ROLES OF CYTOLOGY IN CYTOPATHOLOGICAL DIAGNOSIS OF DISEASE

Cytology is the study of body cells. Cytology play a number of roles in the in the
cytopathological disease diagnosis. The following are some of the roles it plays

 Diagnosis and management of cancer

 Identification of benign neoplasms.
 Intraoperative pathologic diagnosis.
 Diagnosis of non-neoplastic or inflammatory conditions.
 Diagnosis of specific infections
 Cytogenetics.
 Assessment of hormonal status in women.
 Identification of cell of origin
 In The Cytological Evaluation of CSF

Diagnosis and management of cancer

 Valuable adjunct to histopathology
 Provide a preliminary diagnosis of cancer for later confirmation by
histopathology
 Detection and diagnosis of clinically silent early cancer e.g. carcinoma in situ of
the uterine cervix
 Assessing response to therapy
 In the follow-up of previously diagnosed cases of cancer
Identification of benign neoplasms
 • Has ability to distinguish between benign and malignant neoplasms e.g.
Fibroadenoma of the breast versus carcinoma.

Intraoperative pathologic diagnosis

 Complements histopathologic diagnosis e.g. imprint smears along with frozen
section forMbreast lumps.

Assessment of hormonal status in women.

 In early menopause the Pap smear is predominated by superficial squamous
cells. This is caused by the development of nonovulated graafian follicles. As
menopause progresses the smear is predominated by either intermediate cells
or parabasal cells.
 e.g.to confirm the onset of menopause.
Identification of cell of origin.
 eg, identification of spermatogenic elements in aspirates from the testes in
cases of male infertility.
Diagnosis of non-neoplastic or inflammatory conditions
 Allows recognition of specific conditions which do not routinely require surgical
intervention
 Hyperplastic reserve cells gradually transform into immature squamous cells that
exfoliate in sheets or singly. The immature squamous cells have pale, vacuolated
cytoplasm and may show cytoplasmic extensions or tails (spider cells). Their oval
nuclei have fine chromatin and are slightly hyperchromatic. With time, immature
metaplastic squamous 56 cells change into mature squamous cells with more
waxy, basophilic or eosinophilic cytoplasm.

Diagnosis of specific infections

 Bacterial vaginosis is also called a “shift in flora”. It is a common, nonspecific
cervicovaginitis and is often asymptomatic. On Pap smears characteristic “clue
cells” are present in a filmy background of small coccobacilli. These are
superficial and intermediate squamous cells covered by a layer of bacteria
(coccobacilli) that obscures the cell membrane. These cells should be
differentiated from “false-clue cells” that are also squamous cells covered with
bacillary organisms.
 e.g. tubercle bacilli, and Trichomonas

Cytogenetics

 For chromosomal studies and for demonstrating sex-chromatin e.g. buccal

smear for Barr body.
 Fluorescent immunophenotyping and interphase cytogenetics as a tool for the
investigation of neoplasms (FICTION) is a combination of fluorescent
immunophenotyping and in situ hybridization, making it possible to study
genetic abnormalities in phenotypically selected cells.

In The Cytological Evaluation of CSF

It generally enables at least an initial categorization of the diagnosis into one of the
major types of neurological disease. In more concrete terms, classical CSF cytology is
a rapid, inexpensive diagnostic technique that permits all of the following:

 Detection of infectious diseases of the central nervous system (CNS) and their
classification into major categories. Classical CSF cytological examination, when
carried out either as an initial study or as a follow-up study in patients with CNS
 infections, yields information that determines which further test(s) should be done
for identification of the pathogenic source (standard microbiological culture;
enzyme-linked immunosorbent assay (ELISA) and blotting methods using
pathogenspecific antibodies; molecular techniques, particularly
hybridization/amplification with polymerase chain reaction (PCR), multiplex PCR,
and blotting methods; immunocytochemical phenotyping of antibody-secreting
cells, particularly with respect to immunoglobulin typing of activated B
lymphocytes in the CSF).

 Demonstration of acute, or older, hemorrhages into the CSF spaces that cannot
be clearly revealed, or can no longer be clearly revealed, by neuroimaging
studies (subarachnoid hemorrhage, hemorrhage accompanying inflammatory,
traumatic, or neoplastic disease, etc.). Classical CSF cytological examination can
also be used to distinguish true hemorrhage into the CSF space from the
artifactual introduction of blood into the CSF.
 Detection of neoplastic cells and their (at least initial) classification by origin in
patients with an unknown or unclear oncological diagnosis (inadequate
phenotyping of neoplastic cell populations of hematogenic origin, taken from the
patient’s blood, bone marrow, or lymph nodes; probable primary CNS lymphoma;
unknown primary tumor; and unclear cases in which true neoplastic cells must be
distinguished from lymphocytic activated forms, pre-neoplastic stages, non-
neoplastic progenitor cells, and non-neoplastic stimulated cell forms). In such
cases, classical CSF cytology can be followed by appropriate immunocytological
phenotyping techniques for cell-line–specific proteins (characterization of cell
lines by the expression or nonexpression of epithelial, oncofetal, neuroendocrine,
mesenchymal, neuron-associated, and glia associated antigens).
 Follow-up studies and treatment monitoring in patients with pleocytosis and/or
qualitative cellular changes in the CSF, as well as the monitoring of external
ventricular drains for infection or inflammatory reaction to the catheter (material
intolerance).