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Questions and Answers
Which of the following statements is TRUE about goblet cells in Barrett's esophagus?
Which of the following statements is TRUE about goblet cells in Barrett's esophagus?
What is the primary role of cytology in the diagnosis of Barrett's esophagus dysplasia?
What is the primary role of cytology in the diagnosis of Barrett's esophagus dysplasia?
Which of the following staining techniques is crucial for differentiating goblet cells from pseudogoblet cells in Barrett's esophagus?
Which of the following staining techniques is crucial for differentiating goblet cells from pseudogoblet cells in Barrett's esophagus?
Which of the following features is NOT characteristic of goblet cells in Barrett's esophagus?
Which of the following features is NOT characteristic of goblet cells in Barrett's esophagus?
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Which of the following best describes the role of cytology in managing Barrett's esophagus?
Which of the following best describes the role of cytology in managing Barrett's esophagus?
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Which is NOT a characteristic of Microsporidium in cytology specimens?
Which is NOT a characteristic of Microsporidium in cytology specimens?
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Which of the following is NOT a characteristic of duodenal adenoma?
Which of the following is NOT a characteristic of duodenal adenoma?
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What is a distinguishing feature of duodenal adenocarcinoma compared to duodenal adenoma?
What is a distinguishing feature of duodenal adenocarcinoma compared to duodenal adenoma?
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What type of epithelium lines the anal canal?
What type of epithelium lines the anal canal?
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When was screening for anal cancer and its precursor implemented in the US?
When was screening for anal cancer and its precursor implemented in the US?
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What type of microscopic findings are used to diagnose anal squamous intraepithelial lesions and anal squamous cell carcinoma?
What type of microscopic findings are used to diagnose anal squamous intraepithelial lesions and anal squamous cell carcinoma?
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Which of the following is NOT a typical characteristic of Microsporidium?
Which of the following is NOT a typical characteristic of Microsporidium?
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Duodenal adenomas resemble which other type of adenoma?
Duodenal adenomas resemble which other type of adenoma?
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Which of the following cytological findings is NOT characteristic of herpes simplex virus infection in the esophagus?
Which of the following cytological findings is NOT characteristic of herpes simplex virus infection in the esophagus?
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In epithelial repair of the esophagus, which of the following cytological features suggests a potential for malignancy?
In epithelial repair of the esophagus, which of the following cytological features suggests a potential for malignancy?
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What is a distinguishing cytological feature of radiation-induced changes in the esophagus, compared to epithelial repair?
What is a distinguishing cytological feature of radiation-induced changes in the esophagus, compared to epithelial repair?
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Which of the following cytological features is MOST strongly associated with an increased risk of adenocarcinoma in Barrett's esophagus?
Which of the following cytological features is MOST strongly associated with an increased risk of adenocarcinoma in Barrett's esophagus?
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What is the primary risk factor for the development of Barrett's esophagus?
What is the primary risk factor for the development of Barrett's esophagus?
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What is the main difference between epithelial repair in the esophagus and radiation-induced changes?
What is the main difference between epithelial repair in the esophagus and radiation-induced changes?
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What is the significance of "Cowdry A bodies" in the cytological findings of herpes simplex virus in the esophagus?
What is the significance of "Cowdry A bodies" in the cytological findings of herpes simplex virus in the esophagus?
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Which of these cytological findings is NOT typically observed in epithelial repair of the esophagus?
Which of these cytological findings is NOT typically observed in epithelial repair of the esophagus?
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Based on the provided information, which of the following characteristics is MOST LIKELY associated with high-grade dysplasia in Barrett's esophagus (BE)?
Based on the provided information, which of the following characteristics is MOST LIKELY associated with high-grade dysplasia in Barrett's esophagus (BE)?
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Which of the following statements accurately reflects the distinction between low-grade and high-grade dysplasia in BE?
Which of the following statements accurately reflects the distinction between low-grade and high-grade dysplasia in BE?
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Which of the following statements about the cytological features of adenocarcinoma of the esophagus is FALSE?
Which of the following statements about the cytological features of adenocarcinoma of the esophagus is FALSE?
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The presence of '↑ NCR, nuclear membrane irregularities, and slight hyperchromasia' in a cytology sample from the esophagus MOST LIKELY indicates:
The presence of '↑ NCR, nuclear membrane irregularities, and slight hyperchromasia' in a cytology sample from the esophagus MOST LIKELY indicates:
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Based on the provided information, which of the following scenarios would MOST LIKELY warrant further investigation for possible adenocarcinoma of the esophagus?
Based on the provided information, which of the following scenarios would MOST LIKELY warrant further investigation for possible adenocarcinoma of the esophagus?
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Which of the following is a characteristic of the cytological appearance of gastric dysplasia?
Which of the following is a characteristic of the cytological appearance of gastric dysplasia?
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Which of the following conditions is typically associated with the presence of signet ring cells?
Which of the following conditions is typically associated with the presence of signet ring cells?
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Which of the following cytology techniques is most useful for the detection of Giardia lamblia?
Which of the following cytology techniques is most useful for the detection of Giardia lamblia?
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What is the key difference between gastric dysplasia and gastric adenoma?
What is the key difference between gastric dysplasia and gastric adenoma?
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The presence of "holes" in the cytological appearance of the small intestine is indicative of which type of cell or structure?
The presence of "holes" in the cytological appearance of the small intestine is indicative of which type of cell or structure?
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Which of the following is NOT a feature of the cytological appearance of gastric adenocarcinoma, signet ring cell type?
Which of the following is NOT a feature of the cytological appearance of gastric adenocarcinoma, signet ring cell type?
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How does the cytological appearance of high-grade dysplasia differ from that of low-grade dysplasia?
How does the cytological appearance of high-grade dysplasia differ from that of low-grade dysplasia?
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Which of the following cytologic features is NOT associated with dysplasia or adenocarcinoma, but may be present in reactive cells?
Which of the following cytologic features is NOT associated with dysplasia or adenocarcinoma, but may be present in reactive cells?
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Identify the cytologic feature that is typically absent in reactive cells but can be present in dysplasia or adenocarcinoma, suggesting a more abnormal process.
Identify the cytologic feature that is typically absent in reactive cells but can be present in dysplasia or adenocarcinoma, suggesting a more abnormal process.
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According to the provided text, which of the following Bethesda terminologies represent a high-grade squamous intraepithelial lesion (HSIL)?
According to the provided text, which of the following Bethesda terminologies represent a high-grade squamous intraepithelial lesion (HSIL)?
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Which of the following cytologic features is more likely to be pronounced in adenocarcinoma compared to dysplasia?
Which of the following cytologic features is more likely to be pronounced in adenocarcinoma compared to dysplasia?
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Which of these Bethesda terminologies is associated with atypical squamous cells of undetermined significance?
Which of these Bethesda terminologies is associated with atypical squamous cells of undetermined significance?
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The provided text does NOT explicitly mention which of the following cytologic features as being associated with High-grade Squamous Intraepithelial Lesions (HSIL)?
The provided text does NOT explicitly mention which of the following cytologic features as being associated with High-grade Squamous Intraepithelial Lesions (HSIL)?
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According to the provided text, what is the minimum number of nucleated squamous cells needed for a pap smear to be considered adequate?
According to the provided text, what is the minimum number of nucleated squamous cells needed for a pap smear to be considered adequate?
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When comparing the features of reactive cells, dysplasia, and adenocarcinoma, which of the following is typically more prominent in dysplasia and adenocarcinoma?
When comparing the features of reactive cells, dysplasia, and adenocarcinoma, which of the following is typically more prominent in dysplasia and adenocarcinoma?
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What is the primary difference between ASC-US and ASC-H within the Bethesda terminology?
What is the primary difference between ASC-US and ASC-H within the Bethesda terminology?
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Which of the following terms represents an abnormal cell growth in the anal canal similar to that of cervical dysplasia?
Which of the following terms represents an abnormal cell growth in the anal canal similar to that of cervical dysplasia?
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Flashcards
Low-grade esophageal dysplasia
Low-grade esophageal dysplasia
Characterized by crowded groups with mild nuclear atypia and pleomorphism.
High-grade esophageal dysplasia
High-grade esophageal dysplasia
Consists of crowded groups or isolated cells with higher nuclear atypia and pleomorphism.
Nuclear atypia
Nuclear atypia
Variability in the size and shape of cell nuclei indicating abnormal cells.
Adenocarcinoma of the esophagus
Adenocarcinoma of the esophagus
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Barrett's Esophagus (BE)
Barrett's Esophagus (BE)
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Barrett’s Esophagus (BE)
Barrett’s Esophagus (BE)
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Goblet Cells
Goblet Cells
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Swiss Cheese Appearance
Swiss Cheese Appearance
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Mucin Staining
Mucin Staining
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Dysplasia in Barrett’s Esophagus
Dysplasia in Barrett’s Esophagus
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Microsporidium
Microsporidium
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Duodenal adenoma
Duodenal adenoma
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Duodenal adenocarcinoma
Duodenal adenocarcinoma
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Nuclear-to-cytoplasmic ratio (NCR)
Nuclear-to-cytoplasmic ratio (NCR)
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Anal squamous cell carcinoma
Anal squamous cell carcinoma
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Anal pap test
Anal pap test
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Cytomorphology
Cytomorphology
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Herpes simplex virus infection
Herpes simplex virus infection
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Cytological features of epithelial repair
Cytological features of epithelial repair
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Characteristics of enlarged nuclei
Characteristics of enlarged nuclei
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Radiation-induced changes
Radiation-induced changes
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Barrett’s esophagus
Barrett’s esophagus
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Gastroesophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD)
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Cowdry A bodies
Cowdry A bodies
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Atypical stromal cells
Atypical stromal cells
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Bethesda terminology
Bethesda terminology
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HSIL
HSIL
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Nuclear enlargement
Nuclear enlargement
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Nuclear membrane irregularity
Nuclear membrane irregularity
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Chromatin coarsening
Chromatin coarsening
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Reactive vs Dysplasia
Reactive vs Dysplasia
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Atypical mitoses
Atypical mitoses
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Chromatin in Reactive cells
Chromatin in Reactive cells
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Nuclear pleomorphism
Nuclear pleomorphism
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Necrosis in cancer
Necrosis in cancer
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Helicobacter pylori
Helicobacter pylori
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Atypical Mycobacteria
Atypical Mycobacteria
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Gastric Dysplasia
Gastric Dysplasia
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Gastric Adenoma
Gastric Adenoma
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Cytomorphology of Dysplasia
Cytomorphology of Dysplasia
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Signet Ring Cell Type
Signet Ring Cell Type
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Cytological Examination
Cytological Examination
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Giardia Lamblia
Giardia Lamblia
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Normal Small Intestine Morphology
Normal Small Intestine Morphology
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Study Notes
Gastrointestinal Tract Cytology 2
- Programme Learning Outcomes (PLOs): The BBMS program aims to develop skills in analyzing, validating medical lab findings, performing and supervising procedures, collaborating with professionals, demonstrating ethical conduct, presenting information coherently, solving problems, demonstrating lifelong learning principles, and managing laboratory activities.
- Course Learning Outcomes (CLOs): CLO1 – discuss cytopathology techniques; CLO2 – integrate cytopathology foundational knowledge for sample collection, staining, and screening; and CLO3 – prepare reports for cytopathology according to a format.
- Lesson Learning Outcomes: Upon completing the lesson, students will be able to discuss sample collection, preparation, and staining techniques of gastrointestinal tract samples. They will also distinguish cytology features for normal, non-malignant, and malignant gastrointestinal tract conditions
- Lesson Outline: The lesson covers an overview of gastrointestinal tract cytology (GIT), GIT sample collection and smear preparation, cytological examination of the esophagus, stomach, and intestinal portions.
- Overview of GIT Cytology: Clinical indications include suspected malignancy, dysplasia screening (e.g., Barrett's esophagus), and suspected infections. GIT cytology is complementary to tissue biopsy.
- Sample Collection: Sites for cytological sampling include the upper GIT (esophagus, stomach, small intestine), and lower GIT (rectum, anus). Methods like endoscopic direct brushing, endoscopic fine-needle aspiration, and balloon sampling are used.
- Sample Preparation: Smear material is rolled or spread onto a slide, fixed in 95% alcohol followed by air-drying if needed.; LBC samples must follow manufacturer's instructions.
- Staining Methods: Methods discussed include Papanicolaou, Romanowsky staining, May-Grunwald-Giemsa (MGG), and immunocytochemistry. MGG (nucleus: purple; cytoplasm: greyish purple/blue) is a notable stain.
- Cytological Examination of GIT Samples: Slides are examined under low magnification to assess cellularity, arrangements (flat sheets, 3D clusters, isolated cells), and smear background (clean, inflammatory, necrotic).
- Cellular Arrangement: Cells in reactive processes exhibit flat cohesive sheets while neoplastic cells (benign/malignant) tend to aggregate in 3D clusters.
- Smear Background: A clean background suggests a benign process. Numerous necrotic ghost cells without much inflammation indicates malignancy potential.
- High Magnification Examination: Cytologic evaluation focuses on cytoplasmic characteristics and nuclear features.
- Benign vs. Malignant: Benign processes exhibit uniformity in cellular arrangement, nuclear size/shape, and nucleoli number. Malignant neoplasms show haphazard arrangement, irregular cell/nuclear features, and lack of distinct nucleoli.
- Cytological Examination of Esophagus: Conditions examined include infections, epithelial repair, Barrett's esophagus (BE) & dysplasia, squamous cell carcinoma (SCC), adenocarcinoma (adenoCA), and their cytologic presentations (e.g., goblet cell morphology for BE, nuclear characteristics for dysplasia and adenoCA, keratinization for SCC).
- Normal Esophageal Morphology: Superficial and intermediate squamous cells are present, distinguished by abundant cytoplasm and small/pyknotic vs. abundant cytoplasm & vesicular nuclei.
- Esophageal Infections: Infections like Candida are common, while Herpes simplex can feature multinucleation, nuclear molding, ground-glass nuclei, and intranuclear inclusions.
- Epithelial Repair in Esophagus: Characterized by cohesive sheets and uniform/enlarged nuclei with prominent nucleoli, evident mitoses, background inflammation, and atypical stromal cells (as part of the repair process). Radiation-induced changes include cellular/nuclear enlargement, multinucleation, and cytoplasmic/nuclear vacuolization.
- Barrett's Esophagus (BE): Normal stratified squamous epithelium is substituted by columnar epithelium; increased risk of intestinal-type adenocarcinoma (presence of goblet cells)
- BE - Findings: Goblet cells (single large vacuoles displacing nuclei, Swiss-cheese/honeycomb appearance; mucin stains, pseudogoblet cells). Barrett's epithelium displays displaced/crescent-shaped nuclei against the basal membrane.
- Dysplasia of BE: Grading of dysplasia (low-grade: crowded stratified cells, mild nuclear atypia) and (high-grade: crowded/isolated cells, significant nuclear atypia, and pleomorphism) is significant.
- Adenocarcinoma of Esophagus: Esophageal adenocarcinoma is often located in the mid/distal esophagus (arising from BE). Characteristic cytologic features include more abnormal cells, marked nuclear atypia, and macroscopic findings (fungating, ulcerating lesions). Tumor diathesis and atypical nuclear features (enlargement, hyperchromasia, uneven nuclear membrane) are evident.
- Squamous Cell Carcinoma (SCC) of Esophagus: The most common esophageal malignancy. Features (differentiating well vs. poorly differentiated): well-differentiated SCC exhibits hyperchromatic/pyknotic nuclei; poorly differentiated displays less keratization/nuclear angularity/coarseness in chromatin and increased pleomorphism.
- Cytological Examination of Stomach: Focuses on infections, dysplasia, and adenocarcinoma.
- Normal Stomach Morphology: Gastric surface mucous cells, honeycomb pattern, and columnar cells in a palisading arrangement.
- Stomach Infections: Helicobacter pylori (faintly basophilic, S-shaped rods). A typical mycobacteria are present in macrophages.
- Gastric Dysplasia & Adenoma: Both are precursor lesions and distinguished by flat/polypoid appearance, cytologic features depend on dysplasia degree; cytological features of high grade dysplasia include dyshesion and irregular cellular arrangement.
- Gastric Adenocarcinoma: Two main types—intestinal (highly cellular) and diffuse (signet ring cells). Cytomorphology of gastric adenocarcinoma displays small groups/isolated cells, vacuolated cytoplasm, single large vacuole presence, and crescent-shaped/angulated, hyperchromatic nuclei.
- Cytological Examination of Small Intestine: Focuses on infections and adenoma/adenocarcinoma; normal morphology includes absorptive cells (fine granular/vacuolated cytoplasm) and goblet cells (single large mucin vacuoles & crescent-shaped nuclei).
- Small Intestine Infections: Giardia lamblia (flat, gray, pear-shaped, binucleate with 4 pairs of flagella) and Microsporidium (aggregates of brightly eosinophilic rod-shaped/ovoid organisms) are examples of infections detected and identified cytologically.
- Duodenal Adenoma & Adenocarcinoma: Duodenal adenoma displays cohesive 3D clusters of crowded cells, increased NCR/absence of goblet cells, and characteristic palling and molding of elongated nuclei; Duodenal adenocarcinoma displays higher cellularity, increased dyshesion, and marked nuclear atypia/pleomorphism.
- Anal Lesions: Anal squamous cell carcinoma is uncommon. Screening, using anal pap test, is used for detection of cancer/precursors. The Bethesda terminology is crucial in reporting anal findings.
- HSIL (Anal Pap Smear): HSIL cells show nuclear enlargement, membrane irregularity, and chromatin coarsening – analogous to cervical specimens.
Comparison of Cytologic Features
- Tables comparing reactive changes, dysplasia, and adenocarcinoma in terms of various features including 3D cluster arrangement, dyshesion, atypical cell presence, mitoses, chromatin appearance, nuclear pleomorphism, and overlap/irregularity in spacing.
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Description
This quiz focuses on the techniques involved in gastrointestinal tract cytology. Students will learn about sample collection, preparation, and staining, while distinguishing between normal, non-malignant, and malignant conditions. Mastering these skills is essential for effective cytopathology analysis.
