Pap
Dysplastic plasma cell(myelocytes)with accentric nucleus including intracytoplasmic clear zone in Giemsa
46
Malignant melanoma
• Singly scattered or occa. In groups
• Finely granular brown or black melanin pigments
• Round-oval nuclei, central or eccentric nuclei
• Prominent nucleoli, often bizarre forms
Malignant melanoma
47
Thank you
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