1、第1頁/共79頁細針吸取細胞學檢查細針吸取細胞學檢查(fine needle aspiration cytology) Advantages The 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頁/共79頁細針吸取細胞學檢查細針吸取細胞學檢查(fine needle aspiration cytology) Deep-Seated Organ Aspirations FNA biopsy

2、of deep-seated 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頁/共79頁細針吸取細胞學檢查細針吸取細胞學檢查(fine needle aspiration cytology)Disadvantages樣本采集涂片

3、制作細胞學診斷第4頁/共79頁淋巴結針吸細胞學檢查淋巴結針吸細胞學檢查 淋巴結針吸細胞學檢查：操作簡便，快速安全，對于明確淋巴結良惡性病變的性質、快速診斷淋巴結疾病，包括各類反應性增生和淋巴結轉移癌及惡性淋巴瘤，具有臨床實用價值。第5頁/共79頁正常淋巴結細胞學正常淋巴結細胞學正常淋巴結穿刺涂片標本淋巴細胞占95%95%以上，以成熟小淋巴細胞為主，其余5%5%為幼淋巴細胞、原淋巴細胞、網狀細胞和漿細胞等。第6頁/共79頁正常淋巴結細胞學正常淋巴結細胞學 Lymphocytes. Benign, reactive pattern, with predominance of small, matu

4、re lymphocytes, a range of maturation of immature lymphocytes, and a fully differentiated plasma cell. (Diff-Quik) 第7頁/共79頁正常淋巴結細胞學正常淋巴結細胞學 Lymphocytes. The benign pattern showing a range of maturation of lymphocytes, including mature plasma cells. (Pap) 第8頁/共79頁正常淋巴結細胞學正常淋巴結細胞學 Tingible body macrop

5、hages. Specialized histiocyte that engulfs dead (necrobiotic) cells. Associated with germinal center formation and benign lymphadenopathy, but can be seen in any high-grade lymphoma. (Pap) 第9頁/共79頁淋巴結良性病變針吸細胞檢查淋巴結良性病變針吸細胞檢查 1.1.慢性淋巴結炎：本病常見，多由局部慢性感染引起，好發于頸部、頜下和腹股溝等處；涂片內有大量小淋巴細胞，夾有少量轉化的淋巴細胞及組織細胞，有吞噬現象

6、； 第10頁/共79頁慢性淋巴結炎慢性淋巴結炎第11頁/共79頁慢性淋巴結炎慢性淋巴結炎 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. Tingibl

7、e body macrophages and lymphohistio-cytic aggregates also present. Mitotic figures may be seen. (Diff-Quik). 第12頁/共79頁慢性淋巴結炎慢性淋巴結炎 Chronic lymphadenitis Follicular hyperplasia, with large, immature lymphocytes and predominance of small, mature lymphocytes resulting in characteristic full range of ma

8、turation of the lymphoid cells. Note immunoblast with prominent nucleolus and plasmacytoid cytoplasm. Histiocytes, tingible body macrophages, lymphohistiocytic aggregates, and mitotic figures would also be easily found in the smear. 第13頁/共79頁淋巴結良性病變針吸細胞檢查淋巴結良性病變針吸細胞檢查 2.2.急性淋巴結炎：早期病變涂片內有大量小淋巴細胞，及少量轉

9、化的淋巴細胞及組織細胞；炎癥轉為急性化膿性時，見大量中性粒細胞及其退化、壞死。第14頁/共79頁淋巴結良性病變針吸細胞檢查淋巴結良性病變針吸細胞檢查 3.3.結核性淋巴結炎 ：涂片內見到具有診斷意義的類上皮細胞、郎罕巨細胞及干酪樣壞死。抗酸染色可找到結核桿菌。第15頁/共79頁結核性淋巴結炎結核性淋巴結炎 Granulomatous lymphadenitis Granulomas are characterized by nodular collections of epithelioid histiocytes; giant cells are optional. In Diff-Quik

10、, the epithelioid histiocytes have elongated nuclei and abundant, dense, slightly fibrillar cytoplasm. 第16頁/共79頁結核性淋巴結炎結核性淋巴結炎第17頁/共79頁淋巴瘤針吸細胞檢查淋巴瘤針吸細胞檢查 惡性淋巴瘤：是原發于淋巴組織或淋巴結的惡性腫瘤，臨床表現為無痛性淋巴結腫大，以頸部為主，其次是縱隔和腋窩，伴有發熱、夜汗、皮膚瘙癢、體乏和體重下降等表現，晚期可出現后腹膜淋巴結、肝脾和（或）骨髓受累。 第18頁/共79頁霍奇金淋巴瘤霍奇金淋巴瘤（Hodgkins Disease, HD） 細

11、胞學診斷主要依據是出現典型的R-S細胞 (Reed-Sternberg cell, R-S cell) 及其變異型R-S細胞，背景是各種反應性增生樣淋巴細胞。 R-S細胞形態特點第19頁/共79頁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頁/共79頁霍奇金淋巴瘤霍奇金淋巴瘤（Hodgkins Disease, HD）第21頁/共79頁霍奇金淋巴瘤霍奇金淋巴瘤（Hodgkins Disease, HD） Hodgkins di

12、sease. The diagnostic cell is the Reed-Sternberg cell, but it must be present in the proper milieu, ie, a benign, reactive chronic inflammatory background. (Diff-Quik) 第22頁/共79頁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 infiltra

13、te. (Pap) 第23頁/共79頁非霍奇金淋巴瘤非霍奇金淋巴瘤（ Non-Hodgkins Lymphoma NHL ） 細胞學特征是腫瘤細胞形態單一, ,多以一種細胞為主細胞豐富，多彌散分布，細胞核有異型性，可見核膜皺褶，核溝深淺不一 第24頁/共79頁非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins Lymphoma第25頁/共79頁非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins Lymphoma Small (well-differentiated) lymphocytic lymphoma. A cellular aspirate in which most, if

14、not all, of the cells resemble ordinary small, mature lymphocytes. Tingible body macrophages, lymphohistiocytic aggregates, and mitotic figures are not seen. (Diff-Quik) 第26頁/共79頁非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins Lymphoma Small (well-differentiated) lymphocytic lymphoma. Small, mature lymphocytes. Cleaved

15、 cells are not present. (Pap, oil) 第27頁/共79頁非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins Lymphoma Small (well-differentiated) lymphocytic lymphoma. Small, mature lymphocytes. The same cells may be circulating in the blood (chronic lymphocytic leukemia)-an important diagnostic clue. (Diff-Quik, oil) 第28頁/共79頁非霍奇金淋巴瘤非

16、霍奇金淋巴瘤 Non-Hodgkins Lymphoma Small (well-differentiated) lymphocytic lymphoma. In many cases, the malignant cells are slightly larger, with slightly less dense chromatin, compared with normal mature lymphocytes, but nuclear membranes remain smooth. (Diff-Quik, oil) 第29頁/共79頁非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgki

17、ns Lymphoma Plasmacytoid small lymphocytic lymphoma. Also known as lymphoplasmacytic lymphoma, a variant that is morphologically and clinically similar to small lymphocytic lymphoma, except for the presence of plasmacytoid lymphocytes and a few plasma cells. (Diff-Quik, oil) 第30頁/共79頁非霍奇金淋巴瘤非霍奇金淋巴瘤

18、Non-Hodgkins Lymphoma Lymphoblastic lymphoma. Young patient with mediastinal mass is classic presentation. Cytologic finding is medium-sized cells with smooth or convoluted (illustrated, Diff-Quik, oil) nuclei and scant cytoplasm. 第31頁/共79頁淋巴結轉移癌針吸細胞檢查淋巴結轉移癌針吸細胞檢查 淋巴結針吸細胞學有助于判斷是否有癌轉移，還可根據細胞學形態及臨床表現，

19、判斷原發腫瘤的來源；有的原發腫瘤小而隱蔽，常借針吸細胞學而獲診，并可推斷其原發部位。 第32頁/共79頁鱗狀細胞癌淋巴結轉移鱗狀細胞癌淋巴結轉移第33頁/共79頁腺癌淋巴結轉移腺癌淋巴結轉移第34頁/共79頁甲狀腺癌淋巴結轉移甲狀腺癌淋巴結轉移第35頁/共79頁小細胞未分化癌淋巴結轉移小細胞未分化癌淋巴結轉移第36頁/共79頁白血病淋巴結浸潤白血病淋巴結浸潤 確診白血病，一般依據骨髓和血像檢查。有時骨髓檢查不能肯定診斷時，而腫大的淋巴結穿刺細胞學檢查對白血病的診斷和細胞類型的鑒別則有一定參考價值。第37頁/共79頁惡性黑色素瘤淋巴結轉移惡性黑色素瘤淋巴結轉移 本瘤惡性程度較高，好發于足底、下肢

20、、頭頸及外陰部，可為黑痣受刺激惡變而來，可早期發生血道或淋巴結轉移。涂片所見細胞形態除有一般惡性腫瘤的特征外，唯一的特點是胞漿內出現大小不等、彌散分布的棕色黑色素顆粒。 第38頁/共79頁乳腺針吸細胞學檢查乳腺針吸細胞學檢查 (fine needle aspiration cytology of breast) 乳腺針吸細胞學檢查操作簡便、安全迅速，幾乎沒有創傷，主要用于判斷乳腺良惡性病變的性質，快速診斷早期乳腺癌，具有臨床實用價值。 第39頁/共79頁乳腺正常細胞學乳腺正常細胞學 在一般情況下，涂片見到的脫落細胞成分很少，一張涂片只見幾個細胞。常見細胞有乳腺導管上皮細胞、雙極裸核細胞、泡沫細

21、胞、吞噬細胞和脂肪細胞。 第40頁/共79頁Breast (tissue) Duct and lobule of normal breast. In the nonlactating breast, the lobule is composed of terminal ducts and ductules. 第41頁/共79頁Breast (tissue) The normal duct is formed by a double-layered epithelium, consisting of an inner lining of epithelial cells and an outer

22、 lining of myoepithelial cells. Benign disease of the breast. In contrast, cancer is characterized by loss of the myoepithelial layer.第42頁/共79頁乳腺導管上皮細胞乳腺導管上皮細胞 Ductal cells Benign ductal cells are usually seen in breast aspirates as highly cohesive, small epithelial cells, often in flat, honeycombed

23、 sheets, reminiscent of endocervical cells. (Pap) 第43頁/共79頁乳腺導管上皮細胞乳腺導管上皮細胞 Ductal cells Small sheet of ductal cells. Single, intact epithelial cells are usually sparse in benign aspirates. The nuclei are uniform and have smooth nuclear membranes. The chromatin is fine; nucleoli are inconspicuous. (

24、Diff-Quik) 第44頁/共79頁肌上皮細胞肌上皮細胞 Myoepithelial cells Myoepithelial cells are represented by naked, bipolar nuclei in FNA biopsy. Naked, bipolar nuclei are oval to elongated, dark but bland, and stripped of their cytoplasm. The presence of myoepithelial cells or their sentinel nuclei is a hallmark of a

25、 benign breast aspirate. 第45頁/共79頁肌上皮細胞肌上皮細胞 Myoepithelial cells Represented by naked, bipolar nuclei in background of smear. Be cautious diagnosing malignancy in the presence of these sentinel nuclei. (Diff-Quik, oil) 第46頁/共79頁肌上皮細胞肌上皮細胞 Myoepithelial cells Myoepithelial cells. Naked, bipolar nucle

26、i in Pap. (Oil) 第47頁/共79頁乳腺正常細胞學乳腺正常細胞學第48頁/共79頁泡沫細胞泡沫細胞 Foam cells Foam cells. Probably bone marrow-derived histiocytes, these cells have abundant, foamy cytoplasm and are associated with cysts. (Diff-Quik) 第49頁/共79頁乳腺良性病變針吸細胞檢查乳腺良性病變針吸細胞檢查1. 乳腺炎癥乳腺炎癥 Inflammation乳腺急性炎癥絕大多數發生于初次哺乳期婦女，乳汁郁積可發生漿細胞性乳腺炎

27、； 急性炎癥或化膿性炎癥時，涂片中有大量中性粒細胞及膿細胞，有時有紅細胞和泡沫細胞。慢性炎癥時，主要為淋巴細胞，導管上皮細胞一般較為少見。 第50頁/共79頁乳腺炎癥乳腺炎癥 Inflammation第51頁/共79頁乳腺炎癥乳腺炎癥 Inflammation Subareolar abscess. Specific variant of breast abscess that may require excision for cure. In essence represents exuberant, acute, and granulomatous inflammatory respons

28、e to squamous material. (Pap) 第52頁/共79頁乳腺炎癥乳腺炎癥 Inflammation Subareolar abscess. The squames usually stain purple/blue in Diff-Quik (illustrated). 第53頁/共79頁乳腺良性病變針吸細胞檢查乳腺良性病變針吸細胞檢查2. 慢性囊性乳腺病慢性囊性乳腺病 此病屬乳腺異常增生癥，多見于年齡較大的婦女，為界限不清的結節，質稍硬，可有乳頭溢液排出；涂片見泡沫細胞增多，有時成群出現；亦可見排列緊密的導管上皮細胞或大汗腺化生的導管上皮細胞。 第54頁/共79頁乳腺良

29、性病變針吸細胞檢查乳腺良性病變針吸細胞檢查3. 導管內乳頭狀瘤導管內乳頭狀瘤 乳頭溢液常為血性，有時為漿液性。涂片中細胞排列呈分枝狀或乳頭狀，細胞相互擠壓，排列緊密，核輕度異型，形成鑲嵌狀；可見泡沫細胞及大吞噬細胞。第55頁/共79頁乳腺導管內乳頭狀瘤乳腺導管內乳頭狀瘤第56頁/共79頁乳腺良性病變針吸細胞檢查乳腺良性病變針吸細胞檢查4. 乳腺纖維腺瘤乳腺纖維腺瘤 腫塊為圓形結節，有包膜，可活動，多無乳頭溢液，涂片中可見淡紅或淡蘭色云霧狀無結構粘液物質，可見梭形的成纖維細胞，和成團脫落的導管上皮細胞。第57頁/共79頁乳腺纖維腺瘤乳腺纖維腺瘤 Fibroadenoma Tissue showi

30、ng loose myxoid stroma Epithelial proliferation with sharp demarcation from surrounding dense stroma. 第58頁/共79頁乳腺纖維腺瘤乳腺纖維腺瘤 Fibroadenoma The cytologic studies of fibroadenoma numerous epithelial cells, naked oval nuclei, stromal fragments 第59頁/共79頁乳腺纖維腺瘤乳腺纖維腺瘤 Fibroadenoma Three components are typic

31、al, including abundant benign epithelium; numerous naked, oval nuclei; and stroma (stromal fragment, arrow). (Pap) 第60頁/共79頁乳腺纖維腺瘤乳腺纖維腺瘤 Fibroadenoma The three classic findings in fibroadenoma Epithelial cells Naked, oval nuclei Stroma (arrow)第61頁/共79頁乳腺纖維腺瘤乳腺纖維腺瘤 Fibroadenoma Fibroadenoma. Large, h

32、oneycombed sheets are also a common finding in fibroadenoma (Pap). 第62頁/共79頁乳腺纖維腺瘤乳腺纖維腺瘤 Fibroadenoma Fibroadenoma. Antler-like papillary fronds are particularly characteristic of fibroadenoma. 第63頁/共79頁乳腺纖維腺瘤乳腺纖維腺瘤 Fibroadenoma第64頁/共79頁乳腺癌針吸細胞檢查乳腺癌針吸細胞檢查 乳腺癌是婦女最常見的惡性腫瘤，發生于20207070歲，以40405050歲最多。 目前

33、認為乳腺癌最有效的診斷辦法是X X線檢查和針吸細胞學檢查。 臨床表現為：乳房腫塊質地堅硬，固定不活動，界限不清。當腫瘤轉移至淋巴結時，腋下可觸及腫塊。第65頁/共79頁乳腺癌針吸細胞檢查乳腺癌針吸細胞檢查乳腺癌細胞學形態特點乳腺癌細胞學形態特點： 涂片中細胞數量豐富，細胞排列紊亂無極性，細胞及細胞核明顯增大，大小不等，異型明顯，核深染，有核仁。 乳腺癌類型有髓樣癌、硬癌、單純癌、導管內癌、黏液癌、大汗腺樣癌、小管癌或稱腺管癌、小 葉 癌 、 炎 性 乳 癌 和 佩 吉 特 病 （ P a g e tP a g e t s s DiseaseDisease）。第66頁/共79頁乳腺癌乳腺癌 Br

34、east Cancer Two 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頁/共79頁乳腺癌乳腺癌 Breast Cancer To be completely diagnostic, the cells should show obvious cytologic atypia Note the loose aggregation of cells; the single, intact, atypical ep