Cytopathology

Screening - i.e. pap smear, at risk populations (esp asymptomatic)
Dx - nearly any organ for symptomatic cancers
Surveillance - i.e. bladder cancer urine cytopathology follow up
Rule out cancer (why this is different from diagnosis i have no idea)

Abrasive (brushing)
Fine Needle Aspiration (FNA)(imaging guidance) - initial smear to assess adequacy then cell block to Dx
Exfoliative (look in fluids)
*combine w/ FISH!

Abrasive sampling of cervix, Diff Quick stain for air dried or EtOH for Pap stain fixing
Residual material used to detect high risk HPV DNA, chlamydia, gonorrhea

Cell arrangement
Cell size & shape
Cytoplasm
Nucleus
Background

groups, sheets, clusters
papillary - papillary transitional cell carcinoma, papillary adenocarcinoma, malignant mesothelioma
glandular/tubular - adenocarcinoma
follicles - follicular adenoma of the thyroid
rosettes - retinoblastoma
pearls - squamous cell carcinoma

variable (small, large, giant)(polygonal, round, oval, elongate)
malignant neoplasms tend to vary more than benign neoplasms (some exceptions)

Color, texture, presence of inclusions, vacuoles, pigments, other cell products
pap smear: pink/blue
keratin=orange
helps identify cell type
viral & chlamydial infections form inclusions
KOILOCYTOTIC ATYPIA in HPV

Size & Shape (variation = malignancy), Chromatin (darker=hyperchromatic=cancer), Inclusions, Nucleolus (larger & numerous = malignancy)
many explanations for multinucleation

Inflammation, microorganisms, cell necrosis, blood, colloid, crystals

Should follow the Bethesda System
should contain: statement regarding adequacy of specimen, general categorization, and an interpretation

Normal Pap Smear

Low Grade Intraepithelial Lesion

Squamous Cell Carcinoma