diagnostic cytology of cancer cases - khon kaen universityvet.kku.ac.th/yaopdf/diagnostic cytology...

Diagnostic Cytology

of Cancer Cases

Somporn TechangamsuwanCompanion Animal Cancer Research Unit (CAC-RU)

Department of Pathology, Faculty of Veterinary Science,

Chulalongkorn University

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Tumor or Non-tumor

1 2

3 2

•Infectious agents?

•Fluid?

•Tumor cells?

•Inflammatory cells?

3

Cytology >>> Fastest!

Some tumors are diagnosed by

cytology better than biopsy, eg.;

round cell tumor.

Is that final conclusion ?

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Tumor cell

interpretation

Step-by-Step

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At First Glance on Slide1. Significant tumor cells: presence or absence (fluid, blood)

>> DIY: Prepare 2-3 slides

2. Size and shape of tumor cell

>> Easy way to compare tumor size

3. Cellular arrangement

>> clump, sheet, glandular, individual

4. Nuclei and cytoplasm of tumor cell

>> criteria of malignancy

>> intracytoplasmic granules (black, metachromatic)

5. Extracellular matrix (keratin, mucin, osteoid), Foreign bodies, Pathogen6

Interpretation: First Step Approach

Inflammatory cells

Differentiate cell type

Inflammatory cells+

Tissue cells

- Differentiate cell type

- History taking

Tissue cells

Differentiate cell type and

origin

Which cell type??

• Neutrophils>85% = suppurative (pus)• Neutrophils, Macrophages, pus cells

= pyogranulomatous• Macropahges, Lymphocytes, fibroblasts, plasma cells, low neutrophils

= granulomatous• Many Eosinophils >10% = eosinophilic plaques (granuloma) or allergic reaction

•Epithelium•Mesenchymal•Round cell•Mixed, pleomorphic

>> difficult for diagnosisMost malignant tumor 7

Epithelial

Mesenchymal

Discrete round cell

Size Shape Cellularity Cluster

Large Round to Usually high Yescaudate

Small to Spindle to Usually low Nomedium stellate

Small to Round Usually high NomediumMast cell Lymphoma

TVT Histocytoma

3 basic tumor cell types

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Anisokaryosis

Pleomorphism

Anisocytosis

Macrocytosis

Multinucleation

Abnormal mitosis

General criteria

Nuclear criteria

HypercellularityIncrease cell no.

Normal Abnormal

Coarse chromatin

Nuclear molding

Angular nucleoli

AnisonucleosisRBC

Criteria of Malignancy

Macrokaryosis &Increased N:C ratio

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Cell Arrangement

Single,solitary Chain, row Sheet Cluster

Glandular Clump

VG

Mal. histiocytosis

Hepatoid cell Mesothelial cell

MG adenocarcinoma

Fibrosarcoma

Basal cell

Cellular Arrangement

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Anisocytosis

PleomorphismVG

Cellular morphology

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Cell Arrangement

VG

Mal. histiocytosis

Hepatoid cell Mesothelial cell

MG adenocarcinoma

Fibrosarcoma

Basal cell

Cytoplasm

Abundant pale, Multiple vacuoles

Scant cytoplasm, basophilic Abundant pale blue cyto. Abundant pale cyto.,

eccentric vacuole

Abundant basophilic cytoplasm Low to moderate pale blue cytoplasmAbundant pale blue cyto. with multiple vacuoles12

Cell Arrangement

VG

Mal. histiocytosis

Hepatoid cell Mesothelial cell

MG adenocarcinoma

Fibrosarcoma

Basal cell

Nuclear pattern

Heterochromatin, non-prominent nucleoli

Homogeneous, non-obvious nucleoli

Vesicular-prominent large nucleoli

Heterochromatin Prominent large nucleoli

Homogeneous, prominent large nucleoli Heterochromatin, non-obvious small nucleoli

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Abnormal mitosis

Multinucleation

Abnormal Nuclei

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Extracellular Matrix

Intracytoplasmic Granules

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Cluster/single + scant cytoplasm

Cluster/single+ abundant cytoplasm vacuoles

vacuoles

Cluster/sheet/row

glands

Squamous cell tumor group

Basal cell tumor group

Glandular cell tumor group

• Adenoma• Adenocarcinoma• Site of mass

• Epidermal inclusion cyst• Squamous papilloma• Squamous cell carcinoma• Carcinoma

• Sebaceous adenoma• Sebaceous epithelioma

Sebaceous cell tumor group

Epithelial Cell Tumor

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Epithelial Cell Tumor

Trichoblastoma

= Epidermal basal cells (eg ; basal cell tumor,

trichoblastoma, basal cell carcinoma) = Benign hair follicular cells

(eg; trichoepithelioma, pilomatricoma)

Cluster/single + scant cytoplasm Basal cell tumor group

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Cluster/single+ abundant cytoplasm

vacuoles

Squamous cell tumor group

• Epidermal inclusion cyst• Squamous papilloma• Squamous cell carcinoma• Carcinoma

Epithelial Cell Tumor

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Epidermal inclusion cyst

Cluster/single+ abundant cytoplasm

vacuoles

Squamous cell tumor group

• Epidermal inclusion cyst• Squamous papilloma• Squamous cell carcinoma• Carcinoma

Epithelial Cell Tumor

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SCC

Cluster/single+ abundant cytoplasm vacuoles Cluster/sheet/row

• Sebaceous adenoma• Sebaceous epithelioma

Sebaceous cell tumor group

Epithelial Cell Tumor

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Cluster/single+ abundant cytoplasm vacuoles

glands

Glandular cell tumor group

• Adenoma

• Adenocarcinoma

• Site of mass:

mammary gland

Epithelial Cell

Tumor

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Cluster/single+ abundant cytoplasm vacuoles

glands

Glandular cell tumor group

• Adenoma

• Adenocarcinoma

• Site of mass:

Perianal gland

Epithelial Cell

Tumor

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Sheet/ Solitary /ClusterTumor involving superficial squamous epithelial cells

= Benign - squamous epithelium (eg; papilloma)

= Squamous cell carcinoma

= Basal cells group

= Epidermal basal cells (eg ; basal cell tumor, trichoblastoma, basal cell

carcinoma)

= benign hair follicular cells (eg; trichoepithelioma, pilomatricoma)

Sebaceous cell group: -adenoma,-epithelioma,-carcinoma

Glandular PatternPerianal gland adenoma/adenocarcinoma

Apocrine gland adenoma/adenocarcinoma

Tumor of the subcutaneous glandular tissues (salivary, mammary, thyroid etc)

Tumor of internal organs; pancreas, adrenal gl., lung etc.

Un-differentiated carcinoma

Conclusion: Epithelial Cell Tumor

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Granules (brown, black, green)

Melanoma

Vacuoles Lipoma/-sarcoma

Secretion (Mucin)

Myxoma/-sarcoma

Extracellular matrix

Chondrosarcoma, Osteosarcoma

Fibroma/-sarcomaHemangioma/-sarcomaHemangiopericytoma

NeurofibrosarcomaMalignant Fibrous Histiocytoma

Spindle Cell Tumor (Mesenchymal Origin)

+--

- + Giant cells

+ Whorls

+ Giant cells

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Granules (brown, black, green) Melanoma

Spindle Cell Tumor (Mesenchymal Origin)

+

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Granules (brown, black, green)

Vacuoles Lipoma/-sarcoma

Spindle Cell Tumor (Mesenchymal Origin)

-

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Granules (brown, black, green)

Extracellular matrix

Chondrosarcoma, Osteosarcoma

Spindle Cell Tumor (Mesenchymal Origin)

-

Chondrosarcoma

Osteosarcoma

+ Giant cells

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Granules (brown, black, green)

Extracellular matrix

Fibroma/-sarcomaHemangioma/-sarcomaHemangiopericytoma

Spindle Cell Tumor (Mesenchymal Origin)

-

Fibrosarcoma

+ Whorls

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Granules (brown, black, green)

Extracellular matrix

Fibroma/-sarcomaHemangioma/-sarcomaHemangiopericytoma

Spindle Cell Tumor (Mesenchymal Origin)

-+ Whorls

Hemangiosarcoma 29

Granules (brown, black, green)

Extracellular matrix

Fibroma/-sarcomaHemangioma/-sarcomaHemangiopericytoma

Spindle Cell Tumor (Mesenchymal Origin)

-+ Whorls

Hemangiopericytoma 30

Conclusion: Spindle Cell TumorGranulation tissue?

Malignant melanoma melanin

Lipoma/Liposarcoma fat

Osteoma/osteosarcoma bone matrix, giant cells

Chondrosarcoma chondroid matrix

Myxoma & myxosarcoma mucin production

Fibroma/Fibrosarcoma spindle cell

Hemangiopericytoma whorl

Hemangioma/Hemangiosarcoma endothelial, RBC

Neurofibroma/neurofibrosarcoma

Malignant fibrous histiocytoma giant cells, macrophage

Undifferentiated sarcoma = “Malignant mesenchymal cell tumor” 31

Round Cell Tumor

Granules (+)Red / purple Mastocytoma

Black Melanocytoma

Granules (-)

DIP QUIK Toluidine blue32

Round Cell Tumor

Granules (+)Red / purple Mastocytoma

Black Melanocytoma

Granules (-)

Melanocytoma

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Granule(-)

Dense nuclear chromatin

Scant cytoplasm Lymphoid cell

< 50 % with plasma cells, neutrophils= Hyperplasia / Reactive Lymph node

>50%, blast cells, multiple nucleoli = lymphoma

Coarse nuclear chromatin Deep blue cytoplasm

Vacuole(+/-)

TVT

Histiocyte, Basal cell

Large sizeAbundant cytoplasm

With giant cells

Histiocyticlymphoma

Malignant histiocytosis

Medium sizeModerate amount of cytoplasm

Eccentric nucleiCell-rich FNA

Histiocytoma(young dog)

Small sizeScant cytoplasm

Ribbon arrangement

Basal cell tumor (middle-aged dog)

Round Cell Tumor

+

-

Granules (+)

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Mixed breed dog, 12 Y Lymphoma

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Lymphoglandular bodies

Reactive lymph node

Abnormal mitosis

Ruptured cells

Clinical signs– gross• lymphadenopathy (swollen LN)

Cytology• Lymphocytes (main)• Plasma cells (found)• Low lymphoblasts (normal)• Low neutrophils• Lymphoglandular bodies +/-

Lymphoma

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TVT (VG) / ETVT 37

TVT (VG) / ETVT

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Histiocytoma 39

Histiocytoma

Histiocytoma

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Malignant Histiocytosis

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Malignant Histiocytosis

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