9 Exfoliative Cytology

• Exfoliative Cytology is a branch of science dealing with the study of cells that are scrapped off or removed off or coming from lining epithelium and mucosa of different organs of the body.
• Synonyms of Exfoliative Cytology: Papanicolaou’s method or Pap’s method
• Cytopathology is the study of the abnormal cells as Cancer cells
• Cytotechnique is the study of the methods preparing the cells for microscopic examinations
• Pleomorphism are variations in size, shape, form, and external appearance of cells
• Hyperchromatism is increased in staining affinity above the normal affecting, mainly the nuclear structures (basophilism).
• Multinucleation is increased in the number of nuclei per cell.
• Atypical mitotic figures are abnormal stages of mitosis or cell division.
• Vesicular staining cytoplasm has lighter-staining affinity affecting the cytoplasm affecting the cytoplasm producing a great contrast in staining affinity with that of the nucleus (inversion or reversal of the nucleo-cytoplasm ratio).
• Changes in the Cell Membrane

  • Variation in size, shape or form of the cell
  • Enlargement of cells in swelling
  • Diminution in size of cells as in shrinking
  • Cloudiness or indistinctness in cellular boundary
• Changes in the Cytoplasm

  • Accumulation of materials or substances within as water, protein, carbohydrate, fat, and others.
  • Disintegration or breaking down of cytoplasmic organelles.
  • Dissolution of the cytoplasmic components.
• Changes in the Nucleus

  • Pyknosis – condensation of chromatin materials
  • Karyorrhexis – breaking down of nuclear components.
  • Karyolysis – dissolution of nuclear structures.
• Scrapings specimens come from lining epithelium and mucosa or secretions of the female reproductive tract such as various vagina, cervix, and endometrium of the uterus.
• Rubber bulb w/ glass pipette is used for aspiration of fluid in cancer.
• Aryes spatula is used for obtaining mucoid specimens for hormonal studies.
• Curette is a spoon, curved or blunt types; commonly used for many biopsies to obtain pieces of the tissues from the vagina and cervix or placental tissues from the endometrium.
• Diagnostic curettage is used in minor procedure for diagnosis
• Dilatation & Curettage is used in major operation for treatment.
• In Pap smear, cells are scraped from cervix and examined under a microscope to check for disease r other problems
• Prostatic secretions are done by massage through an intra-rectal route using the middle and index finger aseptically
• “Deep cough” specimen is the best study in bronchial secretions or sputum
• Sputum is collected in wide-mouth container containing Saccomano fluid → 50% ETOH, 2% Carbowax
• Gastric contents & Duodenal fluid specimens are obtained by the incubation technique using rubber tubings of specimen diameter and length known as nasogastric tube
• Nasogastric tubes:

  • Levin tube → designed for nostril
  • Rehfuss tube → designed for nostril
• Gastric contents are watery acidic fluid with plenty of food debris.
• Duodenal fluids are greenish-yellow alkaline fluid and mucoid
• Cerebrospinal fluid are obtained by lumbar puncture or lumbar tap down in the intervertebral spaces between the 2nd and 3rd lumbar vertebrae or between 3rd and 4th lumbar vertebrae.
• Cerebrospinal fluid is a secretion of the choroidal plexus of the brain circulating within the ventricles and central canal of the spinal cord
• Serous fluids are specimens from different body cavities.
• Pleural cavity fluids are obtained by thoracentesis, done commonly on the left lateral thoracic wall.
• Pericardial cavity fluids are obtained by pericardiocentesis, done commonly on the left sterna border.
• Peritoneal cavity fluids are obtained by Paracentesis abdominis, done on the midline of the abdomen below the naval (at the linea alba).
• Bone marrow substances are specimen from the bone marrow cavities (red bone marrow or myeloid tissue) obtained by puncture using a bone marrow borer at the sternum or iliac crest.
• Voided urine of male is usually sufficient for cytological evaluation, but for female patients, catheterized specimen is recommended
• Spontaneous nipple discharge is collected with a cotton swab
• Nipple discharge is immediately immersed the slide into a bottle of 95% isopropyl ROH or use spray fixative
• If 1 drop of nipple discharge is obtained, get another slide, and do the pull-apart technique.