Professional Documents
Culture Documents
1) Respiratory tract
2) Urine
3) Pleural, pericardial, and peritoneal fluids
4) Peritoneal washings
5) Cerebrospinal fluid
6) Gastrointestinal tract
7) Breast
8) Thyroid
9) Salivary gland
10) Lymph nodes
11) Liver
12) Pancreas
13) Kidney and adrenal gland
14) Ovary
15) Soft tissue
1) RESPIRATORY TRACT
NORMAL
BENIGN
MALIGNANT
NORMAL
Cytomorphology :
• Terminal bronchioles
Cytomorphology
Pulmonary hematoma
Bland spindle cells
Immature fibromyxoid matrix
Mature cartilage with chondrocytes in lacunae
Benign glandular cells
Adipocytes
Inflammatory myofibroblastic tumor
Spindle cells
Title: cytomorphology of benign cell in respiratory tract
Storiform pattern
Source:http://www.pathologyoutlines.com/caseofweek/case200710
Polymorphous inflammatory cells 0pap.jpg
Minimal to no necrosis
Endobronchial granular cell tumor
Small clusters of macrohage-like cells
Abundant granular cytoplasm
Small, uniform, round to oval nuclei
MALIGNANT
Cytomorphology :
Squamous cell carcinoma
Abundant dyshesive cells
Title : Squamous Cell Carcinoma
Polygonal, rounded, or elongated cells Source : http://nih.techriver.net/patientImages/5713.jpg
Dense cytoplasmic orangeophilia (Papanicolou stain)
Tadpole or fiber - like cells
Pleomorphic, pyknotic nuclei
Obscured nucleoli and chromatin detail
Frequent anucleated cells
Twisted keratin strands (Herxheimer spirals)
NORMAL
UROTHELIAL CELLS
INFLAMMATION
REACTIVE
UROTHELIAL NEOPLASM
LOW GRADE UROTHELIAL LESIONS
HIGH GRADE UROTHELIAL CARCINOMA
UROTHELIAL CELLS
Umbrella cells . These are the largest urothelial cells and cover the surface of the
urothelium. Normal columnar urothelial
cells are also pesent
Cytoplasmic homogeneity
High nuclear to cytoplamic ratio
Irregular borders
Papillary fragments with fibrovascular cores(diagnostic, but rare)
Cell clusters without cores
Irregular cell clusters ( commonly associated with UC than smooth cell clusters)
Cytoplasmic keratinization
Pearls
Bridges
Angulated hyperchromatic nuclei
Urothelial carcinoma
(Diagnostic principles and clinical correlates cytology,
2nd edition, Edmund and Barbara)
3) PLEURAL, PERICARDIAL AND
PERITONEAL FLUIDS
(EFFUSIONS)
BENIGN
MALIGNANT
BENIGN
Cytomorphology
Mesothelial cells
Numerous, isolated cells, small cluster with ‘windows’, single nucleolus, dense cytoplasm with clear
outer rim (lacy skirt), round cells and nucleus.
Histiocytes
Smaller nuclei than mesothelial cells, folded nuclei, cytoplasm granular/vacuolated, no ‘windows’
between adjacent cells.
MALIGNANT
Tips for detection: Second population, numerous large clusters and lacunae (cell block sections).
Cytomorphology
Malignant mesothelioma
~Common pattern
Large cluster with scalloped (knobby) edges, cytomegaly, prominent nucleoli, bi/multinucleation, dense
cytoplasm with peripheral halo, windows, normal nc ratio, round and center nuclei.
~Uncommon pattern
Predominant isolated tumor cells, lymphocytes only, tumor cells with abundant lymphocytes and
histiocytes, psammoma bodies and cytoplasmic vacuolation.
4) PERITONEAL WASHING
NORMAL
MALIGNANT
NORMAL
NORMAL
BENIGN
MALIGNANT
NORMAL
Common
• Lymphocytes
• Monocytes
Rare
• Choroid plexus /ependymal cells
• Brain fragment
• Germinal matrix
• Chondrocytes
• Bone marrows
Title : Normal cell in CSF . Dark purple stain is lymphocyte.
Source: http://serc.carleton.edu/images/woburn/all_csf_150.jpg
BENIGN
Cytomorphology :
Adenocarcinoma
Large cells
Isolated or small cluster
Abundant cytoplasm
Accentric nucleus
ESOPHAGUS
Barrett’s esophagus , Dysplasia in Barrett’s esophagus
Low-grade dysplasia, High-grade dysplasia
Adenocarcinoma
Squamous cell carcinoma
Uncommon tumors
STOMACH
Adenocarcinoma
DUODENUM
Adenoma and Adenocarcinoma
ESOPHAGUS
Barrett’s esophagus
Cytomorphology:
Epithelial repair
Goblet cells
Differential diagnosis
Intestinal metaplasia of the gastric cardia
Dysplasia in Barrett’s esophagus Barrett’s epithelium with goblet cells. A single large cytoplasmic
vacuole expands the apical portion of the cytoplasm and displaces
Cytomorphology the nucleus and shapes it into a crescent against the basal cell
membrane
Background of Barrett’s epithelium
Cytomorphology:
Cytomorphology:
Increased cellularity
Epithelial repair
Dysplasia in Barrett’s epithelium, particularly
high grade
Poorly differentiated squamous cell carcinoma
Squamous cell carcinoma
Prominent nucleoli
Uncommon tumors
Cytomorphology – uncommon tumors:
Verrucous carcinoma
Minimal cytologic atypia
Adenosquamous carcinoma
Both malignant squamous and glandular elements
Mucoepidermoid carcinoma
Mucinous, squamous, and intermediate cell s in varying
proportions
Basaloid carcinoma Helicobacter pylori (gastric brushings).
Numerous faintly basophilic S-shaped
Tight and loose groups of crowded dark basaloid cells
rods are entrapped in mucus.
Often misdiagnosed as an adenoid cystic carcinoma
Adenoid cystic carcinoma
Cribriform, pseudoacinar, and small duct-like structures
Small cell carcinoma
Small or intermediate-sized cells
Scant cytoplasm
Prominent molding
Necrosis and nuclear streaking common
STOMACH
Adenocarcinoma
Cytomorphology:
Palisading and molding of elongated nuclei Ampullary adenoma (ampullary brushings). A crowded group of glandular
cells with mucin depletion and an increased nuclear to cytoplasmic ratio
is present. A gland opening is apparent. In spite of the crowding, the
Fine chromatin and absent or small nucleoli arrangement is orderly. The nuclei are enlarged and elongated but
significant atypia is present.
7) BREAST
BENIGN
MALIGNANT
BENIGN
Cytomorphology
~Fibroadenoma
Hypercellular
Large honeycomb sheets, 3D clusters with antler-like configuration, bipolar cells and spindled/oval naked
nuclei, fibrillar stromal fragments (bluish gray with Papanicolaou stain/intensely red-purple with
Romanowsky type stain), nuclear atypia, some loss of epithelial cohesion, regular nuclear spacing, finely
granular chromatin pattern, small and round nuclei.
MALIGNANT
Cytomorphology
- Breast cancer
Tubular carcinoma
Aporine carcinoma
BENIGN
MALIGNANT
Papillary carcinoma
Anaplastic carcinoma
Medullary carcinoma
Lymphoma
BENIGN CONDITIONS
Giant cells
Lymphocytes
Tingible-body macrophages
Lymphohistiocytic aggregates
MALIGNANT TUMORS
Papillary carcinoma
Cytomorphology:
Nuclear changes
Suspicious for a Hurthle cell neoplasm. These enlarged
‘powdery’ chromatin cells with abundant granular cytoplasm were interpreted
as suspicious, but the patient proved to have a
Grooves multnodular goiter with extensive clear cell change.
Pseudoinclusions
Membrane irregularity
Nuclear crowding/molding
Cytomorphology:
Mostly single cells
Large cells
Osteoclast type
Medullary carcinoma
Cytomorphology:
Loose clusters
Inconspicious nucleoli
multinucleated
Cytomorphology – DLBL type: Marginal zone B-cell lymphoma of MALT type. The
neoplastic lymphoid cells are uniformly small, with
Large lymphoid cells irregularly shaped nuclei a moderate amount of
cytoplasm.
Centroblast
Immunoblasts
Burkitt-like cells
9) SALIVARY GLAND
NORMAL
BENIGN
MALIGNANT
CARCINOMA & ADENOCARCINOMA
SMALL CELL CARCINOMA
NORMAL
Epithelial cells
Myoepithelial cells
Chondromyxoid matrix
Cytomorphology:
Carcinoma
Mucus cells ( predominate in low grade tumors)
Intermediate cells
Mucinous background
Overt cytology malignancy (high grade tumors)
Adenocarcinoma
Cellular aspirate of biphasic cells in 3D cluster
Large clear myoepithelial cells with moderate to abundant cytoplasm and vesicular nuclei
Small dark ductal cells with scant cytoplasm
Peripheral homogenous acellular basement membrane material
Background naked nuclei
Title: Interpretation of suspicious adenoid cystic carcinoma
Source: http://www.pathologyimagesinc.com/sgt-cytopath/chronic-inflamm-
sialadenitis/cytopathology/diff-diagn/fs-chr-sialad-dd.html
Folicular lymphoma
Mixed population of small and large cleaved and large non-cleaved cells
CD45+, CD20,CD10+,CD5-
Cytomorphology
- Reactive hyperplasia
-Inflammatory/infectious condition
~Sarcoidosis
Cytomorphology
Hodgkin Lymphoma
Small lymphocytes, eosinophils (especially in mixed cellularity subtype), Reed – Sternberg cells, classic and
mononuclear variants, no lymphohistiocytic aggregates/tingible – body macrophages (exceptions: partial node
involvement and lymphocyte predominant Hodgkin lymphoma)
NORMAL
MALIGNANT
NORMAL
Hepatocytes
Large polygonal cells.
Isolated cells, thin ribbons (trabeculae), or larger tissue fragments.
Centrally placed, round to oval and variably sized nuclei.
Commonly binucleated
Prominent nucleoli
Intranuclear pseudoinclusions.
Abundant granular cytoplasm.
Pigment:
a)Lipofuscin (common:a normal pigment related to cellular aging-golden with the Papanicolaou strain and
green-brown with a Romanosky-type strain.
b)Homosiderin: (less common : when present in large quantities it suggests a disoder of iron matabolism)-dark
brown with the Papanicolaou strain and blue with with a Ramonowsky-type strain.
c)Bile( not visible under normal conditions but seen in cholestasis) -dark green with both Papanicolaou and
Romanosky strain.
MALIGNANT
MALIGNANT:
Highly cellular smears with single cells or cords, nests, tubules, or sheets.
Spindle-shaped endothelial cells surround thickened cords of neoplastic hepatocytes.
Neoplastic hepatocytes have an increased nuclear to cytoplasmic ratio
Granular cytoplasm with bile or hyaline globules( red with Papanicolaou and blue with Romanosky
stains)
Large, round nuclei with prominent nucleoli
Intranuclear pseudoinclusions.
Large naked nuclei.
Malignant: liver FNAC
BENIGN
PANCREATIC ACINAR EPITHELIUM
PANCREATIC DUCTAL EPITHELIUM
REACTIVE
NEOPLASM
DUCTAL ADENOCARCINOMA
ACINAR CELL CARCINOMA
BENIGN
PANCREATIC ACINAR EPITHELIUM
A
Flat, cohesive epithelial sheets (few single cells)
Round to oval nuclei
Evenly distributed, finely granular chromatin
Even nuclear spacing
Well defined cytoplasmic boundaries
No nuclear crowding or overlapping
Low cellularity
Flat, cohesive sheets
Uniformly spaced nuclei
Round to oval nuclear contours
Rare intact single atypical cells
Increased cellularity
Cohesive epithelial sheets ( with rounded edges)
Nuclear crowding and overlapping
Increased intracytoplasmic mucin
Focally irregular nuclear contours (pyramidal and carrot-shaped nuclei)
b
Nuclear enlargement (particularly marked anisonucleosis within a single
sheet)
Irregular chromatin clearin g
Glomeruli:
Cytomorphology:
Differential diagnosis:
Large papillary structures. Oncocytoma
Capillary loops. Chromophobe RCC
Differential diagnosis:
Distal tubular cells:
Papillary RCC ( renal cell carcinoma) Cytomorphology:
Rare cells with scant cytoplasm and minimal
Proximal tubular cells: atypia.
Cytomorphology: Differential diagnosis
Low grade clear cell or papillary RCC
Rare cells with abundant granular cytoplasm.
MALIGNANT: KIDNEY AND ADRENAL
GLAND (FNA)
MALIGNANT:
Differential diagnosis:
Large cohessive groups
Abundant clear and granular cytoplasm.
Large, around, eccentrically placed nucleus with prominent nucleolus
NORMAL: KIDNEY
FNAC
Oncocytoma:
Clean Background
Dyshesive Single Cells or Loose Clusters, No Stripped Nuclei
Rarely in Large Groups (Unlike RCC)
Small Uniform Nuclei, Smooth Borders (Unlike RCC)
Focal Nuclear Atypia, Binucleation, Inconspicuous Nucleoli
Abundant Uniformly Granular Well-defined Cytoplasm
No Vacuoles (Unlike RCC)
Sharp Well Defined Cell Border (Unlike PCT Cells)
Hale's Colloidal Iron Negative, or Perinuclear/atypical Staining Present
Electron Microscopy: Mitochondria
MIMICS: PCT, Chromophobe RCC, Conventional RCC with Granular Cytoplasm
Renal Cell Carcinoma
http://www.cytologystuff.com/indexnongyn.htm
Kidney - oncocytoma
60x
MALIGNANT: KIDNEY (FNA)
Clean background
Sheets, clusters, single cells (dyshesive, but less than CRCC)
Bare nuclei (unlike oncocytoma)
More variation in cell & nuclear size (than oncocytoma, CRCC)
Vesicular nuclei, binucleation, inclusions
Irregular nuclear outline (unlike oncocytoma, CRCC)
Prominent nucleoli in some abundant granular cytoplasm
Perinuclear clearing, prominent cell borders ("koilocytic")
Fluffy/clear/granular not uniform cytoplasm
Vimentin negative, cytokeratin positive (use biotin block)
Hale's colloidal iron positive - uniform, dense, cytoplasmic
Electron microscopy: microvesicles; mitochondria if eosinophilic variant
MIMICS: oncocytoma, CRCC
http://www.cytologystuff.com/indexnongyn.htm
http://www.cytologystuff.com/indexnongyn.htm
Malignant: Kidney (FNA)
Abundant foamy granular lipid rich background appears Adrenal gland - normal cortex Clusters of vacuolated
in clumps on thin layer. Entrapped vacuolated cells with cells with bland round smoothly contoured nuclei,
round bland regular nuclei. Note bare stripped nuclei as small nucleoli and fragile frayed cytoplasmic edges.
well. 40x 60x
http://www.cytologystuff.com/indexnongyn.htm
MALIGNANT: ADRENAL GLAND (FNA)
MALIGNANT:
Adrenal gland, Metastatic small cell carcinoma Adrenal gland, Metastatic small cell
60x carcinoma
60x
14) OVARY
BENIGN
Serous cystadenoma and cystadenofibroma, Mucinous cystadenoma
MALIGNANT
~Papillary serous cystadenoma of low malignant potential and serous
cystadenocarcinoma
~Mucinous cystadenoma of low malingnant potential and cystadenocarcinoma
~Endometrioid carcinoma
BENIGN EPITHELIAL NEOPLASMS
Cytomorphology:
Cuboidal cells
Ciliated cells
Detached ciliary tufts
Mucinous cystadenoma
Cytomorphology:
Mucinous cells
Isolated cells, ribbons, sheets
Branching clusters
Mild to moderate nuclear atypia
Large cytoplasmic vacuoles (some cells)
Psammoma bodies
Stripped fibrovascular cores In this tight spherical aggregate, some cells have
large cytoplasmic vacuoles
Prominent nucleoli
Psammoma bodies
Mucinous cystadenoma of low malingnant potential
and cystadenocarcinoma
Macrophages
CONTENTS
SPINDLE CELL NEOPLASMS
LEIOMYOSARCOMA
Naked nuclei
Loose clusters
Spindle-shaped cells
‘cigar-shaped’ nuclei
Abundant homogeneous cytoplasm
mitoses
embryonal rhabdomyosarcoma .