漿膜腔積液脫落細(xì)胞學(xué)檢查良性病變脫落細(xì)胞課件

1、漿膜腔積液脫落細(xì)胞學(xué)檢查良性病變脫落細(xì)胞課件漿膜腔積液脫落細(xì)胞學(xué)檢查良性病變脫落細(xì)胞課件痰液脫落細(xì)胞學(xué)檢查肺脫落細(xì)胞學(xué)檢查是早期診斷肺癌的重要手段之一。肺癌的早期診斷可根據(jù)臨床癥狀、X線檢查、痰液涂片檢查和纖維支氣管等多方面配合進(jìn)行。痰液標(biāo)本采集：痰液必須新鮮； 痰液必須是肺部咳出。痰液脫落細(xì)胞學(xué)檢查肺脫落細(xì)胞學(xué)檢查是早期診斷肺癌的重要手段之痰液脫落細(xì)胞學(xué)檢查正常的痰涂片中可見來自口腔的鱗狀上皮細(xì)胞、纖毛柱狀上皮細(xì)胞和肺泡吞噬細(xì)胞（后兩者為確定痰液來自肺及支氣管深部的標(biāo)志）以及中性白細(xì)胞、淋巴細(xì)胞、漿細(xì)胞、嗜酸性白細(xì)胞等。痰液脫落細(xì)胞學(xué)檢查正常的痰涂片中可見來自口腔的鱗狀上皮細(xì)胞、痰液纖毛柱狀

2、上皮細(xì)胞 Ciliated columnar cells痰液纖毛柱狀上皮細(xì)胞 Ciliated columnar 纖毛柱狀上皮細(xì)胞 Ciliated columnar cellsNote the moderately coarse and hyperchromatic chromatin Also note the little tails where the cells were attached to the basement membrane and, of course, the presence of terminal bars and cilia (Oil) 纖毛柱狀上皮細(xì)胞 Ci

3、liated columnar ceGoblet cellsGoblet cell hyperplasia Normally, the ciliated cells far outnumber the secretory cells (by at least 5 to 1).However, in asthma, for example, the goblet cells may actually outnumber the ciliated cells. Goblet cellsGoblet cell hyperp痰液肺泡吞噬細(xì)胞 Alveolar macrophages in sputum

4、Alveolar macrophages are key cells to look for in a sputum specimen. The presence of alveolar macrophages indicates that the deep lung has been sampled. dust cells痰液肺泡吞噬細(xì)胞 Alveolar macrophages痰液肺泡吞噬細(xì)胞 Alveolar macrophages in sputum痰液肺泡吞噬細(xì)胞 Alveolar macrophagesGiant Cell HistiocytesGiant cell histioc

5、ytes can be seen in a wide variety of pulmonary disorders, They can also be seen in apparently healthy people, and therefore do not necessarily indicate the presence of disease. Giant Cell HistiocytesGiant ce痰液良性病變脫落細(xì)胞炎癥病變脫落細(xì)胞：支氣管炎、肺炎和肺結(jié)核等急、慢性呼吸道炎癥引起上皮細(xì)胞發(fā)生細(xì)胞核輕度固縮退變或細(xì)胞輕度腫大。巴氏細(xì)胞（Papaniculaou cell): 因炎

6、癥刺激造成，細(xì)胞體積較小，圓形或卵圓形，胞質(zhì)深紅色，核小而圓形，致密深染，有輕度核異形,可能是鱗狀化生細(xì)胞。痰液良性病變脫落細(xì)胞痰液良性病變脫落細(xì)胞巴氏細(xì)胞Squamous metaplasia can be seen in sputm smear, ie, rounded cells with dense, cyanophilic cytoplasm. 痰液良性病變脫落細(xì)胞巴氏細(xì)胞Squamous metapl肺癌脫落細(xì)胞痰液涂片檢查主要用于檢查癌細(xì)胞，肺癌患者痰內(nèi)癌細(xì)胞檢出率可達(dá)90%。根據(jù)細(xì)胞學(xué)形態(tài)，肺癌主要分為鱗癌，腺癌，未分化癌，混合型癌及類型未明癌。肺癌脫落細(xì)胞痰液涂片檢查主要用于

7、檢查癌細(xì)胞，肺癌患者痰內(nèi)癌細(xì)痰液脫落細(xì)胞學(xué)檢查肺鱗狀細(xì)胞癌：最常見，男性遠(yuǎn)多于女性，主要發(fā)生于大支氣管，多數(shù)為中央型。細(xì)胞形態(tài)和大小異常：癌細(xì)胞單個散在，多形性明顯，可以呈圓形、蝌蚪形、梭形及不規(guī)則形；核的異型：癌細(xì)胞大而畸形，核染色質(zhì)豐富深染，成團塊狀或墨水滴樣。核仁常不明顯；胞質(zhì)的異常：癌細(xì)胞胞漿豐富紅染，有角化傾向；癌細(xì)胞吞噬現(xiàn)象痰液脫落細(xì)胞學(xué)檢查肺鱗狀細(xì)胞癌：痰液鱗狀細(xì)胞癌Keratinizing squamous cell carcinoma (tissue)Note the presence of squamous eddies, or pearls, which are path

8、ognomonic of keratinization. 痰液鱗狀細(xì)胞癌Keratinizing squamous 痰液鱗狀細(xì)胞癌Keratinizing squamous cell carcinomaPearls are characteristic of keratinizing lesions. 痰液鱗狀細(xì)胞癌Keratinizing squamous 角化鱗狀細(xì)胞癌Keratinizing squamous cell carcinomaBizarre keratinizing cells, often single, are a characteristic feature. Such

9、 cells are particularly associated with sputum specimens 角化鱗狀細(xì)胞癌Keratinizing squamous 痰液鱗狀細(xì)胞癌痰液鱗狀細(xì)胞癌痰液鱗狀細(xì)胞癌痰液鱗狀細(xì)胞癌非角化鱗狀細(xì)胞癌Non-keratinizing squamous cell carcinomaThe groups of malignant cells tend to be more cohesive and the cells more uniform Pearls, extensive keratinization, and bizarre-shaped cel

10、ls are not present. 非角化鱗狀細(xì)胞癌Non-keratinizing squa痰液脫落細(xì)胞學(xué)檢查肺腺癌：常發(fā)生于小支氣管，以周圍型肺癌多見，易發(fā)生血道轉(zhuǎn)移和侵犯胸膜引起的癌性胸水。分化好的腺癌以成群脫落為主，細(xì)胞群大，且細(xì)胞相互重疊呈立體結(jié)構(gòu)，單個癌細(xì)胞一般為圓形或卵圓形，胞質(zhì)常有許多小空泡，偶見較大空泡。核圓形或卵圓形，核膜染色質(zhì)呈顆粒狀，有明顯的核仁。痰液脫落細(xì)胞學(xué)檢查肺腺癌：肺腺癌 AdenocarcinomaAdenocarcinomaThree-dimensional cell balls or papillary clusters of malignant ce

11、lls are characteristic architectural features of adenocarcinoma. 肺腺癌 AdenocarcinomaAdenocarcino肺腺癌 AdenocarcinomaMicroacinar or rosette-like structures indicate glandular differentiation. Microacinar complexes are a cytologic equivalent of the gland-in-gland histologic growth pattern of adenocarcino

12、ma. 肺腺癌 AdenocarcinomaMicroacinar 肺腺癌 Adenocarcinoma肺腺癌 Adenocarcinoma肺腺癌 AdenocarcinomaNote that intracytoplasmic secretory vacuole containing mucin (arrow). 肺腺癌 AdenocarcinomaNote that in痰液脫落細(xì)胞學(xué)檢查未分化小細(xì)胞癌：惡性度較高，多為中央型，較早發(fā)生轉(zhuǎn)移。癌細(xì)胞單個或成團脫落，胞體小，比淋巴細(xì)胞稍大，常為不規(guī)則的圓形或卵圓形，胞漿少，呈裸核樣；細(xì)胞核相互擠壓呈鑲嵌狀結(jié)構(gòu)。 痰液脫落細(xì)胞學(xué)檢查未分化小細(xì)胞

13、癌：未分化小細(xì)胞癌 Small cell carcinomaSmall cell carcinoma (brushing specimen)The tumor cells have very little cytoplasm, relatively fine but very hyperchromatic chromatin, and inconspicuous nucleoliNote the similarity of bronchial cell nuclear chromatin to that of the tumor cells. 未分化小細(xì)胞癌 Small cell carcin

14、omaS未分化小細(xì)胞癌 Small cell carcinoma Small cell carcinoma (brushing specimen)The cells obtained by direct brushing appear fresher. well-preserved material未分化小細(xì)胞癌 Small cell carcinoma 未分化小細(xì)胞癌 Small cell carcinoma未分化小細(xì)胞癌 Small cell carcinoma漿膜腔積液脫落細(xì)胞學(xué)檢查漿膜腔，又稱體腔，包括胸膜腔、腹膜腔和心包膜腔。在正常生理情況下，體腔臟層和壁層間有少量液體，起潤滑作用。

15、在炎癥刺激、腫瘤轉(zhuǎn)移或循環(huán)障礙等情況下，可形成胸水、腹水和心包積液。漿膜腔積液脫落細(xì)胞學(xué)檢查主要用于判斷積液中有無癌細(xì)胞。漿膜腔積液脫落細(xì)胞學(xué)檢查漿膜腔，又稱體腔，包括胸膜腔、腹膜腔漿膜腔積液脫落細(xì)胞學(xué)檢查良性病變脫落細(xì)胞：脫落間皮細(xì)胞：圓形或橢圓形，胞漿厚實，胞核居中，胞核亦為圓形或橢圓形，核染色質(zhì)細(xì)顆粒狀，分布均勻。退化變性的間皮細(xì)胞：腫脹性退變表現(xiàn)為細(xì)胞增大，胞漿出現(xiàn)大小不等的液化空泡，胞核腫脹，偏位。漿膜腔積液脫落細(xì)胞學(xué)檢查良性病變脫落細(xì)胞：間皮細(xì)胞 (Mesothelial Cells)Mesothelial cells in an effusion always show reac

16、tive changes of various degrees. Note nuclear enlargement and a prominent nucleolus but fine chromatin and a smooth nuclear membrane. 間皮細(xì)胞 (Mesothelial Cells)Mesoth間皮細(xì)胞 (Mesothelial Cells)Gland-like cluster of benign mesothelial cells mimicking adenocarcinoma. Note that the component cells are ident

17、ical to the other reactive mesothelial cells, and do not constitute a foreign population. 間皮細(xì)胞 (Mesothelial Cells)Gland-組織細(xì)胞 (Histiocyte)Hemosiderin-laden histiocyte.Hemosiderin is a refractile golden brown pigment. The presence of hemosiderin indicates old bleeding. 組織細(xì)胞 (Histiocyte)Hemosiderin-l良性

18、病變脫落細(xì)胞結(jié)核性病變 (Tuberculous effusion)Abundance of lymphocytes and virtual absence of mesothelial cells are characteristic of tuberculous pleural effusions. 良性病變脫落細(xì)胞結(jié)核性病變 (Tuberculous ef漿膜腔積液退化變性的間皮細(xì)胞漿膜腔積液退化變性的間皮細(xì)胞漿膜腔積液脫落細(xì)胞學(xué)檢查惡性病變脫落細(xì)胞：漿膜腔積液中腫瘤細(xì)胞的來源：積液中以上的癌細(xì)胞是轉(zhuǎn)移性的，原發(fā)性的惡性間皮瘤較少見。腫瘤性的胸水和心包水常見于肺癌、乳腺癌等，腫瘤性的腹水

19、常見于卵巢癌、胃癌、腸癌、肝癌、胰腺癌等。原發(fā)性的惡性間皮瘤，惡性淋巴瘤較少見。漿膜腔積液脫落細(xì)胞學(xué)檢查惡性病變脫落細(xì)胞：漿膜腔積液脫落細(xì)胞學(xué)檢查腺癌：占積液中轉(zhuǎn)移癌的80%以上，腺癌細(xì)胞形態(tài)多樣，排列構(gòu)成腺腔樣、乳頭狀，洋蔥皮和桑葚形狀等等，腺癌細(xì)胞形態(tài)多樣，細(xì)胞大小相差數(shù)倍，癌細(xì)胞呈圓或橢圓形，核偏位，核邊不規(guī)則，核仁明顯增大或多個核仁，胞漿中常含空泡，常見異常分裂象。漿膜腔積液脫落細(xì)胞學(xué)檢查腺癌：占積液中轉(zhuǎn)移癌的80%以上，腺腺癌 AdenocarcinomaAdenocarcinoma is the most common cause of a malignant effusion.

20、Among the most useful features in the diagnosis of adenocarcinoma are increased N/C ratio, irregular nuclear membranes, large nucleoli, secretory vacuoles, and three-dimensional aggregates 腺癌 AdenocarcinomaAdenocarcinom腺癌 Adenocarcinoma腺癌 Adenocarcinoma腺癌 AdenocarcinomaThe general patterns of adenoc

21、arcinomas in fluids include cell balls (morulas), papillary or acinar groups, signet ring cells腺癌 AdenocarcinomaThe general p腺癌 AdenocarcinomaPapillary groups are elongated, three-dimensional aggregates. Psammoma bodies may be present. Adenocarcinomas of the lung (illustrated here), breast, and fema

22、le genital tract are common sources 腺癌 AdenocarcinomaPapillary gro腺癌 AdenocarcinomaSignet ring cells are cells with large cytoplasmic vacuoles that compress the nucleus to the periphery of the cell Large signet ring cells are characteristic of carcinoma of the stomach.(Oil) 腺癌 AdenocarcinomaSignet r

23、ing c腺癌 AdenocarcinomaIndian files, Chains of tumor cells, particularly when long, suggest breast cancer. However, other possibilities, such as pancreas or lung cancers as well as mesothelioma, must also be considered. 腺癌 AdenocarcinomaIndian files,漿膜腔積液脫落細(xì)胞學(xué)檢查鱗狀細(xì)胞癌：在積液中少見，僅占2%-3%。高分化鱗癌，細(xì)胞奇形怪狀，胞漿有角化

24、傾向。癌細(xì)胞單個散在，細(xì)胞為圓形，胞核居中，核質(zhì)深染，胞漿厚實并界限清晰，癌細(xì)胞易成堆或成團，背景中伴有或不伴有壞死物。漿膜腔積液脫落細(xì)胞學(xué)檢查鱗狀細(xì)胞癌：在積液中少見，僅占2%-鱗狀細(xì)胞癌 Squamous Cell Carcinoma Irregularly shaped cells Irregularly shaped cells are abnormal and suggest malignancy, such as keratinizing squamous cell carcinoma 鱗狀細(xì)胞癌 Squamous Cell Carcinoma 漿膜腔積液脫落細(xì)胞學(xué)檢查小細(xì)胞型未分

25、化癌：在積液中也很少見，為3%-5%，癌細(xì)胞呈葡萄堆狀排列，細(xì)胞重疊，胞漿極少或裸核樣，核形不規(guī)則，典型者為瓜子狀或燕麥狀，亦有圓或橢圓形，核染色質(zhì)粗顆?；虺蕢K狀。漿膜腔積液脫落細(xì)胞學(xué)檢查小細(xì)胞型未分化癌：在積液中也很少見，小細(xì)胞型未分化癌 Small Cell CarcinomaSmall cell (neuroendocrine) carcinoma, is characterized by small to medium-sized cells with scant cytoplasm, inconspicuous nucleoli, and prominent molding and

26、indian file arrangements . 小細(xì)胞型未分化癌 Small Cell Carcinoma漿膜腔積液脫落細(xì)胞學(xué)檢查間皮瘤（mesothelioma)原發(fā)于漿膜，良性間皮瘤生長局限，包膜完整，很少引起積液；惡性間皮瘤可見到大量增生活躍的間皮細(xì)胞，間皮細(xì)胞的惡性特征與轉(zhuǎn)移性腺癌類似，細(xì)胞呈團或相嵌，單憑光鏡不能明確診斷，應(yīng)輔以電鏡和免疫細(xì)胞化學(xué)技術(shù)，臨床表現(xiàn)及影象學(xué)的診斷進(jìn)行鑒別。漿膜腔積液脫落細(xì)胞學(xué)檢查間皮瘤（mesothelioma)間皮瘤（mesothelioma)Mesothelioma. A clue to the diagnosis is more and big

27、ger cells, in more and bigger clusters. The groups often have very irregular outlines. 間皮瘤（mesothelioma)Mesothelioma.惡性淋巴瘤 (Non-Hodgkins Lymphoma)Non-Hodgkins lymphoma, large cell type. The most characteristic feature of lymphoma is that all of the cells are single, without formation of true tissue

28、aggregates. 惡性淋巴瘤 (Non-Hodgkins Lymphoma)泌尿系統(tǒng)脫落細(xì)胞檢查尿液正常脫落細(xì)胞泌尿系統(tǒng)良性病變脫落細(xì)胞泌尿系統(tǒng)惡性腫瘤脫落細(xì)胞泌尿系統(tǒng)脫落細(xì)胞檢查尿液正常脫落細(xì)胞尿液正常脫落細(xì)胞移行上皮細(xì)胞鱗狀上皮細(xì)胞柱狀上皮細(xì)胞非上皮細(xì)胞成分尿液正常脫落細(xì)胞移行上皮細(xì)胞尿液正常脫落細(xì)胞移行上皮細(xì)胞尿沉渣涂片中的上皮細(xì)胞主要來源于腎盞、腎盂、輸尿管、膀胱和尿道的移行上皮，正常情況下脫屑細(xì)胞不多，無腫瘤細(xì)胞。 尿液正常脫落細(xì)胞移行上皮細(xì)胞尿液正常脫落細(xì)胞移行上皮細(xì)胞涂片內(nèi)表層細(xì)胞體積大，大小相當(dāng)于鱗狀上皮表層細(xì)胞，又稱蓋細(xì)胞呈扁圓行或多邊形；雙核或多核；核圓形或卵圓形，染

29、色質(zhì)細(xì)顆粒狀，分布均勻，核仁不明顯，底層細(xì)胞是圓形或多邊形，中層細(xì)胞梭形或多邊形因尿液滲透壓變化，脫落的移行上皮細(xì)胞常會有不同程度的變性尿液正常脫落細(xì)胞移行上皮細(xì)胞泌尿系統(tǒng)脫落細(xì)胞檢查Bladder (tissue) The mucosa is usually no more than six or seven cells thick. Note eosinophilic umbrella cells covering the surface. 泌尿系統(tǒng)脫落細(xì)胞檢查Bladder (tissue) 泌尿系統(tǒng)脫落細(xì)胞檢查Transitional cellsPleomorphic, but ben

30、ign, transitional cells are normal findings in bladder washing specimens Single, mononuclear, parabasal-sized transitional cells usually predominate in voided urine specimens. Basaloid transitional cells are seen near bottom of field. 泌尿系統(tǒng)脫落細(xì)胞檢查Transitional cells泌尿系統(tǒng)脫落細(xì)胞檢查Transitional cellsSuperfici

31、al transitional cells are large and may have multiple nuclei. Note scalloping of the cytoplasm: the underlying cells fit into the concavities. 泌尿系統(tǒng)脫落細(xì)胞檢查Transitional cells尿液正常脫落細(xì)胞鱗狀上皮細(xì)胞：正常尿液中少見，婦女尿液中有時可見，形態(tài)同陰道涂片柱狀上皮細(xì)胞：正常尿液中極少見，形態(tài)同陰道涂片非上皮細(xì)胞成分：可見少量中性粒細(xì)胞，淋巴細(xì)胞，漿細(xì)胞，組織細(xì)胞和紅細(xì)胞尿液正常脫落細(xì)胞鱗狀上皮細(xì)胞：正常尿液中少見，婦女尿液中有時泌

32、尿系統(tǒng)良性病變脫落細(xì)胞炎癥性疾病病毒感染結(jié)石 放化療影響移植后改變泌尿系統(tǒng)良性病變脫落細(xì)胞炎癥性疾病泌尿系統(tǒng)良性病變脫落細(xì)胞炎癥性疾病：炎癥時，涂片內(nèi)細(xì)胞數(shù)目明顯增多，包括上皮細(xì)胞及炎癥細(xì)胞，細(xì)胞常變形，體積增大，胞質(zhì)內(nèi)可有液化空泡或核固縮細(xì)胞泌尿系統(tǒng)良性病變脫落細(xì)胞炎癥性疾?。好谀蛳到y(tǒng)良性病變脫落細(xì)胞病毒感染巨細(xì)胞包涵體病人多瘤病毒人乳頭狀瘤病毒泌尿系統(tǒng)良性病變脫落細(xì)胞病毒感染泌尿系統(tǒng)良性病變脫落細(xì)胞尿結(jié)石癥 涂片內(nèi)見上皮細(xì)胞呈輕度核異質(zhì)改變，可見大量的表層細(xì)胞，含多個核泌尿系統(tǒng)良性病變脫落細(xì)胞尿結(jié)石癥Stone AtypiaUrolithiasis can cause significan

33、t cytologic atypia sometimes comparable to high-grade malignancy, including nuclear enlargement and pleomorphism, high N/C ratios, coarse, hyperchromatic chromatin, and prominent nucleoli. Be cautious when diagnosing malignancy in patients with stones, particularly if the chromatin appears degenerat

34、ed or smudgy. Stone AtypiaUrolithiasis can cStone AtypiaNote high N/C ratios, irregular nuclear membranes, dark chromatin, and prominent nucleoli, all features that could easily be mistaken for malignancy.Note cytoplasmic vacuolization, a feature seen in reactive cells and high-grade malignancy but

35、usually not present in low-grade tumors. Stone AtypiaNote high N/C rati泌尿系統(tǒng)良性病變脫落細(xì)胞放射及化學(xué)治療對膀胱上皮細(xì)胞的影響盆腔區(qū)放射治療對膀胱影響主要為膀胱壁水腫，上皮細(xì)胞胞質(zhì)和胞核都出現(xiàn)空泡，核固縮或核碎裂，細(xì)胞有時有異形性，易誤認(rèn)為癌細(xì)胞泌尿系統(tǒng)良性病變脫落細(xì)胞放射及化學(xué)治療對膀胱上皮細(xì)胞的影響泌尿系統(tǒng)良性病變脫落細(xì)胞放射及化學(xué)治療對膀胱上皮細(xì)胞的影響化學(xué)治療影響：尿沉渣中上皮細(xì)胞增大，空泡變性，核增大，染色質(zhì)增粗呈粗顆粒狀，核固縮，碎裂，可有明顯核仁膀胱上皮可明顯增多，細(xì)胞退行性改變，與放射治療反應(yīng)類似泌尿系統(tǒng)

36、良性病變脫落細(xì)胞放射及化學(xué)治療對膀胱上皮細(xì)胞的影響泌尿系統(tǒng)良性病變脫落細(xì)胞Radiation. As in other body sites, the classic cytologic change is macrocytosis. However, radiation can also cause reactive or degenerative changes in the cells. Radiation can cause radiation cystitis and cellular atypia, which may be mistaken for malignancy.泌尿系統(tǒng)

37、良性病變脫落細(xì)胞Radiation. As in o泌尿系統(tǒng)良性病變脫落細(xì)胞Chemotherapy. Agents such as cyclophosphamide and busulfan can cause cellular atypia mimicking malignancy. Although both the cell and nucleus enlarge, the nucleus enlarges more, and an increase in the N/C ratio may occur. Cells with bizarre shapes may be seen. 泌

38、尿系統(tǒng)良性病變脫落細(xì)胞Chemotherapy. Agen泌尿系統(tǒng)良性病變脫落細(xì)胞BCG therapyHistiocytic aggregates and giant cell histiocytes (arrow) associated with the granulomatous inflammation induced by this therapy are characteristic. 泌尿系統(tǒng)良性病變脫落細(xì)胞BCG therapy泌尿系統(tǒng)良性病變脫落細(xì)胞移植后尿液細(xì)胞學(xué)改變腎移植的排斥反應(yīng)有項細(xì)胞學(xué)改變：腎小管細(xì)胞，淋巴細(xì)胞，管型，背景壞死物，核退變，紅細(xì)胞，混合細(xì)胞團泌尿系統(tǒng)良性病變脫落細(xì)胞移植后尿液細(xì)胞學(xué)改變泌尿系統(tǒng)良性病變脫落細(xì)胞Renal transplant rejection.Increased in number of renal tubular cells with degenerative changes Increased lymphocytesMixe