2.0 Topic 2 Epithelium Non-Epithelial Cells (HDD30203)

INSTITUTE OF MEDICAL SCIENCE TECHNOLOGY
Topic 2
EPITHELIUM & NON-EPITHELIAL CELLS
Universiti Kuala Lumpur (UniKL) | Where Knowledge Is Applied and Dreams Realised
PROGRAM LEARNING OUTCOME (PLO)
2
HDD30203 CYTOPATHOLOGY
COURSE LEARNING OUTCOME (CLO)
Upon completion of this course, students are able to:
CLO 1 Apply appropriate cytopathology techniques necessary to

carry out scientific investigations. (C4, PLO1)
CLO 2 Perform cytopathology technique competently in

diagnostics laboratory. (P6, PLO2)
CLO 3 Present cytopathology related topics thru written

communication. (A2, PLO5)
2
LESSON LEARNING OUTCOME
At the end of the lesson, students are able to:
Describe the epithelium and non-epithelial cells morphology,

structure and functions.
Describe the cytologic criteria of malignancy.
4
LESSON OUTLINE
Epithelial cells - morphology, structure and function
Non-epithelial cells
Cytologic criteria of malignancy
5
Epithelium:
Morphology, structure &
function
6
Basic cell morphology & structure
7
Nucleus
Nucleus contains the DNA, histones & other proteins
Chromatin
• Represents the complex structure of DNA and proteins - makes
up the chromosome
• Stained with hematoxylin; ↑ staining (hyperchromasia) - ↑
chromatin load
Nucleoli
• Small basophilic spherical bodies - ribosome RNA synthesis
• Presence is physiological or can indicate malignant process
Nuclear shape
• Smooth sphere or spheroid
8
Epithelium: Functions
Epithelium Covers body surfaces and lines hollow organs, body

cavities, duct forms glands
Primary function: Protection (cover surfaces)

Others: Secretion (glands), absorption
9
10
Classification of epithelium
Simple
Number of cell
Stratified
layers
Pseudostratified
Classification
Squamous
Morphology of
Cuboidal
surface layer
Columnar 11
1 cell layer (from basement

Simple
membrane to the free surface
No. of cell Stratified >1 cell layers

layers
1 cell layer; but not all

Pseudostratified
reach the surface
12
Thin, flat, scale-like
Squamous
cells
Morphology of About equal in

Cuboidal
surface layer height & width
Height is more than

Columnar
the width
13
14
16
17
18
Small intestine
• Honeycombed fragment
of small intestinal
epithelium.
• Nuclei are evenly placed

and are interspersed by
mucinous, pale-staining
goblet cells
*Procedure: Brushing
* Pap stain
19
20
Squamous cells
21
Esophagus
• Fragment of squamous
epithelium with uniform
& monomorphic nuclei.
• Note the low nuclear to

cytoplasmic (N:C) ratios
with abundant clear
cytoplasm & polygonal
cell shape.
* Pap stain
22
23
24
25
Bronchus
• Note the columnar
shape of the cells,
basally placed nuclei,
and terminal bar with
well-formed apical cilia
* Pap stain
26
27
Umbrella cells
Note the abundant cytoplasm and low
nuclear to cytoplasmic ratio.
These cells have thickened outer

cytoplasmic margins ("saucer cup edge")
and vacuolated perinuclear areas.
The nuclei are uniform in size and

relatively central in placement.
*Procedure: Bladder wash

*Pap stain
28
Most commonly seen non-epithelial cells:
RBCs
• Often stain red, pink, or orange by Pap stain
Neutrophils
• Found in large no. in acute inflammation/infection; numerous
in cases of malignant ds
Macrophages
• Variable in size & appearance; foamy cytoplasm, eccentric
bean-shaped nucleus
29
Lymphocytes
• Small round cell, round nuclei, a narrow rim of cytoplasm
Plasma cells
• Larger than mature lymphocytes, have more cytoplasm

• Characteristic chromatin pattern → clockface/cartwheel
chromatin, eccentric nuclei
Stromal cells
• Elongated & spindle shape, round to oval nuclei, scant, wispy

cytoplasm;
• Tend to cluster together in disorganized aggregates 30
31
Cytologic criteria of
malignancy
32
It is based on the known or
The hallmarks of cancer expected functional
alterations in cancer cells.
It does not attempt to

account for structural
alterations of cancer cells.
33
Cytologic criteria of neoplastic/malignant
cells
Normal and neoplastic cells are distinguished based on:
Nuclear:cytoplasmic
Cell size & shape Nuclear size & shape
ratio (NCR)
Chromatin Regularity of nuclear

Chromatin pattern
distribution membrane
Intensity of nuclear
staining
34
Cytologic criteria of neoplastic/malignant cells
Cell size & shape
• Size expressed as a diameter measurement

• Shape: round, oval, polygonal, irregular
Nuclear size (absolute) & shape
• Size expressed as a diameter measurement

• Shape: round, oval, irregular
Nuclear:cytoplasmic ratio (NCR) (relative nuclear size)
• Low, high
35
Chromatin pattern
• Refers to the degree of coarsening of chromatin granules
• Pyknotic: dense chromatin pattern
• Vesicular: granular chromatin pattern (‘salt-and-pepper’)
• Bland: no discernible pattern
Chromatin distribution
• Describes the spatial density of chromatin granules over
the area of nucleus
• Uniform, irregular
Regularity of nuclear membrane
• Smooth, wrinkled, angular
Intensity of nuclear staining

• Normochromasia, hyperchromasia, hypochromasia 36
Criteria Benign Malignant
Chromatin
Chromatin is fine & evenly Chromatin is coarse, clumped
pattern &
distributed & unevenly distributed
distribution
Within normal physiological Variation in size & shape within

Nuclear size &
limits for the level of the same cell population
shape
maturation of the cell (pleomorphism)
Irregular in outline & show

Regularity of
indentation and/or thickening
nuclear Even
due to chromatin margination
membrane
& clumping
37

Intensity of Normochromatic & staining Usually hyperchromatic &
nuclear intensity maintained staining varies from one group
staining through all cells to the next
Multinuclea Can be seen but rarely Common, reflecting rapid cell
tion turnover
Nucleoli Small, even in number and (If present) Nucleoli are large,
even in size irregular & vary from nucleus
to nucleus; nucleoli are more
prominent in cancer than
dysplasia/ dyskaryosis
38
Nuclear to ↑ NCR ↑ NCR
cytoplasmic
ratio
Cells Cells are cohesive, Loss of cohesiveness (cells
architecture architecture is maintained coming away from their
groups). Nuclei tend to
crowd each other in
sheets/clusters.
Mitoses & Mitosis normally only ↑ mitoses with abnormal
mitotic figures occur at the basal layer so mitotic figures may be seen
are rarely seen in a
cervical smear
39
Low grade squamous intraepithelial lesion (LSIL)
Increase in NC ratio in SIL (40% in
this cell): the cell has matured to
the size of a normal intermediate
cell.
The nucleus is still fairly round in

shape; chromatin is coarser than
normal and hyperchromatic.
Normal
40
Squamous cell carcinoma
• Pleomorphic nuclei of
variable size including a
tadpole cell with dense
basophilic cytoplasm
Normal
41
THANK YOU
UNIVERSITI KUALA LUMPUR

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INSTITUTE OF MEDICAL SCIENCE TECHNOLOGY

Upon completion of this course, students are able to:

CLO 1 Apply appropriate cytopathology techniques necessary to

CLO 2 Perform cytopathology technique competently in

CLO 3 Present cytopathology related topics thru written

Describe the epithelium and non-epithelial cells morphology,

Describe the cytologic criteria of malignancy.

Cytologic criteria of malignancy

Epithelium Covers body surfaces and lines hollow organs, body

Primary function: Protection (cover surfaces)

1 cell layer (from basement

No. of cell Stratified >1 cell layers

1 cell layer; but not all

Morphology of About equal in

Height is more than

• Nuclei are evenly placed

• Note the low nuclear to

These cells have thickened outer

The nuclei are uniform in size and

*Procedure: Bladder wash

• Small round cell, round nuclei, a narrow rim of cytoplasm

• Larger than mature lymphocytes, have more cytoplasm

• Elongated & spindle shape, round to oval nuclei, scant, wispy

It does not attempt to

Chromatin Regularity of nuclear

Cell size & shape

• Size expressed as a diameter measurement

Nuclear size (absolute) & shape

• Size expressed as a diameter measurement

Nuclear:cytoplasmic ratio (NCR) (relative nuclear size)

Intensity of nuclear staining

Criteria Benign Malignant

Within normal physiological Variation in size & shape within

Irregular in outline & show

Criteria Benign Malignant

The nucleus is still fairly round in

UNIVERSITI KUALA LUMPUR

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