"Clinical" cytology for endoscopists: A practical guide

Abstract

Clinical cytology was originally used by clinicians to provide rapid diagnosis. However, with advancing medical subspecialization, few clinicians interpret cytology themselves these days, for example, gynecologists, hematologists, urologists, and occasional gastroenterologist (mainly in Asian countries). Cytological assessment enjoyed a renaissance with the development of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA). Subsequently, pathologists, most of them more experienced in histology, had to take over. Recently, it has been shown that in-room cytology can be easily performed by the endoscopist themselves for initial evaluation of the quality of the EUS-FNA specimen and an initial diagnosis distinguishing benign or malignant cells. Bringing cytology back to the clinician has some advantages but does not substitute the professional cytopathologist. This report has written to lower the threshold for the clinician to find his way back to the microscope, which may improve both their diagnostic yield and assessment of EUS-FNA sample quality.

Figure 1

Normal pancreatic tissue (May Grünwald Giemsa staining, ×400), note that the cells are connected to each other and the nuclei are similar to each other. The nuclei are roughly the size of an erythrocyte (not visible in this picture)

Figure 2

Adenocarcinoma of the pancreas (May Grünwald Giemsa staining, ×400) Note that the nuclei are inhomogenous and reaching more than 2, 5 fold the size of erythrocytes (some are visible in the left upper end of the picture), mitotic figures are clearly to be seen in the cancerous cells

Figure 3

Neuroendocrine cells of the pancreas (May Grünwald Giemsa staining ×400) note that nuclei are roughly the size of erythrocytes (next to the tumor cells); however, cell connection is lost and the nuclei are slightly different from each other, nuclei are typically hyperchromatic

Figure 4

Lymphoma (May Grünwald Giemsa staining, ×400) cells are hypochromatic and not connected, nuclei are slightly different to each other however spread out closely

Figure 5

Epitheloid granuloma (May Grünwald Giemsa, ×400) cells are connected to each other as a granuloma. Nuclei are bean shaped, hypochromatic, and have a big cytoplasmatic rim (squamous cell like)