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Pleural, Pericardial, and Peritoneal Fluids

The pleural, pericardial, and peritoneal cavities are lined by a single layer of flat mesothelial cells called the serosa . Normally, these cavities are collapsed and contain only a small amount of fluid (50 mL in each pleural cavity in adults ), enough to lubricate the adjacent surfaces as they move over each other with respiration, heartbeats, and intestinal peristalsis. In disease states, a greater amount…

Urine and Bladder Washings

Urine cytology was popularized by George Papanicolaou in the 1940s as a way to detect and monitor patients with bladder cancer. By the 1960s, the cytologic, histologic, and clinical features of high-grade urothelial carcinoma were well established, and cytology became an inexpensive, quick, and reliable way to diagnose high-grade urothelial carcinoma, as well as a variety of less common tumors. Urine cytology is an excellent test…

Respiratory Tract and Mediastinum

Exfoliative cytology was first used to study cells of the respiratory tract in 1845. The ability to diagnose pulmonary diseases cytologically was appreciated as early as 1919, but it was not until the 1950s and 1960s that pulmonary cytology came into its own as a diagnostic discipline. Its emergence was bolstered by the introduction of direct sampling methods via bronchoscopy and fine-needle aspiration (FNA), resulting in…

Cervical and Vaginal Cytology

The 20th century witnessed a remarkable decline in the mortality from cervical cancer in developed countries, an achievement attributable to the implementation of the Papanicolaou (Pap) test. In the 1930s, before Pap test screening was introduced, cervical cancer was the most common cause of cancer deaths in women in the United States. Today it is not even in the top 10, but it has not been…

HPV Detection Techniques

HPV Biology General Information of Human Papillomavirus Human papillomaviruses (HPVs) are members of the Papillomaviridae family of viruses. They are small double-stranded DNA viruses with a circular genome of approximately 8000 base pairs (bp) and an outer protein capsid, with no lipid membrane The HPV genome is composed of eight genes, six of them expressed early in infection (so-called early genes: E1, E2, E4, E5, E6,…

Molecular Techniques

Introduction Molecular techniques have become an integral part of pathology for improved early diagnosis of premalignant lesions and cancer, prognostication, or prediction of therapy response. Cancer is a disease of the genes, and genetic alterations are a hallmark of cancer. Therefore it is not surprising that many molecular applications aim for the detection of genetic changes. In addition, it has become apparent that epigenetic modifications such…

Immunocytochemistry

Introduction Immunocytology or immunocytochemistry (ICC) involves the application of immunohistochemistry (IHC) in aspiration and exfoliative cytopathology. These immunostains have improved the ability to confidently make specific and accurate diagnoses in cytopathology, and have largely replaced the use of special stains. Not surprisingly, there has been a great deal of progress and expansion in ICC over the past decades given its usefulness, which has led to an…

Automation in Cervical Cytology

Introduction On a standard “adoption curve,” where interest in a new technology initially runs high, is followed by disappointment, then by maturation of the technology and finally a plateau of acceptance, cytology automation is firmly entrenched on the acceptance plateau. Over past editions of Comprehensive Cytopathology , that evolution has been well documented, initially with discussions of the research driving computerization and automated morphometry, followed by…

Digital Pathology/Telepathology

Introduction to Digital Cytology: Basic Principles The change in image format from analog to digital has created a revolution. In fields such as photography and radiology, the transfer of imaging technology from film-based to digital formats has seen the bankruptcies of large companies unable to successfully adapt (e.g., Eastman Kodak), and has seen the adoption of digital-based clinical methods to expand capabilities and hence opportunities (e.g.,…

Cytopreparatory Techniques

Introduction The best morphologic presentation obtained from any cytologic specimen requires an understanding of the factors that went into collecting and preparing the specimen. An accurate cytodiagnosis is based on adequate sampling, proper evaluation of the sample, proper fixation, preparation and staining of the cells. The fundamental principle in cytopreparation is to reduce the specimen to a cellular presentation, which can be interpreted and diagnosed. The…

Effects of Therapy on Cytologic Specimens

Introduction The development of novel therapeutic modalities for treating patients with malignancies and transplantation rejection is an ongoing process, at the time of this writing. The prototype of different genres includes radiation therapy, chemotherapeutic agents, biologic response modifiers, and innovative mechanical/physical/molecular biology techniques. Amidst the diversity of these traditional and novel techniques, common characteristics shared is the ability of the modalities to lead to a wide…

Pediatric Tumors

Introduction Incidence of Pediatric Tumors and Histologic Types Children are not small adults, and they show a distinctive incidence, histologic typology, and biologic behavior for most malignancies, which differ considerably from those of adults. Pediatric tumors are often linked to genetic aberrations or familial disorders, the association between developmental abnormalities and tumor induction being common. On the other hand, fetal and neonatal malignancies tend to differentiate…

Pancreas

Introduction Technical Aspects Cytological evaluation of the pancreas is for diagnosis of a pancreatic mass or cyst. A fine-needle aspiration (FNA) of the pancreas can be performed percutaneously by a radiologist or endoscopically by a gastroenterologist. A percutaneous FNA is performed using computed tomography (CT) or ultrasound (US). Endoscopic ultrasound (EUS)-guided FNA has replaced percutaneous FNA over the past two decades in most centers, as it…

Liver

Introduction Cancer growth in the liver is a frequent finding at laparotomy or autopsy. In Tao's series of 1691 cases of aspiration biopsy of the liver, 1217 (72%) were metastatic cancers. Because positive findings for hepatic malignancy imply a grave prognosis and may alter clinical management, biopsy confirmation is often required. For patients with a cancer metastatic to the liver, confirmation of hepatic metastases may obviate…

Kidneys, Adrenals, and Retroperitoneum

Kidneys In 1946, Lindblom, a Swedish radiologist, described percutaneous puncture of renal cysts and tumors. Subsequently, during the 1950s, beginning in the Scandinavian countries, the increasing use of fine-needle aspiration (FNA) of mass lesions in the kidneys, adrenals, and retroperitoneum paralleled the technologic advances in imaging techniques, particularly ultrasonography and computed tomography (CT). Because these techniques in themselves have a high degree of diagnostic accuracy and…

Mediastinum

Introduction Anatomic Compartments and Clinical Correlation The mediastinum is a large anatomic compartment in the thoracic cavity, bounded laterally by the pleurae, anteriorly by the sternum, posteriorly by the vertebrae, superiorly by the thoracic inlet, and inferiorly by the diaphragm. It is further subdivided into four arbitrary portions by the pericardium; namely, superior, anterior, middle, and posterior compartments. The superior mediastinum lies above the pericardium. The…

Breast

Introduction Fine-needle aspiration (FNA) biopsy of the breast was first used in the 1930s by Martin and Ellis and by Stewart at Memorial Hospital, followed in the late 1940s and early 1950s by Adair and Godwin. However, not until the Europeans reported a number of large series of FNA of the breast was aspiration cytology shown to be a valuable and accurate diagnostic procedure. With the…

Lymph Nodes : Cytomorphology and Flow Cytometry

Introduction Fine-needle aspiration (FNA) is a well-established procedure for the evaluation of lymphadenopathy, which may be associated with various pathologies including reactive conditions, infections, and primary and metastatic malignancies. The morphologic criteria for the diagnosis of metastatic tumors and infections in aspirates from lymph nodes are similar to those in other body sites. Therefore, the major focus of this chapter will be devoted to the use…

Thyroid

Introduction Although Martin and Ellis reported using fine-needle aspiration (FNA) to study the thyroid gland as early as 1930, its first widespread use was in Sweden during the 1950s and 1960s and later in the USA in the late 1970s and early 1980s. At present, thyroid FNA is a cost-effective first-line procedure fully accepted in the diagnostic workup of adult and child patients, in conjunction with…

The Bethesda System for Reporting Thyroid Cytopathology

Historical Background Thyroid nodules are common and usually benign but may be malignant, and since there is currently no non-invasive method to determine which ones are malignant, standard of care involves thyroid fine-needle aspiration (FNA). Thyroid FNA is widely accepted for the evaluation of thyroid nodules, since it is rapid, safe, cost-effective, and accurate when definitive. When the cytomorphological diagnosis is benign, thyroid FNA has a…