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

Non-Gynecological Specimen Collection Respiratory Tract Urinary Tract Oral Cavity Gastrointestinal Tract Effusions (pleural, pericardial, joint) Cerebral Spinal Fluid Amniotic fluid Many other body sites

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.

Papanicolaou-stained Cytocentrifuge preparation Cell block Alcohol-fixed Papanicolaou-stained Cytocentrifuge preparation Cell block Adding plasma and thrombin solution Wrapped in filter paper Placed in a cassette Embedded in paraffin Cut and H&E stain Heparinized bottles (3 units heparin/ml) Unfixed 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.

Eosinophils/Basophils: not normally seen in CSF 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.

2- Pleural Fluid: Lung fluid Effusion: Transudate Exudates Lab analysis: Gross exam, cell count, etc. Differential: PMN, Lymph, Mono, etc.

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

4- Pericardial Fluid 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)

Measure pH: pH less than 7 Measure pH: pH less than 7.0 associated with infection or rheumatoid disorder. Cell count: see limited RBCs and WBCs Evaluate sedimentation

5- Seminal Fluid 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

6- Synovial 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,...

Note crystals (intracellular vs. extra cellular) 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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