Cytopathology
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Questions and Answers

What is the main focus of cytopathology?

  • Treatment planning based on histological samples
  • Monitoring disease progression using imaging techniques
  • Diagnosis of disease from the microscopic appearance of single or groups of cells (correct)
  • Diagnosis of disease using solid tissue samples

    • Which of the following sampling methods is used in cytopathology?

  • Urinalysis for microscopic examination
  • Biopsy of solid tissues
  • Blood sample analysis
  • Aspirating cells from any part of the body (correct)

    • What is a criterion for an effective screening programme?

  • Identifying the disease early, ideally in the pre-cancerous stage (correct)
  • Identifying diseases only after symptoms appear
  • Providing unlimited invasive procedures
  • Restricting participation to high-risk individuals only

    • Which factor is important for the participation in a screening programme?

    <p>Avoiding excessive invasiveness during the procedure</p> Signup and view all the answers

    What type of cells lines the endocervix?

    <p>Columnar epithelium</p> Signup and view all the answers

    Which of the following is NOT one of the screening programmes run by the NHS?

    <p>Lung cancer screening</p> Signup and view all the answers

    What is the transformation zone in the cervix primarily associated with?

    <p>Region where two types of cell epithelia meet</p> Signup and view all the answers

    What is an essential requirement for effective treatment identified in a screening programme?

    <p>Treatment options must be available for all identified cases</p> Signup and view all the answers

    What techniques are used to obtain cell samples during surgical procedures for cytopathological examination?

    <p>Brushing, washing, or aspirating cells</p> Signup and view all the answers

    Which sites can provide cytological samples for examination?

    <p>Bladder and pancreas</p> Signup and view all the answers

    Which fluid is NOT commonly used for cytological examination?

    <p>Saliva</p> Signup and view all the answers

    What is a key characteristic of the Papanicolaou stain used in cytopathology?

    <p>It provides excellent nuclear detail</p> Signup and view all the answers

    What is the primary function of cerebrospinal fluid (CSF)?

    <p>To act as a protective cushion for the brain</p> Signup and view all the answers

    What percentage of patients with blood in the urine are likely to have bladder cancer?

    <p>10 to 25%</p> Signup and view all the answers

    Which staining method is suitable for 'air-dried' specimens in cytopathology?

    <p>Romanowsky stain</p> Signup and view all the answers

    In which occupational setting is the risk of bladder cancer notably increased?

    <p>Dye industry</p> Signup and view all the answers

    Which method is used to concentrate fluids with few cells for cytological analysis?

    <p>Cytospin technique</p> Signup and view all the answers

    What is the average latency period from exposure to diagnosis for bladder cancer due to occupational exposure?

    <p>23.3 years</p> Signup and view all the answers

    What does urine cytology commonly check for?

    <p>Infection and inflammation</p> Signup and view all the answers

    Which components are included in the Romanowsky stain used for cytopathology?

    <p>May-Grunwald and Giemsa</p> Signup and view all the answers

    How does smoking influence the risk of bladder cancer?

    <p>It exposes cells to harmful chemicals</p> Signup and view all the answers

    What is the role of the transformation zone in cervical health?

    <p>It is where the endocervix and ectocervix meet and is susceptible to precancerous changes.</p> Signup and view all the answers

    What is the primary target of the E7 protein in HPV?

    <p>Retinoblastoma protein</p> Signup and view all the answers

    How can the transformation zone be identified during examination?

    <p>By following the squamous epithelium until it changes to columnar epithelium.</p> Signup and view all the answers

    What does the Hologic Aptima Assay specifically detect in HPV testing?

    <p>E6/E7 mRNA</p> Signup and view all the answers

    In cytology, what is the primary method for cervical screening?

    <p>Collection of loose cells through a cervical smear test.</p> Signup and view all the answers

    How does mRNA detection compare to DNA tests in HPV detection?

    <p>mRNA tests identify active infections, while DNA tests do not</p> Signup and view all the answers

    What is the purpose of PCR testing in cytology-based cervical screening?

    <p>To identify individuals at higher risk of cervical abnormalities by testing for HPV.</p> Signup and view all the answers

    When are routine cervical screenings offered in the NHS cervical screening programme?

    <p>First at age 25, then every three years until age 49.</p> Signup and view all the answers

    Why is E6/E7 mRNA expression significant in HPV detection?

    <p>It indicates potential for disease progression</p> Signup and view all the answers

    Which HPV test is specifically designed to detect E6/E7 mRNA?

    <p>Aptima HPV Assay</p> Signup and view all the answers

    What is the impact of the Pap test on cervical cancer rates?

    <p>The rate of cervical cancer has fallen by more than 70 percent.</p> Signup and view all the answers

    What sample type can be analyzed using the Aptima HPV Assay?

    <p>Cervical samples in ThinPrep tubes</p> Signup and view all the answers

    What is the primary type of virus that HPV represents?

    <p>Double-stranded DNA virus.</p> Signup and view all the answers

    In which part of the cervical histology do nuclei typically remain visible in a healthy biopsy?

    <p>Parabasal layer</p> Signup and view all the answers

    At what age are individuals in England guaranteed access to the first dose of the HPV vaccine?

    <p>Aged 12 to 13 years.</p> Signup and view all the answers

    What does Gardasil 9 vaccine protect against?

    <p>Nine different types of HPV linked to cancer.</p> Signup and view all the answers

    What colors indicate mature squamous cells during cytological staining?

    <p>Orange</p> Signup and view all the answers

    What is the consequence of not receiving both doses of the HPV vaccine?

    <p>Lower immunity and incomplete protection against HPV.</p> Signup and view all the answers

    What is a characteristic observed in pre-cancerous forms of cells?

    <p>Enlarged and irregular nuclei</p> Signup and view all the answers

    Which analyzer is primarily used for the Aptima HPV Assay in South Central and South East regions?

    <p>Hologic Panther</p> Signup and view all the answers

    What is the significance of oncogene proteins E6 and E7 in HPV-related carcinogenesis?

    <p>They target tumor suppressor gene products to promote cancer.</p> Signup and view all the answers

    What notable historical event is Dr. George Papanicolau recognized for?

    <p>Postulating that cervical cell examination could detect early cancerous changes.</p> Signup and view all the answers

    What volume of tests can the Aptima HPV Assay system perform in approximately five hours?

    <p>250 tests</p> Signup and view all the answers

    What additional measure was introduced alongside the HPV primary screening in 2020?

    <p>Liquid Based Cytology with HPV triage.</p> Signup and view all the answers

    Which of the following stains immature squamous cells in cytological preparations?

    <p>Light green SF yellowish</p> Signup and view all the answers

    What was the impact on cervical cancer death ranking after the introduction of the Pap test?

    <p>It fell from the leading cause to the fifteenth most frequent cause.</p> Signup and view all the answers

    What method is primarily used to confirm cellular activity in HPV infections?

    <p>mRNA detection</p> Signup and view all the answers

    How does cytology differ from histology regarding squamous cells?

    <p>Cytology looks at single cells while histology looks at layers</p> Signup and view all the answers

    What nucleo-cytoplasmic ratio (NCR) indicates mild dyskaryosis?

    <p>NCR &lt; 0.5</p> Signup and view all the answers

    What is a key feature of nuclear hyperchromasia observed in pre-cancerous alterations?

    <p>Increased chromatin density</p> Signup and view all the answers

    During pre-cancerous alterations, which of the following changes is NOT typically observed?

    <p>Flattened nuclei</p> Signup and view all the answers

    What procedure is performed to assess the grade of Cervical Intraepithelial Neoplasia (CIN)?

    <p>Colposcopy</p> Signup and view all the answers

    What signifies severe dyskaryosis in terms of the nucleo-cytoplasmic ratio?

    <p>NCR &gt; 0.67</p> Signup and view all the answers

    In which condition are koilocytes primarily observed?

    <p>CIN 1</p> Signup and view all the answers

    What is the primary goal of performing biopsies during colposcopy?

    <p>To confirm the grade of CIN</p> Signup and view all the answers

    Which type of stain is commonly used to examine cervical tissue sections?

    <p>H&amp;E stain</p> Signup and view all the answers

    What is the role of the transformation zone in cervical cytopathology?

    <p>Area of maximum interest for abnormal cells</p> Signup and view all the answers

    What is a characteristic of fibrous tissues in the cervix?

    <p>None of the above</p> Signup and view all the answers

    What is a definitive surgical intervention for severe CIN cases?

    <p>Hysterectomy</p> Signup and view all the answers

    How can diagnostic samples be obtained in cytopathology?

    <p>By scraping or brushing tissue surfaces</p> Signup and view all the answers

    What method is commonly used to confirm the grade of CIN?

    <p>Colposcopy with biopsy</p> Signup and view all the answers

    Which of the following nuclear characteristics is typically abnormal in pre-cancerous cells?

    <p>Enlarged and irregular nuclei</p> Signup and view all the answers

    What is the primary characteristic of small cell (oat cell) carcinoma?

    <p>It behaves as a highly malignant cancer that metastasizes early.</p> Signup and view all the answers

    How do most cases of small cell carcinoma respond to chemotherapy?

    <p>They respond dramatically.</p> Signup and view all the answers

    Where does small cell carcinoma typically originate?

    <p>In the central bronchus.</p> Signup and view all the answers

    What is the main function of the thyroid gland?

    <p>Producing and storing hormones that regulate metabolism.</p> Signup and view all the answers

    What is the typical malignancy rate of clinically suspicious thyroid nodules?

    <p>Less than 10%.</p> Signup and view all the answers

    What are follicular cells in the thyroid gland primarily responsible for?

    <p>The production of thyroid hormones.</p> Signup and view all the answers

    What is colloid in thyroid tissue composed of?

    <p>Thyroglobulin and stored thyroid hormones.</p> Signup and view all the answers

    What is the primary cause of goitre?

    <p>Iodine deficiency.</p> Signup and view all the answers

    What is the most common type of thyroid carcinoma?

    <p>Papillary thyroid carcinoma.</p> Signup and view all the answers

    What characterizes medullary carcinoma of the thyroid?

    <p>It arises from parafollicular cells and may show diarrhea as a symptom.</p> Signup and view all the answers

    At what age does breast cancer typically peak in incidence?

    <p>Between ages 55 and 69.</p> Signup and view all the answers

    What percentage of breast cancer cases are attributed to inherited genetic predisposition?

    <p>About 5-10%.</p> Signup and view all the answers

    Why is cytology especially useful for detecting flat tumors in the bladder?

    <p>Cytology can detect tumors that cystoscopy fails to identify.</p> Signup and view all the answers

    What is a common sign of breast cancer?

    <p>A lump in the breast.</p> Signup and view all the answers

    What is the most common type of bladder cancer in the UK?

    <p>Urothelial carcinoma</p> Signup and view all the answers

    What is the typical treatment approach for papillary thyroid carcinoma?

    <p>Surgery, particularly total thyroidectomy.</p> Signup and view all the answers

    What role does bronchoalveolar lavage (BAL) serve during bronchoscopy?

    <p>It collects samples suitable for cytology or microbiology.</p> Signup and view all the answers

    Which type of bladder cancer is linked to bilharzia infection?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    How do transitional cells behave as the bladder fills with urine?

    <p>They stretch into a single layer.</p> Signup and view all the answers

    What distinguishes sarcoma from other types of bladder cancer?

    <p>It originates in bladder muscle or structural tissues.</p> Signup and view all the answers

    What is adenocarcinoma's prevalence among bladder cancer cases?

    <p>Only 1 to 2 out of 100 bladder cancers.</p> Signup and view all the answers

    In what condition is bronchoscopy commonly performed?

    <p>When patients exhibit symptoms like haemoptysis.</p> Signup and view all the answers

    What is a primary risk factor for the development of squamous cell carcinoma?

    <p>Tobacco use.</p> Signup and view all the answers

    What characterizes large squamous cell carcinoma tumors?

    <p>They have a central area of necrosis.</p> Signup and view all the answers

    What is a distinct feature of small cell carcinoma (SCC) of the bladder?

    <p>It is an aggressive neuroendocrine neoplasm.</p> Signup and view all the answers

    What is the transformation process of cells in squamous cell carcinoma?

    <p>Bronchial cells convert to squamous cell type.</p> Signup and view all the answers

    What is a common characteristic of adenocarcinoma at diagnosis?

    <p>It is frequently found at an advanced stage.</p> Signup and view all the answers

    How is semen volume measured in the laboratory?

    <p>By weight, with 1g equaling 1ml of semen</p> Signup and view all the answers

    What is the lower reference limit for semen volume?

    <p>1.5 ml</p> Signup and view all the answers

    What initiates the process of sperm production within the seminiferous tubules?

    <p>Stem cells</p> Signup and view all the answers

    What percentage indicates low motility in sperm samples?

    <p>Progressive motility under 32% or total motility under 42%</p> Signup and view all the answers

    What percentage of couples in the UK may experience difficulty conceiving each year?

    <p>1 in 7</p> Signup and view all the answers

    What is used to determine sperm concentration during assessment?

    <p>A haemocytometer</p> Signup and view all the answers

    What does morphology refer to in the context of sperm?

    <p>Size and shape of the sperm</p> Signup and view all the answers

    What indicates that a sperm count is classified as low?

    <p>Less than 16 million per ml</p> Signup and view all the answers

    What is the minimum percentage of normal sperm considered sufficient for fertility according to the WHO?

    <p>4%</p> Signup and view all the answers

    What action is taken if no sperm is seen during the initial assessment?

    <p>1ml of the sample is centrifuged for further assessment</p> Signup and view all the answers

    What factors can increase the percentage of abnormal sperm?

    <p>Increased testicular temperature</p> Signup and view all the answers

    What is the typical success rate of Intrauterine Insemination (IUI)?

    <p>10-12% per month</p> Signup and view all the answers

    What defines subfertility?

    <p>Inability to conceive after actively trying for 12 months or more</p> Signup and view all the answers

    What technique involves injecting a single sperm directly into an egg?

    <p>Intra cytoplasmic sperm injection (ICSI)</p> Signup and view all the answers

    How is sperm morphology typically assessed?

    <p>Semen analysis</p> Signup and view all the answers

    Which method is used if the patient's semen cannot be utilized for reproductive techniques?

    <p>Use of donor sperm</p> Signup and view all the answers

    What is a potential consequence of abnormal sperm morphology?

    <p>Reduced fertility</p> Signup and view all the answers

    What is the dilution ratio used for determining sperm concentration?

    <p>1:20</p> Signup and view all the answers

    What are coiled-tail sperm characterized by?

    <p>Tails that are coiled and damaged</p> Signup and view all the answers

    What abnormal feature characterizes macrocephalic sperm?

    <p>Giant head and extra chromosomes</p> Signup and view all the answers

    What is a potential indicator of a blockage of seminal vesicles in semen?

    <p>pH of 6.8</p> Signup and view all the answers

    What appearance would classify semen as abnormal?

    <p>Dark brown or red coloring</p> Signup and view all the answers

    Which of the following describes the neck of the spermatozoon?

    <p>Connection point between the head and tail</p> Signup and view all the answers

    What do normal breast aspirates typically contain?

    <p>Fat, stroma, and benign ductal cells</p> Signup and view all the answers

    What is a common lesion found in breast aspirates in young women?

    <p>Fibroadenomas</p> Signup and view all the answers

    What percentage of breast cancers are classified as ductal carcinoma?

    <p>80%</p> Signup and view all the answers

    What characterizes ductal carcinoma in situ (DCIS)?

    <p>It remains within the ducts</p> Signup and view all the answers

    In breast aspirates, how do cells in lobular carcinoma generally appear?

    <p>In linear cords or clusters with no myoepithelial cells</p> Signup and view all the answers

    What is the role of gonadotropin-releasing hormone (GnRH) in sperm production?

    <p>It stimulates the release of FSH and LH from the anterior pituitary gland</p> Signup and view all the answers

    What hormone is crucial for the production of testosterone by Leydig cells?

    <p>Luteinizing hormone (LH)</p> Signup and view all the answers

    How many sperm can be produced by the male reproductive system in one day?

    <p>120 million</p> Signup and view all the answers

    What is the approximate length of the seminiferous tubule within the testicle?

    <p>700 feet</p> Signup and view all the answers

    What is a key characteristic of ductal carcinoma in aspirates compared to normal ductal cells?

    <p>Cells are less cohesive with no myoepithelial cells</p> Signup and view all the answers

    What percentage of breast cancers are lobular carcinoma?

    <p>10-15%</p> Signup and view all the answers

    Which cells accumulate adjacent to ductal cells in normal breast aspirates?

    <p>Single background myoepithelial cells</p> Signup and view all the answers

    Why are benign normal breasts rarely aspirated?

    <p>The actual lesion may be missed by the needle</p> Signup and view all the answers

    What type of conditions can be identified in breast aspirates besides cancers?

    <p>Fat necrosis and inflammatory conditions</p> Signup and view all the answers

    What is the primary advantage of cytology over histology?

    <p>Same day diagnosis of benign lesions</p> Signup and view all the answers

    Study Notes

    Overview of Cytopathology

    • Cytopathology focuses on diagnosing diseases by examining the microscopic appearance of individual or grouped cells.
    • Unlike histology, which examines solid tissues, cytopathology analyzes 'loose' cells.

    Sample Collection for Cytopathology

    • Cells can be aspirated, brushed, or collected from various body sites for examination.
    • Diagnostic samples can be obtained from tissue surfaces, body fluids, lumps, or lesions.

    Screening and Diagnostic Work

    • Cytopathology includes both screening and diagnostic work to detect abnormalities.
    • A successful screening program needs to identify diseases early, provide effective treatment, and be non-invasive.

    NHS Cervical Screening Program

    • The NHS runs three main screening programs: bowel, breast, and cervical screening.
    • Cervical screening involves a call at age 25 with repeated screenings every three years until age 50 and every five years until age 65.

    Cervical Anatomy and Cell Types

    • The cervix, located at the top of the vagina and at the entry to the uterus, has both columnar (endocervix) and squamous (ectocervix) epithelial linings.
    • The transformation zone, where the endocervix and ectocervix meet, is highly susceptible to precancerous changes.

    Cytology vs. Histology

    • Cytology uses the cervical smear test to collect and stain loose cells, primarily screening for abnormalities.
    • Histology involves cone biopsy to obtain tissue samples for further examination.

    HPV Testing and Its Importance

    • The primary method in cytology includes PCR testing for HPV, only examining cells if HPV is positive.
    • The HPV vaccine significantly reduces the incidence of cervical cancer and other HPV-related cancers.

    The Impact of the Pap Test

    • The Pap test is renowned as the most effective cancer screening program, reducing cervical cancer death rates by over 70%.
    • Prior to its introduction, cervical cancer was the leading cause of cancer death among women but fell to the fifteenth position afterward.

    Understanding Pre-Cancerous Changes

    • Pre-cancerous changes, known as dyskaryosis, manifest through nuclear enlargement, irregular shape, hyperchromasia, and multinucleation.
    • Dyskaryosis grading is based on the nucleo-cytoplasmic ratio (NCR), classifying it into mild, moderate, or severe.

    Treatment Methods for Cervical Conditions

    • Colposcopy is typically used to treat cervical intraepithelial neoplasia (CIN), allowing for biopsies to determine CIN grade.
    • Large loop excision of the transformation zone (LLETZ) is often performed to remove CIN lesions; hysterectomy may be necessary in severe cases.

    HPV and Its Mechanisms

    • HPV is a double-stranded DNA virus; its oncogenes E6 and E7 contribute to cancer by targeting tumor suppressor genes like p53 and retinoblastoma protein.
    • The expression of E6/E7 mRNA is a key indicator for detecting high-risk HPV infections linked to cervical cancer.

    Diagnostic Techniques in Cytopathology

    • Diagnostic techniques include scraping, centrifugation, brushing, washing, and aspirating cells from various sites.
    • Analyzing samples using H&E staining helps visualize cell morphology, highlighting differences indicative of pre-cancerous or cancerous changes.### Cytopathological Evaluation
    • Cells can be obtained from lumps or lesions using a blood-taking needle for cytopathological evaluation.
    • Common sample sites include the bladder, pancreas, bile duct, breast, thyroid, salivary glands, semen, lymph nodes, and any accumulating fluid.

    Fluid Samples and Preparation

    • Fluids for cytological examination include urine, cerebrospinal fluid (CSF), and various effusions.
    • Fluid samples are centrifuged to separate plasma and cellular components; the Buffy coat contains white blood and tumor cells, which are then prepared on microscope slides for staining.

    Staining Methods

    • Papanicolaou stain (for 'wet-fixed' specimens): Comprises haematoxylin, EA50, OG6, provides excellent nuclear detail.
    • Romanowsky stain (for 'air-dried' specimens): Includes May-Grunwald and Giemsa stains, effective for highlighting cytoplasmic detail.

    Cerebrospinal Fluid (CSF)

    • CSF is a clear fluid surrounding the brain and spinal cord, crucial for cushioning, chemical stability, and nutrient exchange.
    • Cancer spread to the central nervous system may cause neurological symptoms and poor prognosis.

    Urine Cytology

    • Primarily screens for urinary tract infections, cancer, or precancerous conditions.
    • Typically performed in patients with hematuria; may accompany ultrasound and cystoscopy.
    • 10-25% of hematuria patients may be diagnosed with bladder cancer, especially in high-risk occupations.

    Bladder Cancer Overview

    • Urothelial carcinoma is the most common bladder cancer, making up 90% of cases in the UK; it arises from transitional cells.
    • Squamous cell carcinoma (5% of cases) is more prevalent in Africa and Asia and linked to bilharzia infection.
    • Adenocarcinoma is a rare type (1-2% of cases) that develops from glandular cells.

    Cytology Techniques in Bronchoscopy

    • Bronchoscopes utilize fiber optics and instruments for sampling; bronchoalveolar lavage (BAL) washes airways for cytology or microbiology.
    • BAL is especially useful for diagnosing opportunistic infections in immunocompromised patients.

    Lung Cancer Types

    • Squamous cell carcinoma: Second most common lung cancer, linked to smoking, often presents with necrosis.
    • Adenocarcinoma: Most common lung cancer, occurs in smokers and non-smokers, often diagnosed at advanced stages.
    • Small cell carcinoma: Highly malignant, early metastasis, responds dramatically to treatment.

    Thyroid Gland and Pathology

    • The thyroid gland produces hormones (T3 and T4) crucial for metabolic functions; nodules are common, requiring pathological diagnosis.
    • Fine needle aspiration (FNA) is employed to assess nodule malignancy; <10% of suspicious nodules are malignant.

    Thyroid Carcinomas

    • Papillary thyroid carcinoma: Most frequent, often slow-growing, treated with total thyroidectomy.
    • Medullary carcinoma: Arises from parafollicular cells, includes hereditary forms and may present with diarrhea.

    Breast Cancer Statistics

    • Leading cancer in women, comprising 25% of cases, peak incidence age is 55-69, with a 5-year survival rate of 80-90%.
    • Signs include lumps, skin changes, and discharge; about 5-10% of cases are genetically predisposed.

    Breast Carcinoma Types

    • Ductal carcinoma: Makes up 80% of cases, can be invasive or in situ (DCIS), with significant hormone receptor status implications.
    • Lobular carcinoma: Accounts for 10-15% of breast cancers, with distinct histological features.

    Breast Aspiration Findings

    • Normal aspirates yield benign cells; fibroadenomas present cellular samples with benign ductal cells.
    • The absence of myoepithelial cells and crowded epithelial sheets may indicate malignancy.### Lobular Carcinoma
    • Characterized by linear cords or clusters of cells with absent myoepithelial cells.
    • Difficult to detect due to lack of lump formation, low cellularity, and limited atypia.

    Cytology

    • Advantages:
      • Quick results (minutes).
      • Cost-effective and less invasive, allowing faster patient recovery.
      • Can provide same-day diagnosis for benign lesions.
    • Disadvantages:
      • Requires specialized expertise.
      • May lack sensitivity and specificity.

    Histology

    • Advantages:
      • Considered gold standard for diagnosis.
      • Easier to perform ancillary tests.
    • Disadvantages:
      • Results may not be available on the same day.
      • Generally more expensive and invasive.

    Andrology in Hospitals

    • Crucial for fertility clinics, offering insights on male fertility.
    • Typically found within Gynaecology or Urology departments.
    • Andrology labs provide outpatient services, including bookings, patient interviews, and result reporting.

    Hormonal Regulation of Sperm Production

    • Sperm production is driven by hormones from the hypothalamus and anterior pituitary gland.
    • The hypothalamus secretes gonadotropin-releasing hormone (GnRH).
    • Anterior pituitary gland releases follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in response to GnRH.
    • FSH promotes spermatogenesis; LH stimulates testosterone production by Leydig cells.

    Spermatogenesis and Testes Structure

    • Occurs within the seminiferous tubules of the testes.
    • Leydig cells produce testosterone, essential for male reproductive function.
    • Each seminiferous tubule measures approximately 700 feet in length.
    • Up to 120 million sperm can be produced daily; spermatogenesis takes about 64 days.
    • Stem cells lining seminiferous tubules initiate sperm production.

    Germ Cell Arrangement and Quality Control

    • Germ cells are arranged in a systematic manner in seminiferous tubules.
    • Quality control mechanisms ensure biological and genetic integrity of sperm.

    Subfertility and Infertility Statistics

    • Defined as the inability to conceive after 12 months of trying.
    • Approximately 1 in 7 couples in the UK experience difficulties conceiving.
    • Infertility causes: unexplained factors (25%), ovulatory disorders (25%), tubal damage (20%), male factor (30%), and uterine or peritoneal disorders (10%).

    Referral Process for Fertility Evaluation

    • Referrals typically come from GPs, Gynaecology, and Urology departments for patients trying to conceive for a year without success.
    • Patients undergoing radiation or chemotherapy may also be referred for evaluation.

    Spermatozoon Structure

    • Comprises three sections: head, neck, and tail.
    • The head contains a nucleus with compacted DNA and an acrosome for fertilization.
    • The neck connects the head and tail, comprising the connecting piece and proximal centriole.
    • The tail, powered by the midpiece, consists of the axial filament.

    Sperm Morphology and Function

    • Sperm morphology refers to the size and shape of sperm, important for fertility assessments.
    • Normal morphology is deemed sufficient when 4% or more sperm are normal.
    • Abnormal morphology includes misshapen heads, coiled tails, and other defects which can affect fertility.

    Semen Appearance and Consistency

    • Normal semen is gray, liquefies within 30 minutes, and has a distinct odor.
    • Abnormal semen may appear brown or red, fail to liquefy after 60 minutes, or contain mucus.
    • Consistency is classified as normal or viscous based on threading with a sample.

    Semen pH and Volume Measurement

    • pH measured using indicator papers; a pH lower than 7.2 may indicate a blockage, while higher may suggest infection.
    • Semen volume, with a lower reference limit of 1.5 ml, is measured by weight.

    Sperm Motility and Concentration

    • Number of progressive sperm is a key predictor of fertilization and pregnancy success.
    • Sperm motility categorized as progressive, non-progressive, or immotile.
    • Low motility is classified as progressive motility under 32% or total under 42%.
    • Sperm concentration calculated after appropriate dilution and assessed with a haemocytometer.

    Assisted Reproductive Technologies

    • Options for patients with abnormal sperm characteristics include:
      • Intrauterine insemination (IUI): 10-12% success rate per month.
      • In-vitro fertilization (IVF): 25-50% success rate per round.
      • Intra cytoplasmic sperm injection (ICSI): Single sperm injected into an egg with similar success rates as IVF.
    • Donor sperm may be used when a patient's semen is not viable for these techniques.

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    Description

    Explore the fundamentals of cytopathology, including its definition and the types of samples it examines. This quiz covers cell collection methods and the scope of work involved in cytopathological examinations, providing a comprehensive understanding of this essential field in diagnostics.

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