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L9a - Respiratory Cytology

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36 views25 pages

L9a - Respiratory Cytology

Uploaded by

lewoboj243
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Respiratory Cytology

Subject: ABCT4117 Advanced Anatomical Pathology

Dr. Cesar Wong, FF(FSc)RCPA, PhD, MAppSc, BAppSc, CTIAC


Associate Professor
Department of Health Technology and Informatics
The Hong Kong Polytechnic University

Adjunct Associate Professor


Department of Clinical Oncology & School of Public Health and Primary Care
Faculty of Medicine
The Chinese University of Hong Kong

Honorary Scientific Officer (Molecular Pathology & Clinical Oncology)


Department of Pathology
Queen Elizabeth Hospital
Hospital Authority
1
Learning Outcomes
• Respiratory Cytology
• Effusions
• Cerebrospinal Fluid Cytology
• Urinary Cytology

2
Respiratory Cytology
• Respiratory cytopathology involves the
evaluation of a variety of specimens,
including sputum specimens, bronchial
brush and wash, bronchial lavage,
transbronchial needle aspiration.
• Each of these specimen types has
advantages in certain conditions.

3
Respiratory Cytology
• Sputum and bronchoscopy specimens are
generally obtained first in the work-up for a
central lung mass, and a fine-needle
aspiration (FNA) is performed when the
diagnosis cannot be made by
bronchoscopy.

4
Respiratory Cytology
• The diagnostic yield for each of the
specimen types has been variously
reported.
• The success rate for diagnosis of lung
cancer was as follows: sputum, 64.5%;
bronchial brush, 81.1%; transbronchial
biopsy, 84.2%; transbronchial aspiration,
84.2%.

5
Respiratory Cytology
• Sputum may be prepared in either of two
ways.
• A direct smear can be made and fixed with
alcohol.
• The essential factor is that the technologist
preparing the specimen MUST carefully
examine the entire sputum specimen and
then pick the most suspicious particles for
spreading on the slide.
6
Respiratory Cytology
• An alternative method is to put the sputum
specimen into Saccomanno’s carbowax
fixative, which is a cell fixative and a
mucolytic agent.
• After blenderizing and centrifugation, a
portion of the sputum specimen is used to
make cytospin preparation.

7
Respiratory Cytology
• Bronchial brushes are smeared directly on
the slide and fixed immediately in alcohol.
• Bronchial wash and lavage specimens are
freshly sent to the laboratory and may be
fixed in carbowax or alcohol and treated in
the same way as a sputum specimen.

8
Pulmonary Cytology
• An essential assessment for all pulmonary
specimens is whether there has been an
adequate sampling of the lung.
• The criterion generally used for sputum
cytology is the presence of alveolar
macrophages.

9
Pulmonary Cytology
• For bronchial brushes and wash
specimens, ciliated columnar and mucous
goblet cells and alveolar macrophages
should be identified.
• If these cells are not found, the specimen
should be categorized as unsatisfactory
because of the absence of sufficient
pulmonary material.

10
Pulmonary Cytology
• The normal cell components include
ciliated columnar cells, mucous goblet
cells, basal reserve cells, macrophages,
and inflammatory cells.
• Ciliated columnar cells have a columnar
shape, cilia and a terminal bar. The
nucleus is eccentrically located with a
small, triangular, basally placed tail of
cytoplasm.
11
Normal bronchial cells

12
Normal bronchial cells

13
Alveolar macrophages

14
Alveolar macrophages

15
Pneumocystis carinii in sputum

16
Pneumocystis carinii in sputum

17
Neoplasia of the Lung
• Adenocarcinoma
• Squamous cell carcinoma
• Large-cell undifferentiated carcinoma
• Small-cell carcinoma
• Metastatic carcinoma

18
Adenocarcinoma

19
Squamous cell carcinoma

20
Squamous cell carcinoma

21
Large-cell undifferentiated carcinoma

22
Small cell carcinoma

23
Small cell carcinoma

24
25

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