浆膜腔积液脱落细胞学形态.ppt

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1、浆膜腔积液脱落细胞学检查,浆膜腔，又称体腔，包括胸膜腔、腹膜腔和心包膜腔。在正常生理情况下，体腔脏层和壁层间有少量液体，起润滑作用。在炎症刺激、肿瘤转移或循环障碍等情况下，可形成胸水、腹水和心包积液。浆膜腔积液脱落细胞学检查主要用于判断积液中有无癌细胞。,实验要求:1.掌握间皮细胞的形态特点。2.掌握浆膜腔积液癌细胞的形态特征3.绘出正常及异形间皮细胞、常见癌细胞。,浆膜腔积液脱落细胞学检查,良性病变脱落细胞：脱落间皮细胞：圆形或椭圆形，胞浆厚实，胞核居中，胞核亦为圆形或椭圆形，核染色质细颗粒状，分布均匀。退化变性的间皮细胞：肿胀性退变表现为细胞增大，胞浆出现大小不等的液化空泡，胞核肿胀，偏位

2、。异形间皮细胞的形态：体积增大达3060微米、胞浆染色正常，胞核增大，染色质增多、颗粒变粗、核染色略深，核浆比正常，畸形程度不明显。分为轻度、中度、高度异形。,间皮细胞(Mesothelial Cells),Mesothelial cells in an effusion always show reactive changes of various degrees.Note nuclear enlargement and a prominent nucleolus but fine chromatin and a smooth nuclear membrane.,间皮细胞(Mesotheli

3、al Cells),Gland-like cluster of benign mesothelial cells mimicking adenocarcinoma.Note that the component cells are identical to the other reactive mesothelial cells,and do not constitute a foreign population.,组织细胞(Histiocyte),Hemosiderin-laden histiocyte.Hemosiderin is a refractile golden brown pig

4、ment.The presence of hemosiderin indicates old bleeding.,良性病变脱落细胞结核性病变(Tuberculous effusion),Abundance of lymphocytes and virtual absence of mesothelial cells are characteristic of tuberculous pleural effusions.,浆膜腔积液退化变性的间皮细胞,渗出液：细胞数较多，各种细胞增加的意义如下：1、红细胞：多见于恶性肿瘤、结核或穿刺出血；2、中性分叶核粒细胞：常见于化脓性渗出液和 早期浆膜结核；

5、3、淋巴细胞：主要提示慢性疾病，如结核性、梅毒性、肿瘤性；4、嗜酸性粒细胞：见于变态反应、寄生虫病、多次穿刺刺激等所致的渗出液；5、组织细胞：在炎症情况下，大量出现中性粒细胞时，常伴随组织细胞的出现（较白细胞略大，核呈肾形或不规则形，偏位、核致密、胞浆多呈泡沫状）6、间皮细胞：表示浆膜刺激或受损约15-30m，圆形、椭圆或不规则形，核在中心或偏位，胞浆多，可有空泡7、狼疮细胞：偶见于SLE患者的浆膜液中8、癌细胞：大量形态不规则、胞体大小不等、核偏大并可见核仁及胞质染色较深的细胞，应高度重视 9、浆细胞：少量出现没有重要临床意义；若在胸水中见到较多的浆细胞，可能是增殖性骨髓瘤。,10、其 他1

6、）结晶：如胆固醇结晶，可见于陈旧性胸水中的脂肪变性及 胆固醇性胸膜炎的胸水中；无色透明，缺角四方形板状2）寄生虫：微丝蚴、阿米巴等3）脱落细胞学：病理科 怀疑恶性肿瘤时可用细胞玻片离心沉淀仪收集积液中细胞，作巴氏或H-E染色，如见有多量形态不规则，细胞胞体大小不等，核偏大并可见核仁及胞质受色较深的细胞应高度重视认真鉴别。必要时用多克隆或单克隆抗体作免疫组织化学检查。,浆膜腔积液脱落细胞学检查,恶性病变脱落细胞：浆膜腔积液中肿瘤细胞的来源：积液中以上的癌细胞是转移性的，原发性的恶性间皮瘤较少见。肿瘤性的胸水和心包水常见于肺癌、乳腺癌等，肿瘤性的腹水常见于卵巢癌、胃癌、肠癌、肝癌、胰腺癌等。原发性

7、的恶性间皮瘤，恶性淋巴瘤较少见。,浆膜腔积液脱落细胞学检查,腺癌：占积液中转移癌的80%以上，腺癌细胞形态多样，排列构成腺腔样、乳头状，洋葱皮和桑葚形状等等，腺癌细胞形态多样，细胞大小相差数倍，癌细胞呈圆或椭圆形，核偏位，核边不规则，核仁明显增大或多个核仁，胞浆中常含空泡，常见异常分裂象。,腺癌 Adenocarcinoma,Adenocarcinoma is the most common cause of a malignant effusion.Among the most useful features in the diagnosis of adenocarcinoma are in

8、creased N/C ratio,irregular nuclear membranes,large nucleoli,secretory vacuoles,and three-dimensional aggregates,腺癌 Adenocarcinoma,腺癌 Adenocarcinoma,The general patterns of adenocarcinomas in fluids include cell balls(morulas),papillary or acinar groups,signet ring cells,腺癌 Adenocarcinoma,Papillary

9、groups are elongated,three-dimensional aggregates.Psammoma bodies may be present.Adenocarcinomas of the lung(illustrated here),breast,and female genital tract are common sources,腺癌 Adenocarcinoma,Signet ring cells are cells with large cytoplasmic vacuoles that compress the nucleus to the periphery o

10、f the cell Large signet ring cells are characteristic of carcinoma of the stomach.(Oil),腺癌 Adenocarcinoma,Indian files,Chains of tumor cells,particularly when long,suggest breast cancer.However,other possibilities,such as pancreas or lung cancers as well as mesothelioma,must also be considered.,浆膜腔积

11、液脱落细胞学检查,鳞状细胞癌：在积液中少见，仅占2%-3%。高分化鳞癌，细胞奇形怪状，胞浆有角化倾向。癌细胞单个散在，细胞为圆形，胞核居中，核质深染，胞浆厚实并界限清晰，癌细胞易成堆或成团，背景中伴有或不伴有坏死物。,鳞状细胞癌 Squamous Cell Carcinoma,Irregularly shaped cells Irregularly shaped cells are abnormal and suggest malignancy,such as keratinizing squamous cell carcinoma,浆膜腔积液脱落细胞学检查,小细胞型未分化癌：在积液中也很少见

12、，为3%-5%，癌细胞呈葡萄堆状排列，细胞重叠，胞浆极少或裸核样，核形不规则，典型者为瓜子状或燕麦状，亦有圆或椭圆形，核染色质粗颗粒或呈块状。,小细胞型未分化癌 Small Cell Carcinoma,Small cell(neuroendocrine)carcinoma,is characterized by small to medium-sized cells with scant cytoplasm,inconspicuous nucleoli,and prominent molding and indian file arrangements.,浆膜腔积液脱落细胞学检查,间皮瘤（mesothelioma)原发于浆膜，良性间皮瘤生长局限，包膜完整，很少引起积液；恶性间皮瘤可见到大量增生活跃的间皮细胞，间皮细胞的恶性特征与转移性腺癌类似，细胞呈团或相嵌，单凭光镜不能明确诊断，应辅以电镜和免疫细胞化学技术，临床表现及影象学的诊断进行鉴别。,间皮瘤（mesothelioma),Mesothelioma.A clue to the diagnosis is more and bigger cells,in more and bigger clusters.The groups often have very irregular outlines.,