cytopathology dr. nada al-alwan (prof. of pathology) prof. nada alwan prof. nada alwan prof. nada...
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CytopathologyDr. Nada Al-ALwan (Prof. of Pathology)
Prof. Nada Alwan
Prof. Nada Alwan
Prof. Nada Alwan
Prof. Nada Alwan
Histopathology Cytopathology
1. Deals with the form and the structure of the tissue.
2. Evaluation with a tissue biopsy.
3. More invasive traumatic procedure is needed; utilizing surgical instrumentation such as foreceps, scissors, etc..)
4. Needles if used should have a large gauge (i.e., Tru-cut needles measuring 14, 16 ) .
5. Diagnosis obtained after days.
6. Basic stain is H&E
7. Paraffin blocks are needed
8. Difficult to identify specific causative inflammatory pathogen
1. Deals with the structural changes within the nucleus and cytoplasm of individual cells
2. Evaluation requires cells only.
3. Inexpensive simple means of diagnosis which allows frequent repetition of cellular sampling (since it causes no tissue injury).
4. Fine needles with 22, 23 or 24 gauge are usually preferred.
5. Rapid diagnosis that could be obtained within minutes.
6. Basic stain is Pap stain (however H&E could be used as well)
7. Mainly slides are needed
8. Smears permit better evaluation of the nature of the inflammatory process. Fungi and parasites are usually easier to be diagnosed.
Prof. Nada Alwan
Prof. Nada Alwan
Prof. Nada Alwan
Prof. Nada Alwan
Pap Smear
Prof. Nada Alwan
Prof. Nada Alwan
Cervix cytology-normal
superficial cells
parabasal cells
immature sq. cells
endocervical cells en face
endocervical cells-profile
Prof. Nada Alwan
HPV
Prof. Nada Alwan
Prof. Nada Alwan
HPV
Prof. Nada Alwan
Prof. Nada AlwanCIN I or LSIL
Prof. Nada AlwanCIN II or HSIL
Prof. Nada Alwan
CIN III or HSIL
Prof. Nada Alwan
SQUAMOUS CELL CARCINOMA
ADENOCARCINOMA
SMALL CELL CARCINOMA
LARGE CELL CARCINOMA
Prof. Nada Alwan
Prof. Nada Alwan
Fine Needle aspiration Cytology
In general, the definitive diagnosis of any mass can be established by:
Open biopsy,
Tissue core needle (Tru-cut) biopsy,
Fine needle aspiration biopsy.
Compared to FNA, Tru-cut biopsy is a more traumatic procedure which should be performed under local anaesthesia. It requires more time and special equipment that are more expensive. Pain, discomfort and bleeding are common complications.
Prof. Nada Alwan
Fine Needle aspiration Cytology
FNAC, on the other hand, provides many advantages to the surgeons:
It is an easy, reliable, cost effective diagnostictechnique which can give rapid results.
The procedure could be performed in an office setting without anaesthesia. It is usually notmore painful than a venipuncture and can be repeated immediately if the acquired material is inadequate.
Prof. Nada Alwan
Equipments and Procedure of FNAC:
When reduced to its simplest terms, FNA
consists of:
- Using a needle and syringe to remove
material from a mass.
- Smearing it on a glass slide.
- Applying a routine stain.
- Examining it under the microscope.
Prof. Nada Alwan
Prof. Nada Alwann
Malignant epithelial cells
Prof. Nada Alwan
Indications for Cytopathology
1. Differentiation between benign and malignant lesions
2. Diagnosis of the type of Malignancy
3. Diagnosis of premalignant diseases
4. Detection of inflammation and certain types of pathogenic agents
5. Study of hormonal patterns
6. Monitoring of response to therapy and Follow-up of irradiation
7. Study of tumour markers
Prof. Nada Alwan
Criteria of MalignancyHow can we detect the presence of malignant cells
cytologically?
Nuclear Changes
Nuclear Hypertrophy
Nuclear Size Variation
Nuclear Shape Variation
Hyperchromatism and Chromatin Irregularity
Multinucleation
Irregularity of Nuclear Membrane
Irregular and Prominent Nucleoli
Prof. Nada Alwan
in Malignant CellsCytoplasmic Changes
Scantiness of Cytoplasm
Cytoplasmic Boundries (sharp & distinct in Squamous cell
ca & indistibnct in undifferentiated ca)
Variation in Size
Variation in Shape
Cytoplasmic Staining ( deep orange in keratinizing
squamous ca or basophoilic in immature poorly differentiated
ca)
Cytoplasmic Inclusions (melanin pigments in melanoma)
Cytoplasmic & Nuclear membrane relationship
Prof. Nada Alwan
Changes in Cells as a Group in Malignancy
Cellular Phagocytosis or Cannibalism (indicating
rapid growth of cells within a narrow cavity)
Lack of Cellular Adhesion (due to abnormalities in
desmosomes)
Abnormal Mitosis
Bloody Background (fresh blood is meaningless, but
when RBCs are ingested by histeocytes or blood obtained
without trauma)
Foreign Cellular Structures (ex. psammoma Bodies)
Degeneration and Inflammation (Tumour Diathesis)
Prof. Nada Alwan