Transcript Basic cytology

An Analysis on Cytology Diagnoses
of the Effusion
using LBC Technology
Jong Yull Kim, Prof.,PMIAC
Eulji University
Cellntech Bio.,Co.,Research Institute
Zhanar Yeleubayeva, MD.,MIAC
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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
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Conventional methods are sometimes
causing false negative and false positive.
Bloody smear
Dirty background
& overlaping
Degeneration
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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.
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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
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Step 3. Classify specimen according to feature of effusion
for pre-treatment
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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
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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
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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
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Increasing diagnostic rate
Percentage of increasing diagnostic rate
Percentage
100
LBC
con
80
60
40
20
10 24%
Blood
LBC
con
19%
Mucus
LBC
con
21%
Clear
Percentage of increasing
Inadequate diagnosis
diagnostic rate
Among the Inadequate specimen
More than mean 22% of diagnoses
among the each inadequate specimen
are diagnosed to sufficient specimen
as either benign or malignant.
Source: Cellnatech bio, research institute.
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In conclusion
1. Slide smear using the LBC technologies have advantages
compared 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.
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Diagnosis
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Body Cavity: potential space lined by mesothelium
Mesothelium : Single layer of mesothelial cells
Supporting vascular connective tissue
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Condition with Neutrophils in effusion
(Abscess)
dirty background with neutrophils
clean background with neutrophils
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Condition with RBC In Effusion
(Traumatic hemorrhage)
bloody background with lymphocytes
clean background with lymphocytes
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Condition with Eosinophils in Effusion
(parasitic infestation)
portein background with Eosinophils
clean background with Eosinophils
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Parasitic Infestation
Parasitic Ova with Inflammatory
and necrotic debris
Parasitic Ova with clean background
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Tuberculous Effusion
(Caseous necrosis)
amorphous necrotic materials with lymphoid small particle.
“Caseous necrosis”
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Lymphocytes & epithelioid cells
Low power feature
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Langhans giant multinucleated histiocyte
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Rheumatoid Arthritis
Elongated histiocytes(carrot cells)
Macrophages
Amorphous proteinaceous debris
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Multinucleated giant cells(MGH)
Abundant clumps of granular debris
Monolobular or polylobular neutrophils
(degenerating neutrophils)
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Systemic Lupus Erythematosus
LE cells ; enlarged neutrophil nucleus + pink to purplish amorphous
round intracytoplasmic mass
Degenerating cells(atypical plasmacytoid cells)
Nuclear debris
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Mesothelial Reaction
dirty background and degenerative change
of mesothelial cells
clean background and well preserved
chromatin pattern.
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Malignant mesothelioma
&
Mesothelial reaction
many mesothelial cells with thick cytoplasm
We can find different morphology of nuclear between both slides
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Pseudomyxoma peritonei
Viscous and thick mucinous material
Benign looking columnar cells
Well-differentiated columnar and over
distended by large mucinous
containing vacuoles
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Serous cystadenocarcinoma of ovary
dirty background and
degenerated malignant cluster
clean background and well preserved
malignant cluster
Papillary or rosette formation
Often intracytoplasmic large vacuoles
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Mucious cystadenocarcinoma of Ovary
Gray to deep purple colored mucus &
abundant, well defined cytoplasm
Irregular shape in nuclear border with
coarse chromatin, large & bizarre nucleoli
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Signetic ring cell type adenocarcinoma from stomach
• Cellular group
•
Glandular structure
• Indibidual pattern
•
•
•
•
Similar histiocyte
Eccentric nucleus
Macronucleoli
Individual cells
Pap stain. Macronucleoi
& eccentric nucleus
mucicarmine Stain positive
intracytoplasmic mucus
in signet ring cell carcinoma.
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Signetic ring cell type adenocarcinoma from stomach
dirty background with
degenerated cancer cells
clean background with
well preserved cancer cells
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Metastatic Adenocarcinoma From colon
Tall columnar, multi-layer, tubular formation
Necrotic tumor cells with necrotic background
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Adenoid cystic carcinoma
Refractive spherules have three-dimensional
cancer cells with benign looking.
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Giemsa stain pattern
as intracystic pinkish materials
Pap stain pattern as
refractive three-dimensional appearance
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Ductal carcinoma, metastatic
cannibalism
in Ductal carcinoma, metastatic.
structure of ball form
in Ductal carcinoma, metastatic
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Mucinous carcinoma from Breast
so much mucus background
small amount of mucus background
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Breast-Lobular carcinoma
String of small mlignant cells with internuclear space.
We called it as “Indian file appearance”.
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Lobular ca. vs. Small cell ca.
indian file appearance
with 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
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Small cell carcinoma, metastatic
clustes of small cell carcinoma, metastatic.
compact & tight clusters with scanty cytoplasm are remarkable.
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Large cell carcinoma, metastatic
marked nuclear pleomorphism & nuclear
nippling in large cytoplasm.
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Squamous cell carcinma, metastatic
necrotic background
with degenerated cancer cells
well preserved cancer cells
with small amount of necrosis
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Lymphocytes vs. Malignant lymphoma
(Body fluid)
mature lymphocytes including
some pseudofiber
cells of lymphoma including
open chromatin & nucleoli
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Hodgkin’s lymphoma
Reed-Sternberg cell
Single prominent nucleoli
Variable amounts of immature lymphocytes
and plasma cells in background
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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
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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
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Thank you