Lesson 59 - Neoplastic vs Non-neoplastic Lesions

What lesions have low cellularity?

1. cyst

2. lipoma

3. poorly exfoliated lesions

What is an example of a poorly exfoliated lesion?

sarcoma

What are the inflammatory lesions?

1. eosinophilic

2. granulomatous

3. lymphoplasmacytic/lymphocytic

4. pyogranulomatous

5. suppurative

What are the neoplastic lesion types?

1. epithelial

2. mesenchymal

3. round

4. neuroendocrine

5. melanoma

What cells are found in eosinophilic lesions?

1. eosinophils

2. some mast cells

What cells are found in suppurative lesions?

neutrophils, often degenerate

What cells are found in lymphocytic/lymphoplasmacytic lesions?

1. lymphocytes

2. plasma cells

What cells are found in pyogranulomatous lesions?

1. neutrophils

2. macrophages

What cells are found in granulomatous lesions?

macrophages

What are the pros to cytology?

1. cheap

2. quick

3. repeatable

4. good for screening and monitoring

What are the cons to cytology?

1. less architecture

2. more operator-dependent

3. cannot always grade tumor

What are the common indications for cytology?

1. cutaneous/subcutaneous masses

2. lymphadenopathy

3. body cavity effusions

4. respiratory, urogenital, and CSF samples

5. organ masses

What are the techniques for getting samples for cytology?

1. fine-needle aspirate

2. impression smears

3. swabs

4. scrapings/brushings

What are the types of fine-needle aspirate techniques?

1. aspiration technique

2. non-aspiration technique

What are the characteristics of aspiration FNA?

1. small gauge needle (22-25) and syringe

2. negative pressure

What are the characteristics of non-aspiration FNA?

1. needle only

2. multiple redirections

What type of FNA is better for fragile or vascular lesions?

non-aspiration technique

What are impression smears used for?

1. ulcerated lesions

2. biopsies

3. surgical specimens

You want to take an impression smear, but the lesion seems to very bloody. What do you do?

blot tissue to remove blood

What are swabs best for?

1. ear

2. vagina

3. conjunctival

4. nasal

5. fistulas

How do you place a sample from a swab to a microscope slide?

roll the sample, not smear

What lesions are scrapings/brushings used for?

1. keratinized lesions

2. firm lesions

What size needle is used for FNA?

22 - 25 gauge

What size syringe is used for FNA?

5 or 10 mL

What do you not use to label your slide?

pen or sharpie

What do you do if your microscope slides have been sitting out in a drawer for a while?

clean and dry with alcohol

What is the technique for putting sample onto a slide for cytology?

draw air into the syringe and expel it out aiming it towards the slide then place two slides over top of each other and slide away

What is the prefix for change in size/shape of a cell?

aniso

What is the prefix for nucleus?

karyo

What does CHANG stand for?

1. cyst

2. hematoma

3. abscess

4. neoplasia

5. granuloma

What are the criteria for malignancy?

1. anisocytosis

2. anisokaryosis

3. prominent, multiple, and/or bizarrely shaped nucleoli

4. macrocytosis, macrokaryosis, macronuclei

5. anisonucleoliosis

6. multiple nuclei

7. increased N:C ratio

8. nuclear molding

9. coarse chromatin

10. abnormal mitotic figures

What does nuclear molding look like?

hugging nuclei

What does coarse chromatin look like?

looks "ropey"

If you have a mixed sample, how do you classify it?

based on the predominant cell type

What do epithelial lesions look like on cytology?

1. cohesive

2. polygonal

3. moderate to abundant cytoplasm

What do mesenchymal lesions look like on cytology?

1. loose sheets

2. individual

3. wispy cytoplasm

4. spindle or stellate

What do round cell lesions look like on cytology?

1. single discreet cell

2. individual

3. round in shape

What do neuroendocrine lesions look like on cytology?

1. small clusters/rosettes

2. many naked nuceli

What do melanoma lesions look like?

1. individual sometimes with clusters

2. can look like anything

What does the cytoplasm of mast cell tumors show?

purple cytoplasmic granules

What does the cytoplasm of TVT show?

discrete clear vacuoles

What are other features that may be seen with TVT?

background vacuoles

What does the cytoplasm of plasmacytoma show?

paranuclear clearing

What are other features that may be seen with plasmacytoma?

1. significant pleomorphism

2. bi/multinucleation

3. flame cells

What does the cytoplasm of histiocytoma show?

pericytoplasmic clearing

What does the cytoplasm of lymphoma show?

1. infrequently vacuolated

2. occasional paranuclear clearing

What are other features that may be seen with lymphoma?

lymphoglandular bodies

If you tap an abdomen and do cytology on the fluid and see degenerate neutrophils with bacteria, what do you suspect?

septic abdomen

What do lipoma cells show?

peripheral nuclear with large cytoplasm

What malignancy change is this cell showing?

Anisocytosis

What malignancy change is this cell showing?

Anisokaryosis

What malignancy change is this cell showing?

Prominent, bizarrely shaped nucleoli

What type of cell is this?

Mesenchymal

What malignancy change is this cell showing?

Macrocytosis, macrokaryosis, macronucleoli

What malignancy change is this cell showing?

Anisonucleoliosis

What malignancy change is this cell showing?

Multiple nuclei

What malignancy change is this cell showing?

Increased N:C ratio

What malignancy change is this cell showing?

Nuclear molding

What malignancy change is this cell showing?

Coarse chromatin

What malignancy change is this cell showing?

Abnormal mitotic figures

What kind of lesion?

Eosinophilic

What kind of lesion?

Eosinophilic

What kind of lesion?

Suppurative

What kind of lesion?

Suppurative

What lesion is this?

Lymphoma

What lesion is this?

Lymphocytic

What lesion is this?

Pyogranulomatous lesion

What lesion is this?

Granulomatous

What cell is this?

Degenerating neutrophil

What tumor cell type?

Epithelial tumor

What tumor cell type?

Mesenchymal

What tumor cell type?

Lipoma

What tumor cell type?

Mast cell tumor

What tumor cell type?

TVT

What tumor cell type?

TVT

What tumor cell type?v

Plasmacytoma