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: More mesothelial cells,
Few mesothelial acute or chronic
cells, few histocytes inflammatory cells,
and lymphocytes 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.
 Cell block Cytocentrifuge preparation
Heparinized
Alcohol-fixed
Adding plasma and thrombin bottles (3 units
solution heparin/ml)
Unfixed Papanicolaou-stained
Wrapped in filter paper

Placed in a cassette Air-dried cytocentrifuge preparation

Embedded in paraffin (Hematologic malignancy is

suspected)
Cut and H&E stain
 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.

 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 7.0 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,...
• 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

THANK YOU