an analysis on cytology diagnoses of the effusion using lbc technology

An Analysis on Cytology Diagnoses of the Effusion

using LBC Technology

Jong Yull Kim, Prof.,PMIACEulji 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

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Specimen shows varied and different kinds of features of solutions

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Conventional methods are considered as difficult to effectively smear

-Bloody effusion -Mucous effusion -Clear effusion

4

Conventional methods are sometimes caus-ing 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

More than mean 22% of diag-noses among the each inadequate specimen are diagnosed to suf-ficient specimenas either benign or malignant.

10 20 40 60 80

100Percentage of increasing diagnostic rate Among the Inadequate specimen

Blood Mucus Clear

24% 19% 21%

Percen

tage

Source: Cellnatech bio, research institute.

Inadequate diagnosisLBC con LBC LBCcon con

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In conclusion

1. Slide smear using the LBC technologies have advantages com-pared 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”20

Lymphocytes & epithelioid cells

Low power feature

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Langhans giant multinucleated histiocyte

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Rheumatoid Arthritis

Elongated histiocytes(carrot cells)

MacrophagesAmorphous 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 cytoplasmWe can find different morphology of nuclear between both slides

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Pseudomyxoma peritonei

Viscous and thick mucinous materialBenign looking columnar cells

Well-differentiated columnar and over dis-tended by large mucinous

containing vacuoles28

Serous cystadenocarcinoma of ovary

dirty background and degenerated malignant cluster

clean background and well preserved malignant cluster

Papillary or rosette formationOften intracytoplasmic large vacuoles

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Mucious cystadenocarcinoma of Ovary

Gray to deep purple colored mucus & abun-dant, well defined cytoplasm

Irregular shape in nuclear border with coarse chromatin, large & bizarre nucleoli

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• Cellular group• Glandular structure

• Indibidual pattern• Similar histiocyte• Eccentric nucleus• Macronucleoli• Individual cells

Signetic ring cell type adenocarcinoma from stomach

mucicarmine Stain positive intracytoplasmic mucus in signet ring cell carcinoma.

Pap stain. Macronucleoi & eccentric nucleus

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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 appearancewith internclear spaces.

indian file appearance with scanty or abscent internclear spaces

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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 includingopen chromatin & nucleoli

44

Hodgkin’s lymphoma

Reed-Sternberg cell

Single prominent nucleoli

Variable amounts of immature lymphocytes

and plasma cells in background 45

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

46

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

Malignant melanoma

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Thank you