Topic 2 Epithelium & Non-Epithelial Cells PDF

INSTITUTE OF MEDICAL SCIENCE TECHNOLOGY Topic 2 EPITHELIUM & NON-EPITHELIAL CELLS Universiti Kuala Lumpur (UniKL) | Where Knowledge Is Applied and Dreams Realised  PROGRAMME LEARNING OUTCOME (PLO)...

INSTITUTE OF MEDICAL SCIENCE TECHNOLOGY Topic 2 EPITHELIUM & NON-EPITHELIAL CELLS Universiti Kuala Lumpur (UniKL) | Where Knowledge Is Applied and Dreams Realised  PROGRAMME LEARNING OUTCOME (PLO) 2 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  COURSE LEARNING OUTCOME (CLO) CLO1 Discuss various techniques involved in cytopathology investigations. (C5,PLO6) Integrate the fundamental knowledge and technique in CLO2 cytopathology diagnostic laboratory such as sample collection, staining and screening techniques. (P6,PLO2) CLO3 Prepare cytopathology report according to the specified format. (A2,PLO5) 3 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  LESSON LEARNING OUTCOME At the end of the lesson, students are able to: Describe the epithelium and non-epithelial cells morphology, structure and functions. Describe the cytologic criteria of malignancy. 4 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  LESSON OUTLINE Epithelial cells - morphology, structure and function Non-epithelial cells Cytologic criteria of malignancy 5 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Epithelium: Morphology, structure & function 6 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Basic cell morphology & structure 7 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Nucleus Nucleus contains the DNA, histones & other proteins Chromatin Represents the complex structure of DNA and proteins - makes up the chromosome Stained with hematoxylin; ↑ staining (hyperchromasia) - ↑ chromatin load Nucleoli Small basophilic spherical bodies - ribosome RNA synthesis Presence is physiological or can indicate malignant process Nuclear shape Smooth sphere or spheroid 8 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Epithelium: Functions Epithelium Covers body surfaces and lines hollow organs, body cavities, duct forms glands Primary function: Protection (cover surfaces) Others: Secretion (glands), absorption 9 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  10 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Classification of epithelium 1 cell layer (from basement Simple membrane to the free surface Number of cell layers Stratified >1 cell layers 1 cell layer; but not all Pseudostratified reach the surface Squamous Morphology of Cuboidal surface layer Columnar 11 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Classification of epithelium Simple Number of cell Stratified layers Pseudostratified Thin, flat, scale-like Squamous cells Morphology of About equal in height Cuboidal surface layer & width Height is more than Columnar the width 12 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Classification of epithelium 13 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Classification of epithelium 14 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  15 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  16 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  17 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Columnar cells (small intestine) Honeycombed fragment of small intestinal epithelium. Nuclei are evenly placed and are interspersed by mucinous, pale-staining goblet cells *Procedure: Brushing * Pap stain 18 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  19 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Squamous cells (esophagus) Fragment of squamous epithelium with uniform & monomorphic nuclei. Note the low nuclear to cytoplasmic (N:C) ratios with abundant clear cytoplasm & polygonal cell shape. *Procedure: Esophageal brushing * Pap stain 20 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Squamous cells (cervix) 21 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  22 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  23 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  24 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Ciliated columnar cells (bronchus) Note the columnar shape of the cells, basally placed nuclei, and terminal bar with well-formed apical cilia *Procedure: Bronchial brushing * Pap stain 25 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  26 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Umbrella cells (urinary bladder) Note the abundant cytoplasm and low nuclear to cytoplasmic ratio. These cells have thickened outer cytoplasmic margins ("saucer cup edge") & vacuolated perinuclear areas. The nuclei are uniform in size & relatively central in placement. *Procedure: Bladder wash *Pap stain 27 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Non-epithelial cells Most commonly seen non-epithelial cells: RBC Neutrophils Macrophages Lymphocytes Often stain red, Found in large no. Variable in size & Small round cell, pink, or orange in acute appearance; foamy round nuclei, a by Pap stain inflammation / cytoplasm, narrow rim of infection; eccentric bean- cytoplasm Numerous in cases shaped nucleus of malignant ds. 28 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Non-epithelial cells Most commonly seen non-epithelial cells: Plasma cells Stromal cells Larger than mature lymphocytes, Elongated & spindle shape, have more cytoplasm round to oval nuclei, scant, Characteristic chromatin pattern wispy cytoplasm; → clockface/cartwheel Tend to cluster together in chromatin, eccentric nuclei disorganized aggregates 29 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  30 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Cytologic criteria of malignancy 31 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY The hallmarks of cancer It is based on the known or expected functional alterations in cancer cells. It does not attempt to account for structural alterations of cancer cells. 32 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Cytologic criteria of neoplastic/malignant cells Normal and neoplastic cells are distinguished based on: Nuclear:cytoplasmic Cell size & shape Nuclear size & shape ratio (NCR) Chromatin Regularity of nuclear Chromatin pattern distribution membrane Intensity of nuclear staining 33 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Cytologic criteria of neoplastic/malignant cells Cell size & shape Size expressed as a diameter measurement Shape: round, oval, polygonal, irregular Nuclear size (absolute) & shape Size expressed as a diameter measurement Shape: round, oval, irregular Nuclear:cytoplasmic ratio (NCR) (relative nuclear size) Low, high 34 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Cytologic criteria of neoplastic/malignant cells Chromatin pattern Refers to the degree of coarsening of chromatin granules Pyknotic: dense chromatin pattern Vesicular: granular chromatin pattern Bland: no discernible pattern Chromatin distribution Describes the spatial density of chromatin granules over the area of nucleus Uniform, irregular Regularity of nuclear membrane Smooth, wrinkled, angular Intensity of nuclear staining Normochromasia, hyperchromasia, hypochromasia 35 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Cytologic criteria of neoplastic/malignant cells Criteria Benign Malignant Chromatin Chromatin is fine & evenly Chromatin is coarse, clumped pattern & distributed & unevenly distributed distribution Within normal physiological Variation in size & shape within Nuclear size & limits for the level of the same cell population shape maturation of the cell (pleomorphism) Irregular in outline & show Regularity of indentation and/or thickening nuclear Even due to chromatin margination membrane & clumping 36 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Cytologic criteria of neoplastic/malignant cells Criteria Benign Malignant Intensity of Normochromatic & staining Usually hyperchromatic & nuclear intensity maintained staining varies from one group staining through all cells to the next Multinuclea Can be seen but rarely Common, reflecting rapid cell tion turnover Nucleoli Small, even in number and (If present) Nucleoli are large, even in size irregular & vary from nucleus to nucleus; nucleoli are more prominent in cancer than dysplasia/ dyskaryosis 37 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Cytologic criteria of neoplastic/malignant cells Criteria Benign Malignant Nuclear to ↑ NCR ↑ NCR cytoplasmic ratio Cells Cells are cohesive, Loss of cohesiveness (cells architecture architecture is maintained coming away from their groups). Nuclei tend to crowd each other in sheets/clusters. Mitoses & Mitosis normally only ↑ mitoses with abnormal mitotic figures occur at the basal layer so mitotic figures may be seen are rarely seen in a cervical smear 38 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Low grade squamous intraepithelial lesion (LSIL) Increase in NC ratio in SIL (40% in this cell): the cell has matured to the size of a normal intermediate cell. The nucleus is still fairly round in shape; chromatin is coarser than normal and hyperchromatic. Normal 39 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY  Squamous cell carcinoma Pleomorphic nuclei of variable size including a tadpole cell with dense basophilic cytoplasm Normal 40 HDB30303 CLINICAL LABORATORY CYTOPATHOLOGY THANK YOU UNIVERSITI KUALA LUMPUR © Copyright of Universiti Teknikal MARA Sdn. Bhd. Not for commercial use. 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