Cytologic Patterns - Eclinpath PDF
Cytologic Patterns - Eclinpath PDF
Cytologic Patterns - Eclinpath PDF
Non-diagnostic
Inflammation
No cytologic abnormalities
Hyperplasia/dysplasia
Neoplasia
Note: Often more than one category is present, as inflammation can result in dysplastic changes in the
surrounding tissue and inflammation often accompanies a neoplastic process.
Non-diagnostic samples
Many reasons for obtaining a non-diagnostic sample exist including:
Poor cellularity of the sample: due to poorly exfoliating lesion or poor sample collection.
Excessive blood contamination: leukocytes present due to blood contamination are not included in the
sample cellularity and do not aid in interpretation of the lesion.
Many smudged or ruptured cells: this may result from exuberant collection methods or smear preparation,
though some tumor cells are excessively fragile and prone to rupture.
Sampling error: aspiration of surrounding fat or other structure, ex. aspiration of the mandibular salivary
gland when attempting lymph node aspiration.
If the sample has adequate cellularity and the cells are well-stained and well-preserved, the next step in cytologic
diagnosis is the identification of cell-types present. Does the smear contain inflammatory cells or tissue cells (or
both)? If the slide contains mostly inflammatory cells, then the inflammation should be further characterized and
an attempt made to identify the cause of the inflammation (such as infectious agents, foreign bodies).
Inflammation
Based on your identification of inflammatory cells and their relative proportions, inflammatory responses should be
classified as:
Suppurative
>85% neutrophils
Non-degenerate: suspect immune-mediated, sterile irritants (bile, urine), neoplastic lesions
Degenerate: suspect bacterial sepsis, look carefully for phagocytized organisms
Histiocytic/macrophagic
Macrophages predominate, may see multinucleate forms.
Suspect foreign body, fungal or specific bacterial infections (such as Mycobacterium, Nocardia,
or Actinomyces spp.).
Mixed
Neutrophils and macrophages +/- lymphocytes and plasma cells
Suspect chronic tissue injury such as lick granulomas, but can also be seen in reaction to foreign bodies,
fungi and bacteria.
Eosinophilic
>10-20% eosinophils
Suspect hypersensitivity/allergic conditions, some infectious diseases such as parasitic disease and some
fungal infections, as well as neoplastic processes (such as mast cell tumors).
Lymphocytic or lymphoplasmacytic
Heterogeneous mix of mostly small lymphocytes along with plasma cells and other inflammatory cells.
Suspect antigenic/immune stimulation, early viral infections or chronic inflammation.
A homogenous population in the absence of other inflammatory cells is suggestive of lymphoma.
No cytologic abnormalities
Cells are present in normal numbers for the tissue aspirated and do not possess significant criteria of malignancy.
This finding is most common when aspirating internal organs or lymph nodes, as most skin and subcutaneous
masses represent a true pathologic process.
Hyperplasia/dysplasia
The strict definition of hyperplasia is an increase in the number of cells in a tissue; however, the term is often used
in a more generic fashion in cytology as a non-neoplastic enlargement of a tissue. Hyperplasia is often the result
of hormonal influences (ex. benign prostatic hyperplasia), tissue injury (ex. hepatic nodular hyperplasia) or
antigenic stimulation (lymphoid hyperplasia). Aspiration of hyperplastic lesions may result in a higher than
expected cellularity and cells may display some weak criteria of malignancy, such as a mildly increased N:C ratio,
darker blue cytoplasm, slightly more prominent nucleoli or finer chromatin.
Dysplasia, or disordered growth, is most often seen in epithelial tissue secondary to inflammation or irritation.
Dysplasia results in loss of uniformity of the individual cells and disordered architectural arrangement of the cells.
Dysplasia can be cytologically difficult to distinguish from neoplasia as dysplastic lesions often contain more
criteria of malignancy than strictly hyperplastic lesions.
Although hyperplasia and dysplasia are non-neoplastic processes, they likely represent a continuum with benign
neoplasia. Cytologically, a hyperplastic process can be difficult to distinguish from a benign neoplastic process
and if there is significant dysplasia within the tissue, one must exercise caution as to not interpret dysplasia as
malignant neoplasia. Histopathologic assessment of the tissue should always be done if there is any doubt.
Neoplasia
Neoplasia is suspected when an atypical cell population is present, particularly if an inflammatory response is
lacking. This may include identification of a monomorphic population of cells in an atypical location, such as a
large number of mast cells aspirated from a subcutaneous mass or a neoplastic process may be suspected on
finding cells with highly atypical morphology (displaying numerous criteria of malignancy) for the site aspirated.
Neoplastic processes can then be further divided into four general tumor categories: epithelial, mesenchymal,
discrete (round) cell and naked nuclei neoplasms.
Note: As carcinomas become less differentiated they lose some of these features and often become less
cohesive, special staining techniques can be necessary in these situations to confirm an epithelial origin.
Histiocytoma
Cell of origin is the epidermal Langerhans cell, not truly a neoplastic process but more of a reactive process
and as such they usually regress without treatment
Variably distinct cell borders with round to oval nuclei, can be indented
Moderate to abundant amounts of clear to light blue cytoplasm
Minimal cellular atypia, uniform cell size and morphology – bland appearance
Often accompanied by variable numbers of small lymphocytes (tumor infiltrating cytotoxic T-cells)
DDx: plasmacytoma, granulomatous inflammation, systemic histiocytosis, lymphoma
Note: Histiocytomas generally consist of very bland, minimally atypical cells. If a high degree of cellular
atypia (numerous criteria of malignancy) are found and a histiocytic lineage is still suspected, histiocytic
sarcoma should be considered a differential diagnosis.
Plasmacytoma
Cutaneous lymphoma
Other Some tumor types may Cytoplasmic purple Tend to lack cytologic
Characteristics be associated with granules in mast cell features of malignancy
extracellular matrix tumors may regardless of biologic
occasionally stain behavior
poorly with Diff-Quik