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يؤتي الحكمة من يشآء . DIAGNOSIS OF NEOPLASM Depend on triple test. CLINICAL. LABORATORY & PATHOLOGY data. IMAGING. ROLE OF PATHOLOGY. PRE- operative intra operative POST oprative SURGERY CYTOLOGY FROZEN SECTION PARAFFIN
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DIAGNOSIS OF NEOPLASM Depend on triple test CLINICAL LABORATORY &PATHOLOGY data IMAGING
ROLE OF PATHOLOGY • PRE- operative intra operative POST oprative SURGERY • CYTOLOGY FROZEN SECTION PARAFFIN • CNP CYTOLOGY IHC • ISH • SCREENING PRELIMINARY DEFINITIVE • DIAGNOSIS DIAGNOSISDIAGNOSIS
CYTOLOGY • MINIMALY INVASIVE • CHEAP • RAPID • SCREENING - DIAGNOSIS • HIGH ACCURACY • LIMITATION : NO ARCHITECTURE
Cytology Speciments Exfoliative Cytology • Sputum • Urine • Effusion Fluid : pleural fluid. pericard, ascites • Gastric Lavage ; Joint Fluid; Cerebrospinal Fluid • Female’s Genital Discharge/Secret : vagina, cervix • Scrapping : Sex Chromatine Examination, hormonal feature. Superficial Malignancy • Aspiration Cytology • -- Tissue Aspiration : on Localized Nodule -Superfisial mass (lymph node, thyroid, soft tissue, head & neck) - Deep mass (liver, ovary, lung, bone)
Specimen Delivery Requirement, : 1. The specimen should be representative and be fixed with appropriate fixation. 2. Brief and clear description about clinical imaging and other lab data. 3. Send as soon as possible to the laboratory
Cytology examination steps : Acknowledge/Confirmation : B I O P S Y
Result INTERPRETATION (Papaniculaou system):Class I : Normal smearClass II : Infection by bacteria, Fungus, paracytes etc Class III : Cytologic atypical cell either with or without inflammationClass IV : Suspicious malignant cells. Refer to perform biopsy.Class V : Malignant cells. Refer to perform biopsy
EXFOLATIVE CYTOLOGYSPUTUM Requirement Specimens: • Gathering from deep cough • It should be Fresh,the best is morning sputum If sputum < : - Collecting within 12-24 hours in a bottle + alcohol 70% - Add expectorant 2-3 days before sputum collection Better in 3x Delivery, with 3 days interval 1x Collection Accuracy 37 % 5x Collection Accuracy 88 %
SPUTUM DELIVERY and SMEAR PREPARATION: Without FIXATION : - It has life span about 3 hours - Smear it on object glass alcohol 95% fixation ( 15 mnts) ISOLATED PLACE / LONG DISTANCE : - sputum + alcohol 70% smear on object glass air drying (without fire heating)
SPUTUM False Positif: - Lung Abcess - Bronkhiektasis - TBC False Negatif : - tumor unreliable with bronchus - bronchial stenosis - Tumor Localization : pheripher/superior - Tumor Structure : oat cell Ca THE DIAGNOSIS OF LUNG CELL CARCINOMA IS BEST BASED ON COMBINATION OF CYTOLOGY RADIOLOGY AND BRONCHOSCOPY EXAMINATION, .
URINE Best Source : Morning Urine 50 CC Delivery and Smear Preparation : Protective Materials (-) DELIVER AS SOON AS POSSIBLE / Alcohol fixation 50% aa 18
Attention Dry Preparation:
URINE Frequent Abnormality Will be Founded: • Inflammation • Staghorn/Stone: squamousmetaplasia • Benign Tumor : papilloma • 4.Malignant Tumor : intra epithelial neoplasia. Carcinoma , TCC
Squamous Cells Transitional Cells
Effusion fluid Gathering , Delivery and Smear Preparation : Changing position of Patient Punctie 100-200 CC Fixation with alcohol 50% aa Sentrifuge 2500 rpm (10 mnts) Smear on object glass(+egg albumin) Alcohol 95% (10 mnts) Examination Trait : Inflammation Cells >> Mesothel with hiperchromatic nucleus Histiocyte mimics malignant cells
Fixation 1ml of heparin + 100ml of effusion fluid to prevent clotting N.B.: do not use alcohol in fixation of fluid before spread cytological smear on glass slides
Cytocentrifuge preparation Cell block Heparinized bottles (3 units heparin/ml) Unfixed Alcohol-fixed Adding plasma and thrombin solution Papanicolaou-stained Wrapped in filter paper Air-dried cytocentrifuge preparation Placed in a cassette (Hematologic malignancy is suspected) Embedded in paraffin Cut and H&E stain
Female Genital Cytology Location to get the specimens :
Female Genital Cytology Specimen Gathering Requirements : Outside menstrual period No Irrigation Smear is the first step of examination Tx. Local : stop 1 week before Post partum / uterine surgery /radiation : specimen taking 6 weeks afterward Patient in lithotomy position 28
Introduction METHODS INTREPRETATION 30
Introduction METHODS INTREPRETATION Patient Preparation Examiner Preparation Cultivation Method Fixation Coloring 31 HOME
Introduction METHODS INTREPRETATION Patient Preparation Examiner Preparation Cultivation Method Fixation Coloring Cultivation/Gathering Methods : • Do not forget to fulfill and numbering examination forms completely. • Sign the same number on object glass. • Prepare patient in lithotomy position, clean up the vulva with cotton and antiseptic solution. • Apply the speculum and gently perform the portion of the cervix. • Clean up if there are any blood or mucous. • Pay attention if there are any leukoplakia or erosion. 32 HOME
Introduction METHODS INTREPRETATION Patient Preparation Examiner Preparation Cultivation Method Fixation Coloring Cultivation/Gathering Methods (cont’d) : Insert Ayre spatula to the vagina, make sure that the longest edge of the spatula entering the canal of cervix and rotate 360o with a little bit pressure. Insert cytobrush to the canal of cervix 1-2 cm in depth, and then rotate ¼ or ½. Smear gently the edge of the device (spatula/cytobrush) in one way and once move on object glass. Do Fixation properly. Keep the preparation slides on safe placement and send them with the examination form. 33 HOME
Introduction METHODS INTREPRETATION Patient Preparation Examiner Preparation Cultivation Method Fixation 34
Result INTERPRETATION and Management :Class I : Normal smear next year visit to reapply examination.Class II : Infection by bacteria, Fungus, paracites etc followed by light dischariotic. Treat and control 1-6 months later.Class III : Mild Dischariotic cell with severe inflammation.Treat and control a month later.Class IV : Suspicious malignant cells. Refer to perform kolposcopy biopsy.Class V : Malignant cells. Refer to perform kolposcopy biopsy Introduction METHODS INTREPRETATION Adequacy Evaluation Cultivation Method Report System 36 HOME
Introduction METHODS INTREPRETATION Adequacy Evaluation Report System 40 HOME
Introduction METHODS INTREPRETATION HPV Infection 41
HPV INFECTION KOILOCYTOSIS & NIS
Introduction METHODS INTREPRETATION CIN I LSIL 44
Introduction METHODS INTREPRETATION CIN II HSIL CIN II 45
Introduction METHODS INTREPRETATION CIN III 46
Introduction METHODS INTREPRETATION SQUAMOUS CELL Ca 47
MILD MODERATE SEVERE CA INVASIVE
Introduction METHODS INTREPRETATION ADENO Ca 49
Tissue Acquisition Devices - Types and Indications • FNA ( Fine –needle aspiration) • Core biopsy • Vacuum assisted core biopsy • Fine needle localization devices