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1、第1页/共79页细针吸取细胞学检查细针吸取细胞学检查(fine needle aspiration cytology)AdvantagesThe advantages of FNA biopsy can be summed up in the acronym SAFE.It is Simple,Accurate,Fast,and Economic,as well as safe.第2页/共79页细针吸取细胞学检查细针吸取细胞学检查(fine needle aspiration cytology)Deep-Seated Organ AspirationsFNA biopsy of deep-se
2、ated organs,such as lung,liver,pancreas,kidney,or adrenal,is in many ways similar to,but in some ways different from,FNA biopsy of superficial targets.Ultrasound,Computered Tomography Guiding the Needle第3页/共79页细针吸取细胞学检查细针吸取细胞学检查(fine needle aspiration cytology)Disadvantages样本采集涂片制作细胞学诊断第4页/共79页淋巴结针吸
3、细胞学检查淋巴结针吸细胞学检查 淋巴结针吸细胞学检查：操作简便，快速安全，对于明确淋巴结良恶性病变的性质、快速诊断淋巴结疾病，包括各类反应性增生和淋巴结转移癌及恶性淋巴瘤，具有临床实用价值。第5页/共79页正常淋巴结细胞学正常淋巴结细胞学正常淋巴结穿刺涂片标本淋巴细胞占95%95%以上，以成熟小淋巴细胞为主，其余5%5%为幼淋巴细胞、原淋巴细胞、网状细胞和浆细胞等。第6页/共79页正常淋巴结细胞学正常淋巴结细胞学Lymphocytes.Benign,reactive pattern,with predominance of small,mature lymphocytes,a range of
4、 maturation of immature lymphocytes,and a fully differentiated plasma cell.(Diff-Quik)第7页/共79页正常淋巴结细胞学正常淋巴结细胞学Lymphocytes.The benign pattern showing a range of maturation of lymphocytes,including mature plasma cells.(Pap)第8页/共79页正常淋巴结细胞学正常淋巴结细胞学Tingible body macrophages.Specialized histiocyte that e
5、ngulfs dead(necrobiotic)cells.Associated with germinal center formation and benign lymphadenopathy,but can be seen in any high-grade lymphoma.(Pap)第9页/共79页淋巴结良性病变针吸细胞检查淋巴结良性病变针吸细胞检查 1.1.慢性淋巴结炎：本病常见，多由局部慢性感染引起，好发于颈部、颌下和腹股沟等处；涂片内有大量小淋巴细胞，夹有少量转化的淋巴细胞及组织细胞，有吞噬现象；第10页/共79页慢性淋巴结炎慢性淋巴结炎第11页/共79页慢性淋巴结炎慢性淋巴结
6、炎 Chronic lymphadenitis Chronic lymphadenitis is probably the most common diagnosis in aspiration of enlarged lymph nodes.A cellular smear with numerous immature,or follicular center cells,but an overall predominance of small,mature lymphocytes.Tingible body macrophages and lymphohistio-cytic aggreg
7、ates also present.Mitotic figures may be seen.(Diff-Quik).第12页/共79页慢性淋巴结炎慢性淋巴结炎 Chronic lymphadenitisFollicular hyperplasia,with large,immature lymphocytes and predominance of small,mature lymphocytes resulting in characteristic full range of maturation of the lymphoid cells.Note immunoblast with pr
8、ominent nucleolus and plasmacytoid cytoplasm.Histiocytes,tingible body macrophages,lymphohistiocytic aggregates,and mitotic figures would also be easily found in the smear.第13页/共79页淋巴结良性病变针吸细胞检查淋巴结良性病变针吸细胞检查 2.2.急性淋巴结炎：早期病变涂片内有大量小淋巴细胞，及少量转化的淋巴细胞及组织细胞；炎症转为急性化脓性时，见大量中性粒细胞及其退化、坏死。第14页/共79页淋巴结良性病变针吸细胞检查
9、淋巴结良性病变针吸细胞检查 3.3.结核性淋巴结炎 ：涂片内见到具有诊断意义的类上皮细胞、郎罕巨细胞及干酪样坏死。抗酸染色可找到结核杆菌。第15页/共79页结核性淋巴结炎结核性淋巴结炎 Granulomatous lymphadenitisGranulomas are characterized by nodular collections of epithelioid histiocytes;giant cells are optional.In Diff-Quik,the epithelioid histiocytes have elongated nuclei and abundant,
10、dense,slightly fibrillar cytoplasm.第16页/共79页结核性淋巴结炎结核性淋巴结炎第17页/共79页淋巴瘤针吸细胞检查淋巴瘤针吸细胞检查恶性淋巴瘤：是原发于淋巴组织或淋巴结的恶性肿瘤，临床表现为无痛性淋巴结肿大，以颈部为主，其次是纵隔和腋窝，伴有发热、夜汗、皮肤瘙痒、体乏和体重下降等表现，晚期可出现后腹膜淋巴结、肝脾和（或）骨髓受累。第18页/共79页霍奇金淋巴瘤霍奇金淋巴瘤（Hodgkins Disease,HD）细胞学诊断主要依据是出现典型的R-S细胞(Reed-Sternberg cell,R-S cell)及其变异型R-S细胞，背景是各种反应性增生样淋
11、巴细胞。R-S细胞形态特点第19页/共79页霍奇金淋巴瘤霍奇金淋巴瘤（Hodgkins Disease,HD）Classic Reed-Sternberg cells Benign,reactive inflammatory background 第20页/共79页霍奇金淋巴瘤霍奇金淋巴瘤（Hodgkins Disease,HD）第21页/共79页霍奇金淋巴瘤霍奇金淋巴瘤（Hodgkins Disease,HD）Hodgkins disease.The diagnostic cell is the Reed-Sternberg cell,but it must be present in th
12、e proper milieu,ie,a benign,reactive chronic inflammatory background.(Diff-Quik)第22页/共79页霍奇金淋巴瘤霍奇金淋巴瘤（Hodgkins Disease,HD）Hodgkins disease.Malignant Reed-Sternberg cell and benign chronic inflammatory infiltrate.(Pap)第23页/共79页非霍奇金淋巴瘤非霍奇金淋巴瘤（Non-Hodgkins Lymphoma NHL）细胞学特征是肿瘤细胞形态单一,多以一种细胞为主细胞丰富，多弥散分布
13、，细胞核有异型性，可见核膜皱褶，核沟深浅不一 第24页/共79页非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins Lymphoma第25页/共79页非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins LymphomaSmall(well-differentiated)lymphocytic lymphoma.A cellular aspirate in which most,if not all,of the cells resemble ordinary small,mature lymphocytes.Tingible body macrophages,lymphohistioc
14、ytic aggregates,and mitotic figures are not seen.(Diff-Quik)第26页/共79页非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins LymphomaSmall(well-differentiated)lymphocytic lymphoma.Small,mature lymphocytes.Cleaved cells are not present.(Pap,oil)第27页/共79页非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins LymphomaSmall(well-differentiated)lymphocytic l
15、ymphoma.Small,mature lymphocytes.The same cells may be circulating in the blood(chronic lymphocytic leukemia)-an important diagnostic clue.(Diff-Quik,oil)第28页/共79页非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins LymphomaSmall(well-differentiated)lymphocytic lymphoma.In many cases,the malignant cells are slightly larger,
16、with slightly less dense chromatin,compared with normal mature lymphocytes,but nuclear membranes remain smooth.(Diff-Quik,oil)第29页/共79页非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins LymphomaPlasmacytoid small lymphocytic lymphoma.Also known as lymphoplasmacytic lymphoma,a variant that is morphologically and clinically
17、 similar to small lymphocytic lymphoma,except for the presence of plasmacytoid lymphocytes and a few plasma cells.(Diff-Quik,oil)第30页/共79页非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins LymphomaLymphoblastic lymphoma.Young patient with mediastinal mass is classic presentation.Cytologic finding is medium-sized cells wit
18、h smooth or convoluted(illustrated,Diff-Quik,oil)nuclei and scant cytoplasm.第31页/共79页淋巴结转移癌针吸细胞检查淋巴结转移癌针吸细胞检查淋巴结针吸细胞学有助于判断是否有癌转移，还可根据细胞学形态及临床表现，判断原发肿瘤的来源；有的原发肿瘤小而隐蔽，常借针吸细胞学而获诊，并可推断其原发部位。第32页/共79页鳞状细胞癌淋巴结转移鳞状细胞癌淋巴结转移第33页/共79页腺癌淋巴结转移腺癌淋巴结转移第34页/共79页甲状腺癌淋巴结转移甲状腺癌淋巴结转移第35页/共79页小细胞未分化癌淋巴结转移小细胞未分化癌淋巴结转移第3
19、6页/共79页白血病淋巴结浸润白血病淋巴结浸润 确诊白血病，一般依据骨髓和血像检查。有时骨髓检查不能肯定诊断时，而肿大的淋巴结穿刺细胞学检查对白血病的诊断和细胞类型的鉴别则有一定参考价值。第37页/共79页恶性黑色素瘤淋巴结转移恶性黑色素瘤淋巴结转移本瘤恶性程度较高，好发于足底、下肢、头颈及外阴部，可为黑痣受刺激恶变而来，可早期发生血道或淋巴结转移。涂片所见细胞形态除有一般恶性肿瘤的特征外，唯一的特点是胞浆内出现大小不等、弥散分布的棕色黑色素颗粒。第38页/共79页乳腺针吸细胞学检查乳腺针吸细胞学检查(fine needle aspiration cytology of breast)乳腺针吸
20、细胞学检查操作简便、安全迅速，几乎没有创伤，主要用于判断乳腺良恶性病变的性质，快速诊断早期乳腺癌，具有临床实用价值。第39页/共79页乳腺正常细胞学乳腺正常细胞学 在一般情况下，涂片见到的脱落细胞成分很少，一张涂片只见几个细胞。常见细胞有乳腺导管上皮细胞、双极裸核细胞、泡沫细胞、吞噬细胞和脂肪细胞。第40页/共79页Breast (tissue)Duct and lobule of normal breast.In the nonlactating breast,the lobule is composed of terminal ducts and ductules.第41页/共79页Bre
21、ast (tissue)The normal duct is formed by a double-layered epithelium,consisting of an inner lining of epithelial cells and an outer lining of myoepithelial cells.Benign disease of the breast.In contrast,cancer is characterized by loss of the myoepithelial layer.第42页/共79页乳腺导管上皮细胞乳腺导管上皮细胞 Ductal cells
22、Benign ductal cells are usually seen in breast aspirates as highly cohesive,small epithelial cells,often in flat,honeycombed sheets,reminiscent of endocervical cells.(Pap)第43页/共79页乳腺导管上皮细胞乳腺导管上皮细胞 Ductal cellsSmall sheet of ductal cells.Single,intact epithelial cells are usually sparse in benign asp
23、irates.The nuclei are uniform and have smooth nuclear membranes.The chromatin is fine;nucleoli are inconspicuous.(Diff-Quik)第44页/共79页肌上皮细胞肌上皮细胞 Myoepithelial cellsMyoepithelial cells are represented by naked,bipolar nuclei in FNA biopsy.Naked,bipolar nuclei are oval to elongated,dark but bland,and s
24、tripped of their cytoplasm.The presence of myoepithelial cells or their sentinel nuclei is a hallmark of a benign breast aspirate.第45页/共79页肌上皮细胞肌上皮细胞 Myoepithelial cellsRepresented by naked,bipolar nuclei in background of smear.Be cautious diagnosing malignancy in the presence of these sentinel nucl
25、ei.(Diff-Quik,oil)第46页/共79页肌上皮细胞肌上皮细胞 Myoepithelial cellsMyoepithelial cells.Naked,bipolar nuclei in Pap.(Oil)第47页/共79页乳腺正常细胞学乳腺正常细胞学第48页/共79页泡沫细胞泡沫细胞 Foam cellsFoam cells.Probably bone marrow-derived histiocytes,these cells have abundant,foamy cytoplasm and are associated with cysts.(Diff-Quik)第49页
26、/共79页乳腺良性病变针吸细胞检查乳腺良性病变针吸细胞检查1.乳腺炎症乳腺炎症 Inflammation乳腺急性炎症绝大多数发生于初次哺乳期妇女，乳汁郁积可发生浆细胞性乳腺炎；急性炎症或化脓性炎症时，涂片中有大量中性粒细胞及脓细胞，有时有红细胞和泡沫细胞。慢性炎症时，主要为淋巴细胞，导管上皮细胞一般较为少见。第50页/共79页乳腺炎症乳腺炎症 Inflammation第51页/共79页乳腺炎症乳腺炎症 InflammationSubareolar abscess.Specific variant of breast abscess that may require excision for c
27、ure.In essence represents exuberant,acute,and granulomatous inflammatory response to squamous material.(Pap)第52页/共79页乳腺炎症乳腺炎症 InflammationSubareolar abscess.The squames usually stain purple/blue in Diff-Quik(illustrated).第53页/共79页乳腺良性病变针吸细胞检查乳腺良性病变针吸细胞检查2.慢性囊性乳腺病慢性囊性乳腺病 此病属乳腺异常增生症，多见于年龄较大的妇女，为界限不清的结
28、节，质稍硬，可有乳头溢液排出；涂片见泡沫细胞增多，有时成群出现；亦可见排列紧密的导管上皮细胞或大汗腺化生的导管上皮细胞。第54页/共79页乳腺良性病变针吸细胞检查乳腺良性病变针吸细胞检查3.导管内乳头状瘤导管内乳头状瘤 乳头溢液常为血性，有时为浆液性。涂片中细胞排列呈分枝状或乳头状，细胞相互挤压，排列紧密，核轻度异型，形成镶嵌状；可见泡沫细胞及大吞噬细胞。第55页/共79页乳腺导管内乳头状瘤乳腺导管内乳头状瘤第56页/共79页乳腺良性病变针吸细胞检查乳腺良性病变针吸细胞检查4.乳腺纤维腺瘤乳腺纤维腺瘤 肿块为圆形结节，有包膜，可活动，多无乳头溢液，涂片中可见淡红或淡兰色云雾状无结构粘液物质，可
29、见梭形的成纤维细胞，和成团脱落的导管上皮细胞。第57页/共79页乳腺纤维腺瘤乳腺纤维腺瘤 FibroadenomaTissue showing loose myxoid stroma Epithelial proliferation with sharp demarcation from surrounding dense stroma.第58页/共79页乳腺纤维腺瘤乳腺纤维腺瘤 FibroadenomaThe cytologic studies of fibroadenomanumerous epithelial cells,naked oval nuclei,stromal fragmen
30、ts 第59页/共79页乳腺纤维腺瘤乳腺纤维腺瘤 FibroadenomaThree components are typical,including abundant benign epithelium;numerous naked,oval nuclei;and stroma(stromal fragment,arrow).(Pap)第60页/共79页乳腺纤维腺瘤乳腺纤维腺瘤 FibroadenomaThe three classic findings in fibroadenoma Epithelial cellsNaked,oval nucleiStroma(arrow)第61页/共7
31、9页乳腺纤维腺瘤乳腺纤维腺瘤 FibroadenomaFibroadenoma.Large,honeycombed sheets are also a common finding in fibroadenoma(Pap).第62页/共79页乳腺纤维腺瘤乳腺纤维腺瘤 FibroadenomaFibroadenoma.Antler-like papillary fronds are particularly characteristic of fibroadenoma.第63页/共79页乳腺纤维腺瘤乳腺纤维腺瘤 Fibroadenoma第64页/共79页乳腺癌针吸细胞检查乳腺癌针吸细胞检查乳腺癌
32、是妇女最常见的恶性肿瘤，发生于20207070岁，以40405050岁最多。目前认为乳腺癌最有效的诊断办法是X X线检查和针吸细胞学检查。临床表现为：乳房肿块质地坚硬，固定不活动，界限不清。当肿瘤转移至淋巴结时，腋下可触及肿块。第65页/共79页乳腺癌针吸细胞检查乳腺癌针吸细胞检查乳腺癌细胞学形态特点乳腺癌细胞学形态特点：涂片中细胞数量丰富，细胞排列紊乱无极性，细胞及细胞核明显增大，大小不等，异型明显，核深染，有核仁。乳腺癌类型有髓样癌、硬癌、单纯癌、导管内癌、黏液癌、大汗腺样癌、小管癌或称腺管癌、小 叶 癌、炎 性 乳 癌 和 佩 吉 特 病（PagetPagets s DiseaseDis
33、ease）。第66页/共79页乳腺癌乳腺癌 Breast CancerTwo key features:Cellularity(lots of cells to look at)Atypia(and they all look malignant)To be completely diagnostic,the smears should be highly cellular and single cells should be present.(Pap)第67页/共79页乳腺癌乳腺癌 Breast CancerTo be completely diagnostic,the cells shou
34、ld show obvious cytologic atypia Note the loose aggregation of cells;the single,intact,atypical epithelial cells;and the absence of naked,bipolar(myoepithelial)nuclei.Also note the nuclear atypia and the presence of intracytoplasmic lumens.第68页/共79页乳腺癌乳腺癌 Breast CancerLoose aggregation of cells,with
35、 single cells falling away from groups.Note the nuclear enlargement,which is greater than two RBC diameters,and the absence of naked,bipolar nuclei.第69页/共79页乳腺癌乳腺癌 Breast Cancer第70页/共79页乳腺癌形态特点乳腺癌形态特点第71页/共79页乳腺癌形态特点乳腺癌形态特点第72页/共79页乳腺癌腋下淋巴结转移乳腺癌腋下淋巴结转移第73页/共79页乳腺癌腋下淋巴结转移乳腺癌腋下淋巴结转移第74页/共79页乳腺癌乳腺癌 Bre
36、ast CancerThe presence of intracytoplasmic lumens,which are sharply demarcated,secretory vacuoles containing inspissated mucin,is highly suggestive of breast cancer.Lobular carcinoma is illustrated.(Pap)第75页/共79页乳腺癌乳腺癌 Breast CancerThe presence of intracytoplasmic lumens,which are sharply demarcated
37、,secretory vacuoles containing inspissated mucin,is highly suggestive of breast cancer(Diff-Quik,oil).The mucin tends to stain metachromatically(pink)in Diff-Quik.第76页/共79页胰腺针吸细胞检查胰腺针吸细胞检查正常胰腺细胞学胰腺炎细胞学检查胰腺癌细胞学检查第77页/共79页思考题思考题试述霍奇金淋巴瘤R-SR-S细胞形态特点 试述结核性淋巴结炎形态特点 试述乳腺纤维腺瘤形态特点 试述乳腺癌形态特点第78页/共79页感谢您的观看。第79页/共79页