MHD II Laboratory SessionCytology

APRIL 24, 2014

Case 1

Case 1

Q1 Define “cytopathology”

Q2 Define the following terms as they relate to cytopathology and give examples:-“exfoliated cells”-”washings”-”brushings”-”fine needle aspirations”

Q3 What test is currently the most common clinical application of cytopathology?

Case 2

Case 2

CHIEF COMPLAINT:Annual routine physical examination.HISTORY:The patient is a 31 year-old sexually active female, witha history of several partners. She feels healthy, and has nocomplaints.PHYSICAL EXAMINATION:Heart, lung, abdominal exams are normalBreast exam is normal and without massesPelvic exam is unremarkable.A Pap Test is obtained.

Q1 For the following patient groups how often is a cervical PAP smear indicated? (use the U.S.P.S.T.F. Guidelines – a link is available on LUMEN under “Vertical Curricula”: “Health Maintenance Screening and Prevention” under “Screening Recommendations”•less than 21 years old

•21-29 years old

•30-65 years old

•>65 years old

•s/p hysterectomy with removal of the cervix and in patients who do not have a history of cervical intraepithelial neoplasia [CIN] grade 2 or 3 or cervical cancer

Q2 Is there a role for testing for Human papillomavirus infection in this patient?

Q3 Describe the steps required to perform a Pap Test (use the images to help your discussion)

Q4 Define “Liquid Based” cytology prep

Q5 Define “Conventional” cytology prep

Possible Pap testfindings/interpretations

in patients are

– Normal findings– Evidence of inflammation– Sexually transmitted

diseases– Squamous intraepithelial

lesion– Carcinoma

Normal cervix cytology/histologyQ6 Describe the normal histologyCorrelate the cytology findings with the histology

Q7 Make a diagnosis based on each of the following PAP smearsYour options are:-Evidence of acute inflammation-Herpes simplex virus infection-Trichomonas infection-Human Papillomavirus infection-Squamous cell carcinoma(hints are provided)

A

B

Cnormal

DHigh Power

Correlative tissue section

E

hint

Q8 An HPV test is performed in this patient and reveals the presence of a high-risk type of the virus. What is the chance that she will develop a cervical cancer?

Q9 If a woman receives the HPV vaccine does she still need routine Pap Tests?

Case 3

Case 3

CHIEF COMPLAINT:“I see blood in my urine”.

HISTORY:The patient is a 72 year-old-man with a history of low-grade

urothelial carcinoma.

PHYSICAL EXAMINATION:Physical examination is unremarkable

LAB TESTS:Urinalysis – Numerous RBC’s.

Q1 What is the main clinical problem?

Q2 Develop a differential diagnosis for this problem.

Diagnostic Work-upCystoscopy did not revealany papillarytumors, but did show focalerythematous areas.

Bladder washing(barbotage) was performedand the specimen wassubmitted forcytologic examination.

Q3 Describe the findings in urine specimen (compare to normal, are the cells cytologically benign or malignant?)

Normal urothelial cell

The urologist performs a followup bladder biopsy to confirm the diagnosis.

Q4 Describe the histologic findings.

Normal bladder

Q5 Does the histology correlate with the cytology?

Q6 What is your diagnosis?

Q7 What molecular changes can youexpect in this patient’s urothelium?

Case 4

Case 4CHIEF COMPLAINT:“I found a lump in my neck.”HISTORY:The patient is a 55 year-old-woman with a history of

radiation to the neck 20 years ago for hyperthyroidism.PHYSICAL EXAMINATION:A nodule is palpated in the right lobe of the thyroid gland (2

cm) and also an enlarged right cervical lymph node is present.

LAB TESTS:Thyroid function tests were normal. Ultrasound confirmed

the presence of a 2 cm nodule in the right thyroid and an enlarged lymph node. It was a “cold” nodule on scintiscan.

Q1 What is the main clinical problem?

Q2 A fine needle aspiration (FNA) biopsy is performed. Compare/contrast what is being done in each of the photos below

What are the advantages of FNA? What are the advantages of FNA?

• FNA is SAFE – – Simple, Accurate, Fast

and Economic– as well as safe – the best safety record

of any method of procuring tissue for a morphologic diagnosis

Describe characteristic cytologic findings.

Normal thyroid cytologyQ3 What is the cell type present?What structure are the cells forming?

Q4 Patient specimen. What “structure” are the cells forming?

Hint – histology correlate

Q5 Describe characteristic cytologic features of the cells

Q6 What is depicted in the image?

Hint – histologycorrelate

Q7 What is your diagnosis?

Q8 What molecular changes are associated with this lesion?

Q9 What is the patient’s prognosis?

Case 5

Case 5

CHIEF COMPLAINT:“My stomach hurts”.HISTORY:The patient is a 72 year-old woman who presents with

vague abdominal pain for the past several months. She denies nausea, vomiting and blood in her stool.

PHYSICAL EXAMINATION:The patient is alert and oriented. Vital signs are normal.

Her abdominal exam reveals normal bowel sounds with no tenderness to palpation or rebound tenderness. On rectal exam stool is brown and hemoccult negative.

CT scan abdomenCT scan reveals a 4 cm well-demarcated exophytic mass

extending into the gastric lumen.

Mayo Clinical Proceeding; Volume 83(4), April 2008, p 384

Q1 Develop a differential diagnosis for a gastric mass.

As part of the workup, esophagogastroduodenoscopy was performed, revealing a gastric sub-mucosal mass. This mass was arising from the muscularis propria. Endoscopic ultrasound-guided fine needle aspiration (EUS FNA) was performed.Q2 Briefly describe what an “EUS FNA” is.

Q3. Describe cytologic findings (hint focus on the shape of the cells)

High power

Immunohistochemical stains are performed.

C-kit (CD 117)

Q4 What is your diagnosis?

Q5 Describe the intro-op findings

Mayo Clinical Proceeding; Volume 83(4), April 2008, p 384

Q6 Name the cell of origin for this tumor

Q7 With what syndrome(s) is this tumor associated?

Q8 What is Imatinib?