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Salivary Glands and Rare Head and Neck Lesions

Salivary Glands Introduction A nodule or diffuse enlargement of the salivary glands may be caused by a cystic lesion, an inflammation, a degenerative process, a benign or malignant neoplasm. For adequate management, the exact nature of the process must be revealed, which can be done only by microscopic evaluation. Incisional or cutting needle biopsies have not been accepted as the procedure of choice for obtaining tissue…

Imaging Techniques

Introduction Although modern imaging and laboratory methods permit precise identification of the presence and location of disease throughout the body, cytologic or histologic examination of tissue remains an essential step in establishing a definitive diagnosis and in planning patient management. Tissue sampling by excision or biopsy, coupled with modern methods of tissue processing and examination for specific immunohistochemical markers, plays an important role in the differentiation…

Fine-needle Aspiration Biopsy Techniques

History of Aspiration Biopsy The first report on the use of “needle puncture” is referred to in The Kitab al-Tarif ( The Method of Medicine ), the most influential book of Arab medieval medicine, authored by Albucasis or Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi (936–1013). Albucasis was the court physician to the caliph of Andalucia and described the first account of fine-needle aspiration (FNA) of the…

Pleural, Peritoneal, and Pericardial Effusions

Introduction Cytologic examination of a serous effusion is of paramount importance because the finding of cancer cells in such a specimen denotes that the patient has cancer that is not only advanced but also almost always incurable. Apart from the finding of cancer cells, cytologic examination of pleural, peritoneal, and pericardial effusions may also reveal information about inflammatory conditions of the serous membranes, parasitic infestations, and…

Cytology of Soft Tissue, Bone, and Skin

Soft Tissue Tumors Introduction Fine-needle aspiration biopsy (FNAB) of mesenchymal lesions is still controversial. It is not as widely accepted as FNAB of solid organs. One of the possible reasons for the low acceptance might be the inexperience of most cytopathologists as soft tissue neoplasms are relatively uncommon. Sarcomas represent less than 1% of all malignancies and mostly are treated in tertiary care centers. There is…

Eye

Introduction Ocular cytology challenges cytologists, in part because of the rarity of these specimens. Surprising to most cytologists, definitive ophthalmic cancer therapy rarely requires cellular or tissue diagnosis. Instead, experienced ocular oncologists, with the aid of direct visualization, can accurately diagnose these ocular lesions. This fact does not diminish the importance of ocular cytology. Rather, it emphasizes the importance of close collaboration between cytologists and ophthalmologists.…

Central Nervous System

Introduction The focus of this chapter is primarily on utilizing cerebrospinal fluid analysis as a means to diagnose central nervous system (CNS) disease (both neoplastic and non-neoplastic). Prior editions have included fine-needle aspiration (FNA) of brain lesions; however, we feel the cytomorphology of these entities is best characterized in dedicated neuropathology textbooks. If the reader is interested, we would refer them to Smears and Frozen Sections…

Urinary Tract

Introduction Urine cytology as a method for diagnosing bladder carcinoma was introduced in 1945 by Papanicolaou and Marshall. Urothelial cells are present in all urine specimens and exfoliate readily from tumors of the urothelial lining. Urine cytology is therefore an important primary method of diagnosing urothelial tumors, and it is used as an adjunct in combination with cytoscopy and biopsy. Cytologic examination of urine is performed…

Alimentary Tract (Esophagus, Stomach, Small Intestine, Colon, Rectum, Anus, Biliary Tract)

Introduction The digestive system is an integrated collection of anatomically and physiologically distinct organs and structures. They may be involved in a large number of important inflammatory and neoplastic diseases, most of which have been well characterized histologically. Yet, the key cytologic features of many of these entities are less widely recognized, despite the fact that the majority of clinically significant disorders originate in, or are…

Respiratory Tract

Introduction Hippocrates, in ancient Greece, is recorded to have used sputum to diagnose pulmonary disease. Thousands of years later with the discovery of the microscope, the pioneers of modern medicine in the seventeenth and eighteenth centuries started observing the sputum under the microscope. It was not until 1838 that Johannes Mueller and, a year later, Gottlieb Gluge described the microscopic appearance of cancer cells. The first…

Peritoneal Washings and Ovary

Peritoneal Washings Peritoneal cytology has an important role in the diagnosis and staging of abdominal and gynecologic neoplasms. Where peritoneal involvement by malignant tumors is extensive such as mesothelioma or high-grade abdominal or ovarian carcinomas, diagnosis can usually be confirmed by examination of ascites. However, additional procedures to assist diagnosis are required for localized tumors, less advanced disease, or follow-up of treatment. This may include examination…

Vulva, Vagina, and Anus

Introduction Vulvar and vaginal exfoliative cytology, although not a substitute for biopsy, may provide valuable information about the nature of a lesion without causing significant discomfort to a patient. Although unsuspected cancer is rarely identified by this approach, a wide variety of infectious and inflammatory diseases, dermatologic diseases, and benign and malignant tumors have characteristic cytologic features. A biopsy remains the standard management for any suspicious…

Endometrial Hyperplasia and Carcinoma, Extrauterine Cancer, and Unusual Tumors

Introduction The primary purpose of gynecologic exfoliative cytology remains the detection of cervical carcinoma and its precursor lesions. Although gynecologic cytology may detect significant endometrial disease, screening for endometrial disease using gynecologic cytology is not appropriate. Direct endometrial cytology may be used to detect endometrial neoplasia. Both endometrial and extrauterine tumors may be detected using cervicovaginal (CV) exfoliative cytologic and direct endometrial sampling. Endometrial cytology has…

Glandular Neoplasms of the Uterine Cervix

Introduction The relevance of lesions derived from the glandular portions of the endocervical canal has increased in recent years. There has been a reported increase in the incidence of preneoplastic and neoplastic endocervical lesions, both absolute and relative, when compared with the more common squamous lesions. In a study of US Surveillance, Epidemiology, and End Results (SEER) databases, incidence rates of squamous and adenocarcinomas of the…

Benign Proliferative Reactions, Intraepithelial Neoplasia, and Invasive Cancer of the Uterine Cervix

Introduction and History Diagnostic cytology of the uterine cervix was not the first application of cytology in clinical diagnosis of diseases, but it is definitely one of the most widespread and best known. In its early days, vaginal cytology was primarily directed at the diagnosis of invasive cancer of the uterine cervix and of the endometrium, but cytologists later began to realize that cervical lesions were…

Microbiology, Inflammation, and Viral Infections

Introduction The lower female genital tract includes the vulva, the vagina, the cervix, and the uterine cavity. It is in direct communication with the external environment, and prone to various non-infectious and infectious inflammatory reactions. Although most of these infections remain confined locally; they can progress and the organisms may ascend to the fallopian tubes and the ovaries. Occasionally, microbial infections from the lower genital tract…

The Bethesda System for Reporting Cervical Cytology

The Bethesda System: Historical Perspective Terminology forms the basis for effective communication between the laboratory and clinician. The clinician is expected to provide relevant patient information to the laboratory. It is the laboratory's responsibility to report results using terminology that clearly conveys the diagnostic interpretation of the morphologic findings. The use of a uniform diagnostic terminology facilitates communication by establishing a common language that, in theory,…

Evaluation of the Non-gynecologic Sample in Smears and Liquid-based Preparations

Introduction Several factors play a role in the evaluation of the cellular sample. The method of sample collection and fixation, the laboratory procedure to process the sample, and the integration of the morphologic features observed in the sample with the clinical information may affect the quality of interpretation/diagnosis reached. The ultimate goal in specimen processing is to preserve, as much as possible, in vitro or in…

Diagnostic Quality Assurance in Cytopathology

Introduction Cytopathologists are concerned about and committed to quality assurance and quality control in their laboratories. These practices include, among others, the use of intralaboratory and extradepartmental consultations, case reviews, correlation of cytologic and histopathologic specimens, hierarchic review of cytopathology, and review of completed diagnostic reports. Most of the quality assurance techniques are well described. In the past, formal organization and mandatory documentation of these quality…

Cytologic Screening Programs

Principles of Screening Screening of diseases gained significance in medicine at the end of the nineteenth century, when public health authorities emphasized the importance of screening methods for certain diseases. An example is the radiological screening of immigrants, searching for infectious diseases such as tuberculosis in the USA. The idea of screening for early detection of cancer was accepted in the 1920s after the development of…