CYTOLOGY OF BODY

FLUID
Schematic representation of the three body cavities
Accumulation of fluids in body cavities

Transudates
Increased hydrostatic pressure: Congestive heart
failure
Decreased oncotic pressure (decreased albumin) :
liver cirrhosis, nephrosis, and malnutrition
Exudate
Inflammation: Infection, infarction, hemorrhage
Tumor
 DIFFERENCES BETWEEN TRANSUDATE AND EXUDATE

Feature Transudate Exudate

Gross appearance Watery, clear Turbid or cloudy
Specific gravity Less than 1015 More than 1015
Protein Less than 3mg/dl More than 3mg/dl
Clots No Yes
cells Usually benign: More mesothelial cells,
Few mesothelial acute or chronic
cells, few histocytes inflammatory cells,
and lymphocytes RBCs, malignant cells
 DIAGNOSTIC ROLE OF EFFUSION CYTOLOGY

It is very useful for diagnosis of premalignant and

malignant tumors, especially metastatic tumors.

It is very useful for diagnosis of inflammatory

conditions (septic effusion, or chronic specific

inflammation e.g. TB
Non-Gynecological Specimen Collection
Respiratory Tract
Urinary Tract
Oral Cavity
Gastrointestinal Tract
Effusions (pleural, pericardial, joint)
Cerebral Spinal Fluid
Amniotic fluid
Many other body sites
 EXAMINATION OF BODY FLUID
Gross exam

Total cell count

Microscopic exam

Any other special test (Chemistry, Microbiology,

cytology(

Test are performed in various areas of lab based on what

the physician orders.

Body fluids sterile vs. non-sterile

SAMPLE COLLECTION

FNA of effusion fluids

Tapping
Collection and preparation of specimen
 FIXATION

1ml of heparin + 100ml of effusion fluid to prevent

clotting

N.B.: do not use alcohol in fixation of fluid before

spread cytological smear on glass slides

TYPES OF STAINING SMEARS

PAP

Gram Stain

Hx &E

Cell block for remnant sediment and histopathological

examination.

Other special stains for the most suspected diseases, to

confirm diagnosis.
 Cell block Cytocentrifuge preparation
Heparinized
Alcohol-fixed
Adding plasma and thrombin bottles (3 units
solution heparin/ml)
Unfixed Papanicolaou-stained
Wrapped in filter paper

Placed in a cassette Air-dried cytocentrifuge preparation

Embedded in paraffin (Hematologic malignancy is

suspected)
Cut and H&E stain
 1- CEREBROSPINAL FLUID
Fluid surrounding brain and spinal cord

Sterile

Specimen collection: by Lumbar puncture

Collect 3-5 vials, each tube has a designated department.

Gross exam: Turbidity, Color, microscopic exam, cell

count
 CSF CELL DIFFERENTIAL
Numerate and differentiate cells seen

Lymphocytes: usually are few; increased with viral,

fungal, bacterial meningitis, or nervous system disease

Monocytes: Less than 2% of normal CSF, increased

with TB meningitis, viral encephalitis, subarachnoid

hemorrhage.
 PMN: are few, associated with Viral and acute bacterial

inflammation.

Macrophages: are few in number associated with malignancy,

hemorrhage, inflammation

Eosinophils/Basophils: not normally seen in CSF

 Plasma cells: not normally present; associated with viral disorders,

and Hodgkin's diseases.

Red Blood Cells: Few to none present

Mesothelial cells: not present

Malignant cells: will see with malignant disease and infiltrate.

 2- Pleural Fluid: Lung fluid

Effusion:

Transudate

Exudates

Lab analysis: Gross exam, cell count, etc.

Differential: PMN, Lymph, Mono, etc.

 Cells unique to the lungs: Mesothelial cells

RBCs and WBCs: are limited, if increased without

traumatic tap ----- indicates infarction

Cytology exam: useful in identifying malignancy or

abnormal morphological cells.

 3- PERITONEAL FLUID

Abnormal accumulation of fluid (effusion) in peritoneal

cavity: Ascites

Ascites: a condition in which fluid accumulates within

the peritoneal space.
Must have an accumulation of > 100ml (several 100) before effusion
can be detected on physical exam.
 Removal procedure- paracentesis
Lab analysis: distinguish between transudate and exudates,

gross exam, cell count, sedimentation, chemical analysis

PHYSICAL CHARACTERISTICS
Peritoneal Fluid Appearance: Color and clarity.

Color and clarity can indicate certain infections and diseases.

Total Cell Count: Assist in diagnosis of certain

diseases by determining total RBC and WBC number.

 Lymphocytes: CHF, liver cirrhosis, nephrotic syndrome

Mesothelial Cells: Associated with TB effusions

Malignant cells: seen with malignancy

 4- Pericardial Fluid

Pericardial Fluid: accumulation of fluid of the lining of

the heart (effusion)

Cause: neoplasm, infections, collagen disease, renal

disease, Cardiovascular disease.

Gross Exam: Report appearance (bloody, clear, cloudy)

 Measure pH: pH less than 7.0 associated with infection or

rheumatoid disorder.

Cell count: see limited RBCs and WBCs

Evaluate sedimentation
 5- Seminal Fluid

Examine physical, chemical and microscopic detail

Count number of sperm, report morphology and

motility

Specimen must be a fresh collection-clean, sterile

container.

Gross Exam: Color, pH, Volume, and viscosity.

Agglutination study
 6- Synovial Fluid:
Joint Fluid: normally clear, viscous

Functions as a lubricate and transports nutrient

Arthrocentesis: aspirate of the joint fluid, aseptic

technique

Lab Assay: Gross exam, microscopic exam, Gram

stain, cultures,...
 Appearance: clear, transparent, viscous

Viscosity test

Mucin Clot test

Note crystals (intracellular vs. extra cellular)

Slide exam: usually performed on concentration of the fluid

using Giemsa or Papnicolaou

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