CYTOLOGY OF BODY FLUID

Schematic representation of the three body cavities

Accumulation of fluids in body cavities

Transudates

• Increased hydrostatic pressure: Congestive heart failure

• Decreased oncotic pressure (decreased albumin) : liver cirrhosis, nephrosis, and malnutrition

Exudate

• Inflammation: Infection, infarction, hemorrhage

• Tumor

DIFFERENCES BETWEEN TRANSUDATE AND EXUDATE

Feature Transudate Exudate

Gross appearance Watery, clear Turbid or cloudy

Specific gravity Less than 1015 More than 1015

Protein Less than 3mg/dl More than 3mg/dl

Clots No Yes

cells Usually benign:

Few mesothelial

cells, few histocytes

and lymphocytes

More mesothelial cells,

acute or chronic

inflammatory cells,

RBCs, malignant cells

DIAGNOSTIC ROLE OF EFFUSION CYTOLOGY

It is very useful for diagnosis of premalignant and

malignant tumors, especially metastatic tumors.

It is very useful for diagnosis of inflammatory

conditions (septic effusion, or chronic specific

inflammation e.g. TB

Respiratory Tract

Urinary Tract

Oral Cavity

Gastrointestinal Tract

Effusions (pleural, pericardial, joint)

Cerebral Spinal Fluid

Amniotic fluid

Many other body sites

Non-Gynecological Specimen Collection

EXAMINATION OF BODY FLUID

Gross exam

Total cell count

Microscopic exam

Any other special test (Chemistry, Microbiology,

cytology (

Test are performed in various areas of lab based on what

the physician orders.

Body fluids sterile vs. non-sterile

SAMPLE COLLECTION

FNA of effusion fluids

Tapping

Collection and preparation of specimen

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

TYPES OF STAINING SMEARS

PAP

Gram Stain

Hx & E

Cell block for remnant sediment and histopathological

examination.

Other special stains for the most suspected diseases, to

confirm diagnosis.

Heparinized bottles (3 units heparin/ml) Unfixed

Alcohol-fixed

Papanicolaou-stained

Cytocentrifuge preparationCell block

Adding plasma and thrombin solution

Wrapped in filter paper

Placed in a cassette

Embedded in paraffin

Cut and H&E stain

Air-dried cytocentrifuge preparation

(Hematologic malignancy is suspected)

1- CEREBROSPINAL FLUID

Fluid surrounding brain and spinal cord

Sterile

Specimen collection: by Lumbar puncture

Collect 3-5 vials, each tube has a designated department.

Gross exam: Turbidity, Color, microscopic exam, cell

count

CSF CELL DIFFERENTIAL

Numerate and differentiate cells seen

Lymphocytes: usually are few; increased with viral,

fungal, bacterial meningitis, or nervous system disease

Monocytes: Less than 2% of normal CSF, increased

with TB meningitis, viral encephalitis, subarachnoid

hemorrhage.

PMN: are few, associated with Viral and acute bacterial

inflammation.

Macrophages: are few in number associated with malignancy,

hemorrhage, inflammation

Eosinophils/Basophils: not normally seen in CSF

Plasma cells: not normally present; associated with viral disorders,

and Hodgkin's diseases.

Red Blood Cells: Few to none present

Mesothelial cells: not present

Malignant cells: will see with malignant disease and infiltrate.

• Effusion:

• Transudate

• Exudates

• Lab analysis: Gross exam, cell count, etc.

• Differential: PMN, Lymph, Mono, etc.

2- Pleural Fluid: Lung fluid

• Cells unique to the lungs: Mesothelial cells

• RBCs and WBCs: are limited, if increased without

traumatic tap ----- indicates infarction

• Cytology exam: useful in identifying malignancy or

abnormal morphological cells.

3- PERITONEAL FLUID

Abnormal accumulation of fluid (effusion) in peritoneal

cavity: Ascites

Ascites: a condition in which fluid accumulates within

the peritoneal space.

Must have an accumulation of > 100ml (several 100) before effusion

can be detected on physical exam.

Removal procedure- paracentesis

Lab analysis: distinguish between transudate and exudates,

gross exam, cell count, sedimentation, chemical analysis

PHYSICAL CHARACTERISTICS

Peritoneal Fluid Appearance: Color and clarity.

Color and clarity can indicate certain infections and diseases.

Total Cell Count: Assist in diagnosis of certain

diseases by determining total RBC and WBC number.

Lymphocytes: CHF, liver cirrhosis, nephrotic syndrome

Mesothelial Cells: Associated with TB effusions

Malignant cells: seen with malignancy

Pericardial Fluid: accumulation of fluid of the lining of

the heart (effusion)

Cause: neoplasm, infections, collagen disease, renal

disease, Cardiovascular disease.

Gross Exam: Report appearance (bloody, clear, cloudy)

4- Pericardial Fluid

Measure pH: pH less than 7.0 associated with infection or

rheumatoid disorder.

Cell count: see limited RBCs and WBCs

Evaluate sedimentation

• Examine physical, chemical and microscopic detail

• Count number of sperm, report morphology and

motility

• Specimen must be a fresh collection-clean, sterile

container.

• Gross Exam: Color, pH, Volume, and viscosity.

• Agglutination study

5- Seminal Fluid

• Joint Fluid: normally clear, viscous

• Functions as a lubricate and transports nutrient

• Arthrocentesis: aspirate of the joint fluid, aseptic

technique

• Lab Assay: Gross exam, microscopic exam, Gram

stain, cultures,...

6- Synovial Fluid:

• Appearance: clear, transparent, viscous

• Viscosity test

• Mucin Clot test

• Note crystals (intracellular vs. extra cellular)

• Slide exam: usually performed on concentration of the fluid

using Giemsa or Papnicolaou

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