BOOK
Diagnostic Cytopathology Essentials E-Book
Gabrijela Kocjan | Winifred Gray | Philippe Vielh | Tanya Levine | Ika Kardum-Skelin
(2013)
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Book Details
Abstract
Diagnostic Cytopathology Essentials is a succinct yet comprehensive guide to diagnosis in both non-gynecological and gynecological cytology. It provides quick answers to diagnostic problems in the cytological interpretation and recognition of a wide range of disease entities. With content derived from Diagnostic Cytopathology, 3rd Edition, the authoritative reference work by Winifred Gray and Gabrijela Kocjan, Diagnostic Cytopathology Essentials delivers the dependable guidance you need - in a user-friendly format that makes essential facts about any given condition easy to find and apply.
- Consult this title on your favorite e-reader , conduct rapid searches, and adjust font sizes for optimal readability.
- Efficiently review the key cytological features of a broad spectrum of disease entities with more than 1,300 images, consistently presented on opposing pages from the corresponding text summaries for ease of reference.
- Find the answers you need quickly and easily using an at-a-glance bullet-point format and structure, with every section organized consistently to include Definition, Cytological Findings, and Differential Diagnosis.
- Streamline decision making and avoid diagnostic pitfalls with the aid of Differential Diagnosis boxes.
- Improve your diagnostic cytology skills by referencing representative Case Studies throughout.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Diagnostic Cytopathology Essentials | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Foreword | vii | ||
| List of contributors | ix | ||
| Dedication | xi | ||
| Acknowledgements | xi | ||
| 1 Introduction | 1 | ||
| 2 Female genital tract | 3 | ||
| Contents | 3 | ||
| Normal anatomy of the gynaecological tract (Fig. 2.1) | 3 | ||
| Transformation zone (Figs 2.2–2.4) | 4 | ||
| Cytology of normal cells from the cervical transformation zone | 6 | ||
| Squamous cells (Figs 2.5–2.8) | 6 | ||
| Metaplastic cells (Figs 2.9–2.11) | 6 | ||
| Anucleate squames (Figs 2.12, 2.13) | 6 | ||
| Endocervical cells (Figs 2.14–2.19) | 8 | ||
| Endometrial cells (Figs 2.20–2.22) | 8 | ||
| Reserve cells (Figs 2.23, 2.24) | 10 | ||
| Inflammatory cells | 10 | ||
| Other inflammatory cells (Fig. 2.25) | 10 | ||
| Other findings in cervical samples | 11 | ||
| Spermatozoa (Fig. 2.26) | 11 | ||
| Infestations (Figs 2.27–2.29) | 11 | ||
| External/atmospheric contaminants (Figs 2.30–2.32) | 11 | ||
| Artefacts in processing (Figs 2.33, 2.34) | 11 | ||
| Pregnancy and post-partum (Fig. 2.35) | 11 | ||
| Post-menopausal changes (Figs 2.36–2.40) | 11 | ||
| Cytological findings in cervicitis/vaginitis | 14 | ||
| Non-specific changes (Figs 2.41–2.45) | 14 | ||
| Specific types (Figs 2.46–2.49) | 14 | ||
| Common cervical/vaginal microorganisms | 16 | ||
| Bacteria (Figs 2.50–2.52) | 16 | ||
| Protozoa (Figs 2.53–2.55) | 16 | ||
| Fungi (Figs 2.56–2.58) | 16 | ||
| Common viral infections | 18 | ||
| Human papillomavirus (HPV) | 18 | ||
| Microscopic appearances (Figs 2.59–2.61) | 18 | ||
| Diagnostic pitfalls | 18 | ||
| Herpes simplex virus infection (HSV) | 19 | ||
| Iatrogenic changes in cervical cytology | 20 | ||
| Hormonal therapy | 20 | ||
| Intrauterine devices (IUD) (Figs 2.63–2.65) | 20 | ||
| Diagnostic pitfalls | 20 | ||
| Iatrogenic changes – surgical intervention | 21 | ||
| Iatrogenic changes – radiation | 22 | ||
| Repair and regeneration in the cervix | 23 | ||
| Cervical sample adequacy | 24 | ||
| Conventional/direct smears | 24 | ||
| Liquid-based cytology samples (Figs 2.73, 2.74) | 24 | ||
| Reasons for inadequate samples | 24 | ||
| Cytology of CIN and cervical squamous cancer | 25 | ||
| Dyskaryosis and abnormal chromatin (Figs 2.75–2.80) | 25 | ||
| Other features of dyskaryotic cells | 25 | ||
| Grading of squamous dyskaryosis (Table 2.1) | 25 | ||
| Mild dyskaryosis/low-grade dyskaryosis (Figs 2.81–2.88) | 28 | ||
| Moderate and severe/high-grade dyskaryosis (Figs 2.89–2.105) | 30 | ||
| Invasive squamous cell carcinoma of the cervix | 35 | ||
| Diagnostic pitfalls for cytology of squamous cell carincoma (Figs 2.124–2.127) | 37 | ||
| Keratinising CIN III | 37 | ||
| Repair and regeneration | 37 | ||
| Borderline nuclear changes in cervical cytology (Figs 2.128–2.136) | 38 | ||
| Management of borderline nuclear changes | 38 | ||
| Glandular neoplasms in cervical cytology | 40 | ||
| Primary cervical adenocarcinoma (Figs 2.137–2.144 and Table 2.2) | 40 | ||
| Cytologic appearances of CGIN | 40 | ||
| Non-cervical adenocarcinoma (Figs 2.145–2.153) | 42 | ||
| Cytological appearances of endometrial adenocarcinoma | 42 | ||
| Diagnostic pitfalls of CGIN and adenocarcinoma (Figs 2.154–2.161 and Table 2.3) | 44 | ||
| Management of women with abnormal cervical cytology | 46 | ||
| Squamous dyskaryosis | 46 | ||
| Glandular dyskaryosis | 46 | ||
| Follow-up after treatment and HPV testing as ‘test of cure’ | 46 | ||
| Cytology of the vulva and vagina | 47 | ||
| VIN, VAIN and invasive malignancy (Figs 2.163–2.172) | 47 | ||
| Malignant melanoma (Figs 2.173–2.175) | 49 | ||
| Paget’s disease of the vulva (Figs 2.176, 2.177) | 49 | ||
| Uterine cytology | 50 | ||
| Cytology of normal directly sampled endometrium (Figs 2.178, 2.179) | 50 | ||
| Cytology of non-neoplastic conditions | 50 | ||
| Endometrial hyperplasia and/or malignancy (Figs 2.180–2.187) | 51 | ||
| Ovarian cytology | 53 | ||
| Non-neoplastic ovarian cysts (Figs 2.188–2.194) | 53 | ||
| Simple cysts – including serosal inclusion cysts, paraovarian cysts and regressing follicular cysts | 55 | ||
| Ovarian neoplasms (Figs 2.195, 2.196) | 55 | ||
| Serous cystadenoma | 55 | ||
| Mucinous cystadenoma | 55 | ||
| Borderline epithelial ovarian tumours (Fig. 2.197) | 56 | ||
| Malignant ovarian tumours (Figs 2.198–2.203) | 56 | ||
| Mature cystic teratoma (Figs 2.204, 2.205) | 56 | ||
| 3 Respiratory | 59 | ||
| Contents | 59 | ||
| Introduction | 59 | ||
| Normal cytological findings | 60 | ||
| Reactive changes | 62 | ||
| Case Study | 63 | ||
| Reactive atypia due to drug toxicity | 63 | ||
| Common lung tumours | 64 | ||
| Diagnosis and management of lung tumours | 64 | ||
| Tumour spread | 64 | ||
| Lung cancer diagnosis by cytology (Figs 3.21–23) | 64 | ||
| Squamous cell carcinoma (SqCC) | 66 | ||
| Small cell carcinoma | 69 | ||
| Adenocarcinoma | 71 | ||
| Adenocarcinoma – lepidic predominant | 73 | ||
| Large cell carcinoma | 75 | ||
| Case Study (Fig 3.73) | 76 | ||
| Large cell tumour | 76 | ||
| Carcinoid tumours | 77 | ||
| Other lung tumours and metastases | 79 | ||
| Mesenchymal tumours and lymphomas | 81 | ||
| Pulmonary lymphomas, leukaemia | 83 | ||
| Mediastinal tumours | 84 | ||
| Mediastinal germ cell tumours (GCTs) | 86 | ||
| Lung infections | 88 | ||
| Bacterial infections | 88 | ||
| Chronic bacterial infections (Figs 3.120–3.125) | 88 | ||
| Bacterial infections: differential diagnosis | 88 | ||
| Pulmonary TB: cytological findings (Figs 3.120–3.125) | 88 | ||
| Viral infections | 90 | ||
| Fungal infections | 92 | ||
| Aspergillus spp.: clinical settings in lung | 92 | ||
| Pneumocystis jirovecii (previously P. carinii) | 93 | ||
| Other fungal infections (Figs 3.139–3.144) | 94 | ||
| Parasitic infections | 95 | ||
| Other pulmonary conditions | 96 | ||
| Chronic obstructive pulmonary disease (COPD) | 96 | ||
| Bronchiectasis (Fig. 3.151) | 96 | ||
| Allergic bronchopulmonary disease | 97 | ||
| Sarcoidosis (Figs 3.156, 3.157) | 98 | ||
| Diffuse parenchymal lung disease (Fig. 3.158) | 99 | ||
| Occupational lung diseases (Figs 3.159 and 3.160) | 99 | ||
| Iron pigment deposition (Fig. 3.161) | 100 | ||
| Lipoid pneumonitis (Fig 3.162) | 100 | ||
| Pulmonary alveolar proteinosis (Fig. 3.163) | 101 | ||
| Amyloidosis (Fig. 3.164) | 101 | ||
| Talc granuloma (Fig. 3.165) | 101 | ||
| 4 Serous effusions | 103 | ||
| Contents | 103 | ||
| Introduction | 103 | ||
| Clinicopathological significance of serous effusions (Table 4.1) | 104 | ||
| Cytology of normal and reactive mesothelial cells | 105 | ||
| Mesothelial cells | 105 | ||
| Diagnostic pitfalls: non-specific reactive mesothelial cells (Figs 4.13–4.15) | 107 | ||
| Conditions causing non-specific effusions | 107 | ||
| ‘Atypical’ mesothelial cells (Fig. 4.15) | 107 | ||
| Other benign findings in reactive effusions | 108 | ||
| Cytology of other cells/entities (Figs 4.18–4.23) | 108 | ||
| Benign reactive effusions with specific features | 110 | ||
| General diagnostic approach to malignant effusions | 112 | ||
| Metastatic carcinoma cells in serous effusions | 113 | ||
| Examples of metastatic carcinoma effusions from breast (Figs 4.42–4.44) | 116 | ||
| Examples of metastatic carcinoma effusions from lung (Figs 4.45–4.47) | 116 | ||
| Examples of metastatic effusions from female genital tract carcinomas (Figs 4.48–4.53) | 117 | ||
| Examples of metastatic carcinoma effusions: gastrointestinal tract (Figs 4.54–4.59) | 118 | ||
| Other metastatic carcinoma examples in effusions (Figs 4.60–4.63, Table 4.2) | 119 | ||
| Haematolymphoid malignancies in effusions (Figs 4.64–4.69) | 120 | ||
| Mesothelioma | 123 | ||
| Clinical details | 123 | ||
| Clues to cytological diagnosis (Tables 4.5, 4.6, p. 127) | 124 | ||
| Diagnostic approach: mesothelioma morphology (Tables 4.5, 4.6) | 127 | ||
| Diagnostic approach: immunocytochemistry (Fig. 4.86 and Tables 4.7, 4.8) | 128 | ||
| Immunomarker examples: malignant cell types (Figs 4.87–4.100) | 130 | ||
| 5 Urine cytology | 135 | ||
| Contents | 135 | ||
| Introduction | 135 | ||
| Specimen types and appearances (Figs 5.1–5.9) | 135 | ||
| Instrumented samples (Figs 5.10–5.15) | 137 | ||
| Ileal conduit samples (Figs 5.16–5.18) | 137 | ||
| Malignancy in urine cytology (Figs 5.19–5.27) | 139 | ||
| Differential diagnosis in urothelial malignancy | 143 | ||
| Degenerative changes (Figs 5.37–5.39) | 143 | ||
| BK/human polyomavirus | 143 | ||
| Instrumentation effects (Figs 5.40–5.47) | 144 | ||
| Papillaroid groups | 144 | ||
| Lithiasis/calculus formation | 144 | ||
| Other reactive conditions | 144 | ||
| Other infections | 144 | ||
| 6 Thyroid gland | 147 | ||
| Contents | 147 | ||
| Introduction (Figs 6.1–6.3) | 147 | ||
| Benign thyroid nodules | 148 | ||
| Types of goitre – diffuse enlargement of the thyroid | 148 | ||
| Thyroid cysts | 150 | ||
| Thyroglossal cyst | 152 | ||
| Thyroiditis | 153 | ||
| Subacute thyroiditis (de Quervain’s) (Figs 6.30–6.34) | 154 | ||
| Riedel’s thyroidtis (Riedel’s struma) (Figs 6.35–6.38) | 155 | ||
| Thyroid hyperplasia/hyperthyroidism | 156 | ||
| Follicular lesions | 158 | ||
| Thyroid neoplasms | 160 | ||
| Follicular and oncocytic (Hürthle cell) neoplasms | 160 | ||
| Papillary carcinoma | 162 | ||
| Papillary carcinoma: special types | 164 | ||
| Medullary carcinoma | 166 | ||
| Anaplastic carcinoma | 168 | ||
| FNA thyroid reporting categories and their management implications | 170 | ||
| 7 Haemopoietic | 173 | ||
| Contents | 173 | ||
| Introduction | 173 | ||
| Fine needle aspiration of the lymph node | 173 | ||
| Bone marrow aspiration | 174 | ||
| The role of FNA in management of lymphadenopathy | 174 | ||
| Ancillary technologies and the tumour bank | 175 | ||
| Cytospin preparations | 175 | ||
| Flow cytometry | 175 | ||
| Molecular techniques | 175 | ||
| Normal lymph node | 176 | ||
| Non-specific lymph node hyperplasia (Fig. 7.4) | 177 | ||
| Reactive lymphadenopathy | 178 | ||
| Sinus histiocytosis – Rosai–Dorfmann disease (Fig. 7.5) | 178 | ||
| Granulomatous lymphadenopathy | 178 | ||
| Tuberculous lymphadenitis (Figs 7.6, 7.7) | 178 | ||
| Sarcoidosis (Fig. 7.8) | 179 | ||
| Kikuchi–Fujimoto disease – histiocytic necrotising lymphadenitis (Fig. 7.9) | 179 | ||
| Cat-scratch disease (Fig. 7.10) | 179 | ||
| Kimura’s disease (Fig. 7.11) | 180 | ||
| Castleman’s disease (giant or angiofollicular lymph node hyperplasia, lymphoid hamartoma) | 181 | ||
| Neoplastic lesions of lymph node | 182 | ||
| Lymphoid neoplasms | 182 | ||
| Precursor lymphoid neoplasms | 183 | ||
| Lymphoblastic leukaemia/lymphoma | 183 | ||
| Mature B-cell neoplasms | 185 | ||
| Chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) | 185 | ||
| Marginal zone lymphoma (MZL) | 187 | ||
| Plasma cell myeloma and primary amyloidosis | 189 | ||
| Clinical variants of plasma cell myeloma | 189 | ||
| Mantle cell lymphoma | 191 | ||
| Follicular lymphoma (FL) | 192 | ||
| Diffuse large B-cell lymphoma (DLBCL) | 193 | ||
| Primary effusion lymphoma | 195 | ||
| Burkitt’s lymphoma/leukaemia | 197 | ||
| Mature T- and NK-cell neoplasms | 198 | ||
| Hepatosplenic T-cell lymphoma | 198 | ||
| Peripheral T-cell lymphoma, not otherwise specified (NOS) | 199 | ||
| Mycosis fungoides/Sézary syndrome | 200 | ||
| Angioimmunoblastic T-cell lymphoma (AITL) | 201 | ||
| Anaplastic large cell lymphoma (ALCL) | 202 | ||
| Hodgkin lymphoma | 204 | ||
| Immunodeficiency-associated lymphoproliferative disorders | 205 | ||
| Lymphoma associated with HIV infection | 205 | ||
| Post-transplant lymphoproliferative disorders (PTLD) | 206 | ||
| Lymph node metastases (Figs 7.69–7.77) | 207 | ||
| Myeloid neoplasms | 209 | ||
| Myeloproliferative neoplasms | 210 | ||
| Chronic myeloid leukaemia, BCR-ABL 1 positive (CML) | 210 | ||
| Polycythaemia vera (PV) | 212 | ||
| Primary myelofibrosis (PM) | 213 | ||
| Essential thrombocythaemia (ET) | 214 | ||
| Chronic eosinophilic leukaemia, not otherwise specified (CEL-NOS) | 215 | ||
| Mastocytosis | 216 | ||
| Myelodysplastic/myeloproliferative neoplasms (MDS/MPN) | 217 | ||
| Chronic myelomonocytic leukaemia (MDS/MPN-CMML) | 217 | ||
| Juvenile myelomonocytic leukaemia (MDS/MPN-JMML) | 218 | ||
| Myelodysplatic/myeloproliferative neoplasms, unclassifiable (MDS/MPN-U) | 219 | ||
| Myelodysplastic syndromes (MDS) | 220 | ||
| Refractory cytopenia with unilineage dysplasia (RCUD) | 220 | ||
| Refractory anaemia with ring sideroblasts (RARS) | 221 | ||
| Refractory cytopenia with multilineage dysplasia (RCMD) | 222 | ||
| Refractory anaemia with excess blasts (RAEB) | 223 | ||
| Myelodysplastic syndrome with isolated del(5q) | 224 | ||
| Myelodysplastic syndrome, unclassifiable (MDS-U) | 225 | ||
| Refractory cytopenia of childhood (RCC) | 226 | ||
| Acute myeloid leukaemia | 227 | ||
| Acute myeloid leukaemia with recurrent genetic abnormalities – acute myeloid leukaemia with t(8;21) | 227 | ||
| Acute myeloid leukaemia with recurrent genetic abnormalities – acute promyelocytic leukaemia (PML) | 228 | ||
| Acute myeloid leukaemia with recurrent genetic abnormalities – acute myeloid leukaemia with inv(16) or t(16;16) | 229 | ||
| Acute myeloid leukaemia with myelodysplastic-related changes | 230 | ||
| Acute myeloid leukaemia, not otherwise specified – acute myeloid leukaemia with minimal differentiation | 231 | ||
| Acute myeloid leukaemia, not otherwise specified – acute myeloid leukaemia without maturation | 232 | ||
| Acute myeloid leukaemia, not otherwise specified – acute myeloid leukaemia with maturation | 233 | ||
| Acute myeloid leukaemia, not otherwise specified – acute myelomonocytic leukaemia | 234 | ||
| Acute myeloid leukaemia, not otherwise specified – acute monoblastic and monocytic leukaemia | 235 | ||
| Acute myeloid leukaemia, not otherwise specified – acute erythroid leukaemia | 236 | ||
| Acute myeloid leukaemia, not otherwise specified – acute megakaryoblastic leukaemia | 237 | ||
| Acute leukaemia, not otherwise specified – acute basophilic leukaemia | 238 | ||
| Acute myeloid leukaemia, not otherwise specified – acute panmyelosis with myelofibrosis | 239 | ||
| Acute leukaemias of ambiguous lineage | 240 | ||
| Myeloid sarcoma | 241 | ||
| Histiocytic and dendritic cell neoplasms | 242 | ||
| Histiocytic sarcoma (HS) | 242 | ||
| Langerhans cell histiocytosis | 243 | ||
| Other rare dendritic cell tumours | 244 | ||
| Fibroblastic reticular cell tumour | 244 | ||
| 8 Breast | 245 | ||
| Contents | 245 | ||
| The normal breast | 245 | ||
| FNA of palpable lesions: capillary technique (Fig. 8.6) | 247 | ||
| Galactocele and gynaecomastia | 248 | ||
| Galactocele | 248 | ||
| Gynaecomastia (Figs 8.9–8.11) | 248 | ||
| Inflammatory conditions | 249 | ||
| Fat necrosis | 249 | ||
| Periductal mastitis (Fig. 8.15) | 250 | ||
| Subareolar abscess (Figs 8.16, 8.17) | 250 | ||
| Granulomatous mastitis (Figs 8.18–8.21) | 251 | ||
| Abscess and acute mastitis (Fig. 8.22) | 252 | ||
| Sclerosing lymphocytic lobulitis (Fig. 8.23) | 252 | ||
| Benign breast changes (Figs 8.24–8.32) | 253 | ||
| Benign tumours and tumour-like lesions | 255 | ||
| Fibroadenoma (Figs 8.33–8.41) | 255 | ||
| Benign phyllodes tumour (Figs 8.42–8.46) | 257 | ||
| Tubular adenoma (Fig. 8.47) | 258 | ||
| Lactating adenoma and lactational changes in benign lesions (Figs 8.48, 8.49) | 258 | ||
| Mammary hamartoma | 258 | ||
| Other benign lesions (Figs 8.50–8.55) | 259 | ||
| Cytological findings and differential diagnosis of epidermoid cyst | 259 | ||
| Other benign lesions include: | 259 | ||
| Epithelial hyperplasia and tumour-like lesions | 261 | ||
| Epithelial hyperplasia without atypia (Figs 8.56–8.58) | 261 | ||
| Complex sclerosing and fibrocystic lesions (Figs 8.59–8.61) | 262 | ||
| Benign papillary lesions | 262 | ||
| Borderline epithelial lesions (Figs 8.62–8.67) | 263 | ||
| Columnar cell lesions (CCL) | 263 | ||
| Hyperplasia with atypia | 263 | ||
| Cellular (florid) papillary lesions | 264 | ||
| Lobular intraepithelial neoplasia | 264 | ||
| Common malignant breast epithelial tumours (Table 8.1, Box 8.1) | 265 | ||
| Ductal carcinoma (Figs 8.68–8.78) | 267 | ||
| Invasive lobular carcinoma (Figs 8.79–8.83) | 269 | ||
| Uncommon malignant breast epithelial tumours | 270 | ||
| Tubular carcinoma (Figs 8.84, 8.85) | 270 | ||
| Medullary carcinoma with lymphoid stroma (Fig. 8.86) | 270 | ||
| Mucinous (colloid) carcinoma (Fig. 8.87) | 271 | ||
| Neuroendocrine carcinoma (Figs 8.88, 8.89) | 271 | ||
| Papillary carcinoma (Figs 8.90, 8.91) | 272 | ||
| Apocrine carcinoma (Fig. 8.92) | 272 | ||
| Glycogen-rich (clear cell) carcinoma (Fig. 8.93) | 273 | ||
| Carcinoma with osteoclast-like stromal giant cells (Fig. 8.94) | 273 | ||
| Paget’s disease of the nipple (Fig. 8.95) | 273 | ||
| Metaplastic carcinoma/carcinosarcoma (Figs 8.96–8.98) | 274 | ||
| Malignant myoepithelioma | 274 | ||
| Primary sarcomas, lymphomas and metastatic tumours (Figs 8.99–8.107) | 275 | ||
| Reporting breast FNAs: the role of FNA in management | 277 | ||
| The role of the multidisciplinary team | 277 | ||
| The role of FNA in management of breast lesions (Fig. 8.108) | 277 | ||
| 9 Salivary gland | 279 | ||
| Contents | 279 | ||
| Introduction (Figs 9.1–9.3) | 279 | ||
| Normal salivary gland (Figs 9.4–9.6) | 280 | ||
| Tumours of the salivary gland | 281 | ||
| Most common tumour types (WHO classification 2005*) | 281 | ||
| Benign tumours | 281 | ||
| Malignant tumours | 281 | ||
| Pleomorphic adenoma | 282 | ||
| Warthin’s tumour (adenolymphoma) | 284 | ||
| Benign salivary gland tumours: basal cell adenoma and myoepithelioma | 286 | ||
| Other benign salivary gland tumours | 287 | ||
| Malignant salivary gland neoplasms: acinic cell carcinoma (Figs 9.32–9.38) | 288 | ||
| Mucoepidermoid carcinoma (Figs 9.39–9.47) | 290 | ||
| Adenoid cystic carcinoma (Figs 9.48–9.53) | 292 | ||
| Squamous cells in salivary gland aspirates | 294 | ||
| Polymorphous low-grade adenocarcinoma (Figs 9.61–9.63) | 296 | ||
| Salivary duct carcinoma (Figs 9.64–9.66) | 297 | ||
| Rare types of salivary gland malignant tumours | 298 | ||
| Carcinoma ex-pleomorphic adenoma (Fig. 9.67) | 298 | ||
| Epimyoepithelial carcinoma (Fig. 9.69) | 298 | ||
| Other primary and metastatic malignant tumours (Figs 9.70–9.75) | 298 | ||
| Non-neoplastic conditions | 300 | ||
| Pathogenesis and clinical findings | 300 | ||
| Salivary gland cysts | 302 | ||
| Mucus cyst (mucocele) | 302 | ||
| Mucocele (Figs 9.86–9.88) | 302 | ||
| Lymphoepithelial and branchial cleft cyst | 303 | ||
| Myoepithelial sialadenitis (Figs 9.93–9.97) | 304 | ||
| Mucosa associated lymphoid tissue (MALT) lymphoma (Figs 9.96–9.101) | 304 | ||
| Hyaline globules and basaloid cells in salivary gland FNA | 306 | ||
| Oncocytic cells in salivary gland | 307 | ||
| Diagnostic approach to salivary gland FNA | 308 | ||
| 10 Liver, biliary tree and pancreas | 309 | ||
| Chapter contents | 309 | ||
| Introduction | 309 | ||
| Liver | 309 | ||
| Normal cytology of the liver | 310 | ||
| Liver pigments and fatty change | 311 | ||
| Inflammatory and reactive conditions | 312 | ||
| Liver infections | 312 | ||
| Pyogenic abscess | 312 | ||
| Amoebic abscess | 312 | ||
| Actinomyces spp. abscess | 312 | ||
| Echinococcus spp. (Figs 10.9–10.11) | 312 | ||
| Granulomatous inflammation | 312 | ||
| Granulomata (non-infectious) | 312 | ||
| Lesions mimicking neoplasms | 313 | ||
| Bile duct hamartoma | 313 | ||
| Mesenchymal hamartoma | 313 | ||
| Inflammatory pseudotumour | 313 | ||
| Miscellaneous benign lesions | 314 | ||
| Benign neoplasms | 315 | ||
| Benign hepatic nodules | 316 | ||
| Dysplastic nodule | 316 | ||
| Focal nodular hyperplasia | 316 | ||
| Hepatocellular adenoma | 316 | ||
| Malignant neoplasms | 318 | ||
| Primary liver malignant neoplasms | 318 | ||
| Hepatocellular carcinoma | 318 | ||
| Variants of hepatocellular carcinoma | 321 | ||
| Fibrolamellar variant | 321 | ||
| Acinar cell variant | 321 | ||
| Clear cell variant | 321 | ||
| Hepatoblastoma | 322 | ||
| Cholangiocarcinoma | 323 | ||
| Angiosarcoma | 324 | ||
| Embryonal sarcoma | 324 | ||
| Metastatic liver tumours | 325 | ||
| Role of liver FNA in patient management | 325 | ||
| Gall bladder and extrahepatic bile ducts | 326 | ||
| Procedures for collecting cytological material from the biliary tree | 326 | ||
| Bile sampling | 326 | ||
| Brush or catheter samples | 326 | ||
| Liquid based cytology (LBC) | 326 | ||
| FNA samples | 326 | ||
| Normal cytology of bile ducts | 327 | ||
| Inflammatory and reactive processes of the biliary ducts | 328 | ||
| Parasitic infestation | 328 | ||
| Sclerosing cholangitis and stent placement (Fig. 10.57B) | 328 | ||
| Biliary Intraepithelial Neoplasia (BilIN) (previously dysplasia) | 329 | ||
| Neoplasms of the biliary tree | 330 | ||
| Biliary papillomatosis/intraductal papillary tumour | 330 | ||
| Cholangiocarcinoma | 330 | ||
| Special tumour types | 331 | ||
| Adenosquamous and squamous cell carcinoma (Fig. 10.65) | 331 | ||
| Villous adenoma and well-differentiated papillary carcinoma | 331 | ||
| Cystadenoma and cystadenocarcinoma | 331 | ||
| Pancreas | 332 | ||
| Normal cytology: pancreas | 332 | ||
| Pancreatitis | 334 | ||
| Acute pancreatitis | 334 | ||
| Chronic pancreatitis | 334 | ||
| Autoimmune pancreatitis (AIP) | 335 | ||
| Solid malignant neoplasms of the pancreas | 336 | ||
| Ductal adenocarcinoma | 336 | ||
| Variants of pancreatic ductal adenocarcinoma | 338 | ||
| Undifferentiated carcinoma | 338 | ||
| Adenosquamous carcinoma and acinar cell carcinoma | 339 | ||
| Solid pseudopapillary neoplasm of the pancreas (SPN) | 340 | ||
| Pancreatic endocrine neoplasm (PEN) | 341 | ||
| Poorly differentiated PEN (small cell carcinoma) (Fig. 10.99) | 343 | ||
| Pancreatic cysts | 344 | ||
| Non-neoplastic cysts of the pancreas | 345 | ||
| Pseudocyst | 345 | ||
| Lymphoepithelial cyst | 345 | ||
| Cystic neoplasms | 346 | ||
| Serous cystadenoma | 346 | ||
| Intraductal papillary mucinous neoplasm (IPMN) (Figs 10.104–10.109) | 346 | ||
| Mucinous cystic neoplasm (MCN) of the pancreas | 349 | ||
| The role of FNA in management of pancreatic lesions | 350 | ||
| 11 Childhood tumours | 351 | ||
| Contents | 351 | ||
| Introduction | 351 | ||
| Role of the cytopathologist | 351 | ||
| Obtaining a cytological sample from a child | 352 | ||
| Main malignant small round cell tumours of childhood | 352 | ||
| Lymphoma | 353 | ||
| Neuroblastoma | 354 | ||
| Nephroblastoma (Figs 11.7, 11.8) | 355 | ||
| Rhabdomyosarcoma | 357 | ||
| Morphology and prognosis | 357 | ||
| Ewing’s (sarcoma) family of tumours (pPNET) | 358 | ||
| 12 Miscellaneous | 359 | ||
| Contents | 359 | ||
| Cerebrospinal fluid | 360 | ||
| Clinical indications for CSF cytology | 360 | ||
| Preparation methods for CSF cytology | 360 | ||
| Inflammatory diseases (Fig. 12.4) | 362 | ||
| Bacterial infections (Fig. 12.4A–D) | 362 | ||
| Viral infections (Fig. 12.4E–G) | 362 | ||
| Fungal infections (Fig. 12.4H, I) | 362 | ||
| Other infectious causes | 362 | ||
| Unknown causes of inflammation | 362 | ||
| CSF in primary CNS tumours | 363 | ||
| CSF in secondary CNS tumours | 364 | ||
| CSF involvement in lymphomas and leukaemia | 365 | ||
| Skin | 366 | ||
| Sampling techniques | 366 | ||
| Skin infections | 367 | ||
| Pemphigus vulgaris, seborrhoeic keratosis, actinic keratosis, Bowen’s disease/carcinoma in situ | 368 | ||
| Seborrhoeic keratosis (Fig. 12.23) | 368 | ||
| Malignant tumours | 369 | ||
| Basal cell carcinoma | 369 | ||
| Squamous cell carcinoma, malignant melanoma | 370 | ||
| Other skin tumours | 371 | ||
| Soft tissue and musculoskeletal system | 372 | ||
| The role of FNA cytology in management of soft tissue and bone tumours | 372 | ||
| Technical procedures (Table 12.1) | 372 | ||
| FNA of soft tissue tumours | 372 | ||
| FNA of bone | 372 | ||
| Ancillary methods | 372 | ||
| Immunocytochemistry | 372 | ||
| Cytogenetics | 372 | ||
| Cytological findings in normal and reactive soft tissues | 373 | ||
| Soft tissue tumours | 375 | ||
| Benign soft tissue tumours (Figs 12.41–12.44) | 375 | ||
| Benign adipocytic tumours (Table 12.2) | 375 | ||
| Benign fibroblastic/myofibroblastic and fibrohistiocytic tumours | 376 | ||
| Nodular fasciitis | 376 | ||
| Proliferative myositis/fasciitis (Fig. 12.46) | 376 | ||
| Desmoid fibromatosis | 376 | ||
| Tumours of peripheral nerves | 377 | ||
| Miscellaeneous soft tissue tumours (Figs 12.51–12.54 and Table 12.3) | 378 | ||
| Malignant soft tissue tumours | 379 | ||
| Liposarcoma (Figs 12.55–12.57) | 379 | ||
| Malignant tumours of adipose tissue according to the WHO classification of soft tissue tumours | 379 | ||
| Rhabdomyosarcoma | 381 | ||
| Synovial sarcoma | 382 | ||
| Alveolar soft part sarcoma (Fig. 12.66) | 382 | ||
| Clear cell sarcoma (Fig. 12.67) | 382 | ||
| Skeletal tumours/lesions | 383 | ||
| Chondroma | 383 | ||
| Chondroblastoma | 383 | ||
| Chondrosarcoma | 383 | ||
| Osteogenic tumours | 384 | ||
| Osteoblastoma | 384 | ||
| Osteosarcoma | 384 | ||
| Bone: miscellaneous lesions | 385 | ||
| Langerhans cell histiocytosis (Fig. 12.73) | 385 | ||
| Ewing’s family of tumours (ES/PNET) | 385 | ||
| Bone: metastatic tumours and reporting of FNA in bone and soft tissue lesions | 386 | ||
| The cytological report | 386 | ||
| Synovial fluid | 387 | ||
| Basic approach to synovial fluid microscopy | 387 | ||
| The ‘wet prep’: crystal identification (Figs 12.75–12.78) | 387 | ||
| The ‘wet prep’: other particulate material (Fig. 12.79) | 388 | ||
| The cytocentrifuge preparation (Figs 12.80–12.82) | 388 | ||
| Management of synovial fluid cytology | 389 | ||
| 13 Techniques | 391 | ||
| Contents | 391 | ||
| Routine procedures | 392 | ||
| Exfoliative cytology | 392 | ||
| Collection and transport of cytological material | 392 | ||
| General points | 392 | ||
| Fine needle aspiration cytology (FNAC) | 394 | ||
| Cytological preparations | 394 | ||
| Direct smear (Fig. 13.6) | 394 | ||
| Fluids (Fig. 13.7) | 394 | ||
| Cell block (Fig. 13.8) | 394 | ||
| Cell imprints (Fig. 13.9) | 395 | ||
| Liquid-based cytology (LBC) | 395 | ||
| Fixation | 395 | ||
| Most common pitfalls (Fig. 13.10) | 395 | ||
| Staining methods | 396 | ||
| Papanicolaou stain (Fig. 13.11) | 396 | ||
| May Grunwald Giemsa stain (Fig. 13.12) | 396 | ||
| Diagnostic pitfalls: PAP staining | 397 | ||
| Rapid staining method (Fig. 13.13) | 397 | ||
| The most commonly used histochemical stains on cytological preparations are | 397 | ||
| Immunocytochemistry | 398 | ||
| Introduction | 398 | ||
| Main applications of ICC | 398 | ||
| Sample preparation | 398 | ||
| Fixation | 398 | ||
| Fixatives | 398 | ||
| Antigen retrieval (AR) in ICC | 398 | ||
| Principles of ICC staining | 399 | ||
| Manually/automated | 399 | ||
| Direct/indirect methods (Fig. 13.15) | 399 | ||
| PAP method (Fig. 13.16) | 399 | ||
| ABC method (Fig. 13.17) | 400 | ||
| LSAB method (Fig. 13.18) | 400 | ||
| Polymeric methods (Fig. 13.19) | 400 | ||
| ICC staining | 400 | ||
| Internal quality control | 401 | ||
| Positive control (PC) | 401 | ||
| Negative control (NC) | 401 | ||
| External quality control | 401 | ||
| Pitfalls – weak reaction/no reaction | 403 | ||
| Pitfalls – background staining and unspecific bindage | 403 | ||
| Polymerase chain reaction | 404 | ||
| Introduction | 404 | ||
| Rationale | 404 | ||
| Sample types | 404 | ||
| Nucleic acid extraction | 404 | ||
| Techniques | 405 | ||
| Applications | 405 | ||
| Nucleic acid targets | 405 | ||
| Pitfalls | 405 | ||
| Clonality analysis to aid lymphoma diagnosis | 406 | ||
| Clonality analysis | 406 | ||
| Method of cell preparation in suspected lymphoma | 406 | ||
| PCR product analysis (Figs 13.39, 13.40) | 406 | ||
| Pitfalls | 406 | ||
| Chromosome translocation detection | 407 | ||
| Diagnosis of lymphomas | 407 | ||
| Diagnosis of sarcomas | 407 | ||
| Method: Lymphomas | 407 | ||
| Method: Sarcomas | 407 | ||
| Pitfalls | 407 | ||
| Mutation detection for therapy selection in lung cancer | 408 | ||
| Epidermal growth factor receptor (EGFR) | 408 | ||
| Selection of first-line therapy in non small cell lung carcinoma (NSCLC) | 408 | ||
| Pitfalls | 408 | ||
| PCR detection of infectious agents | 409 | ||
| Mycobacterial infection (Fig. 13.46) | 409 | ||
| Pitfalls in detection of infectious agents | 409 | ||
| Pneumocystis carinii (Fig. 13.47) | 409 | ||
| Future developments in molecular diagnostics | 409 | ||
| In situ hybridisation (ISH) (Figs 13.48, 13.49) | 410 | ||
| The principle | 410 | ||
| DNA probes | 410 | ||
| Fluorescence in situ hybridisation: protocol and laboratory equipment (Figs 13.50–13.52) | 411 | ||
| Types of preparation | 411 | ||
| FISH protocol flow chart | 411 | ||
| Fluorescence in situ hybridization in lymphomas: gene translocation (Figs 13.53–13.56) | 412 | ||
| Other translocations and genes detected by FISH in lymphomas | 412 | ||
| Fluorescence in situ hybridisation in solid tumours: detection of gene amplification (Figs 13.57–13.61) | 413 | ||
| Other solid tumours (different types), and the genes which are frequently amplified | 413 | ||
| Fluorescence in situ hybridisation in solid tumours: gene translocation (Figs 13.62–13.65) | 414 | ||
| Other mesenchymal solid tumours and genes involved in their pathogenesis detected by FISH | 414 | ||
| 14 Self-assessment questions | 415 | ||
| Case 1 Routine cervical cytology sample from a 32-year-old woman | 416 | ||
| Subject Index | 443 | ||
| A | 443 | ||
| B | 444 | ||
| C | 446 | ||
| D | 448 | ||
| E | 448 | ||
| F | 449 | ||
| G | 450 | ||
| H | 450 | ||
| I | 451 | ||
| J | 451 | ||
| K | 452 | ||
| L | 452 | ||
| M | 454 | ||
| N | 455 | ||
| O | 456 | ||
| P | 456 | ||
| Q | 458 | ||
| R | 458 | ||
| S | 458 | ||
| T | 460 | ||
| U | 461 | ||
| V | 462 | ||
| W | 462 | ||
| X | 462 | ||
| Z | 462 |