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1、细针吸取细胞学检查细针吸取细胞学检查(fine needle aspiration cytology)使用细针穿刺病灶吸取出少量细胞成分作涂使用细针穿刺病灶吸取出少量细胞成分作涂片来观察病灶部位肿瘤或非肿瘤性细胞的形片来观察病灶部位肿瘤或非肿瘤性细胞的形态，从而作出诊断。态，从而作出诊断。细针吸取活检细针吸取活检( fine needle aspiration biopsy )细针细胞病理细针细胞病理(fine needle aspiration cytopathology)细针吸取细胞学检查细针吸取细胞学检查(fine needle aspiration cytology)Advantage
2、sThe advantages of FNA biopsy can be summed up in the acronym SAFE. It is Simple, Accurate, Fast, and Economic, as well as safe. 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-seated organs, such as lung, liver, pancreas, kidney, or adrenal, is in
3、many ways similar to, but in some ways different from, FNA biopsy of superficial targets. Ultrasound, Computered Tomography Guiding the Needle细针吸取细胞学检查细针吸取细胞学检查(fine needle aspiration cytology)Disadvantages样本采集样本采集涂片制作涂片制作细胞学诊断细胞学诊断淋巴结针吸细胞学检查淋巴结针吸细胞学检查 淋淋巴巴结结针针吸吸细细胞胞学学检检查查：操操作作简简便便，快快速速安安全全，对对于于明明确确
4、淋淋巴巴结结良良恶恶性性病病变变的的性性质质、快快速速诊诊断断淋淋巴巴结结疾疾病病，包包括括各各类类反反应应性性增增生生和和淋淋巴巴结结转转移移癌癌及及恶恶性性淋淋巴巴瘤瘤，具有临床实用价值。具有临床实用价值。正常淋巴结细胞学正常淋巴结细胞学正正常常淋淋巴巴结结穿穿刺刺涂涂片片标标本本淋淋巴巴细细胞胞占占95%95%以以上上，以以成成熟熟小小淋淋巴巴细细胞胞为为主主，其其余余5%5%为为幼幼淋淋巴巴细细胞胞、原原淋淋巴巴细细胞胞、网网状状细细胞胞和浆细胞等。和浆细胞等。正常淋巴结细胞学正常淋巴结细胞学Lymphocytes. Benign, reactive pattern, with pre
5、dominance of small, mature lymphocytes, a range of maturation of immature lymphocytes, and a fully differentiated plasma cell. (Diff-Quik) 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) 正常淋巴结细胞学正常淋巴结细胞学Tingible body
6、macrophages. 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) 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：慢性淋巴结炎：本病常见，多由局部慢性感染引起，好发本病常见，多由局部慢性感染引起，好发于颈部、颌下和腹股沟等处；于颈部、颌下和腹股沟等
7、处；涂片内有大量小淋巴细胞，夹有少量转化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；的淋巴细胞及组织细胞，有吞噬现象； 慢性淋巴结炎慢性淋巴结炎慢性淋巴结炎慢性淋巴结炎 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 overa
8、ll predominance of small, mature lymphocytes. Tingible body macrophages and lymphohistio-cytic aggregates also present. Mitotic figures may be seen. (Diff-Quik). 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 r
9、esulting in characteristic full range of maturation 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. 淋巴结良性病变针吸细胞检查淋巴结良性病变针吸细胞
10、检查 2.2.急性淋巴结炎：急性淋巴结炎：早期病变涂片内有大量小淋巴细胞，及少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；量转化的淋巴细胞及组织细胞；炎症转为急性化脓性时，见大量中性粒细炎症转为急性化脓性时，见大量中性粒细胞及其退化、坏死。胞及其退化、坏死。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 3.3.结核性淋巴核性淋巴结炎炎 ：涂片内涂片内见到具有到具有诊断意断意义的的类上皮上皮细胞、胞、郎罕巨郎罕巨细胞及干酪胞及干酪样坏死。坏死。抗酸染色可找到抗酸染色可找到结核杆菌。核杆菌。结核性淋巴结炎结核性淋巴结炎 Granulomatous lymphadenit
11、isGranulomas are characterized by nodular collections of epithelioid histiocytes; giant cells are optional. In Diff-Quik, the epithelioid histiocytes have elongated nuclei and abundant, dense, slightly fibrillar cytoplasm. 结核性淋巴结炎结核性淋巴结炎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
12、为无痛性淋巴结的恶性肿瘤，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。淋巴结、肝脾和（或）骨髓受累。 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细胞学诊断主要依据是出现典型的R-S细细胞胞 (Reed-Sternberg cell, R-S cell) 及其变及其变异型异型R-S细胞，背景是各种反应性增生样细胞，背景是各种反应性增生
13、样淋巴细胞。淋巴细胞。 R-S细胞形态特点细胞形态特点霍奇金淋巴瘤霍奇金淋巴瘤（Hodgkins Disease, HD）Classic Reed-Sternberg cells Benign, reactive inflammatory background 霍奇金淋巴瘤霍奇金淋巴瘤（Hodgkins Disease, HD）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 the prope
14、r milieu, ie, a benign, reactive chronic inflammatory background. (Diff-Quik) 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) 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细胞学特征是肿瘤细胞形态单一, ,多以一多以一种细胞为主细胞丰富，
15、多弥散分布，种细胞为主细胞丰富，多弥散分布，细胞核有异型性，可见核膜皱褶，核沟细胞核有异型性，可见核膜皱褶，核沟深浅不一深浅不一 非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins Lymphoma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
16、 body macrophages, lymphohistiocytic aggregates, and mitotic figures are not seen. (Diff-Quik) 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) 非霍奇金淋巴瘤非霍奇金淋巴瘤 Non-Hodgkins LymphomaSmall (well-di
17、fferentiated) lymphocytic lymphoma. Small, mature lymphocytes. The same cells may be circulating in the blood (chronic lymphocytic leukemia)-an important diagnostic clue. (Diff-Quik, oil) 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 maligna
18、nt cells are slightly larger, with slightly less dense chromatin, compared with normal mature lymphocytes, but nuclear membranes remain smooth. (Diff-Quik, oil) 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 mo
19、rphologically and clinically similar to small lymphocytic lymphoma, except for the presence of plasmacytoid lymphocytes and a few plasma cells. (Diff-Quik, oil) 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
20、is medium-sized cells with smooth or convoluted (illustrated, Diff-Quik, oil) nuclei and scant cytoplasm. 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，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，并可而隐蔽，常借针吸细胞学而获诊，并可推断其原发部位。推断其原发部位。 鳞状细胞癌淋巴结转移鳞状细胞癌
21、淋巴结转移腺癌淋巴结转移腺癌淋巴结转移甲状腺癌淋巴结转移甲状腺癌淋巴结转移小细胞未分化癌淋巴结转移小细胞未分化癌淋巴结转移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。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。断和细胞类型的鉴别则有一定参考价值。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、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头颈及外阴部，
22、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。等、弥散分布的棕色黑色素颗粒。 乳腺针吸细胞学检查乳腺针吸细胞学检查 (fine needle aspiration cytology of breast) 乳腺针吸细胞学检查操作简便、安全迅乳腺针吸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，快速诊断早期乳腺良恶性病变的性质，
23、快速诊断早期乳腺癌，具有临床实用价值。癌，具有临床实用价值。 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。胞、泡沫细胞、吞噬细胞和脂肪细胞。 Breast (tissue)Duct and lobule of normal breast. In the nonlactating breast, the lobule is composed of terminal ducts
24、 and ductules. Breast (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.乳腺导管上皮细胞乳腺导管上皮细胞
25、Ductal cellsBenign ductal cells are usually seen in breast aspirates as highly cohesive, small epithelial cells, often in flat, honeycombed sheets, reminiscent of endocervical cells. (Pap) 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
26、benign aspirates. The nuclei are uniform and have smooth nuclear membranes. The chromatin is fine; nucleoli are inconspicuous. (Diff-Quik) 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 b
27、land, and stripped of their cytoplasm.The presence of myoepithelial cells or their sentinel nuclei is a hallmark of a benign breast aspirate. 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
28、 nuclei. (Diff-Quik, oil) 肌上皮细胞肌上皮细胞 Myoepithelial cellsMyoepithelial cells. Naked, bipolar nuclei in Pap. (Oil) 乳腺正常细胞学乳腺正常细胞学泡沫细胞泡沫细胞 Foam cellsFoam cells. Probably bone marrow-derived histiocytes, these cells have abundant, foamy cytoplasm and are associated with cysts. (Diff-Quik) 乳腺良性病变针吸细胞检查1.
29、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；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，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。导管上皮细胞一般较为少见。 乳腺炎症乳腺炎症 Inflammation乳腺炎症乳腺炎症 InflammationSubareolar abscess. Specific
30、variant of breast abscess that may require excision for cure. In essence represents exuberant, acute, and granulomatous inflammatory response to squamous material. (Pap) 乳腺炎症乳腺炎症 InflammationSubareolar abscess. The squames usually stain purple/blue in Diff-Quik (illustrated). 乳腺良性病变针吸细胞检查2.慢性囊性乳腺病慢性
31、囊性乳腺病 此病属乳腺异常增生症，多此病属乳腺异常增生症，多见于年于年龄较大的大的妇女，女，为界限不清的界限不清的结节，质稍硬，可有乳稍硬，可有乳头溢液溢液排排出；出；涂片涂片见泡沫泡沫细胞增多，有胞增多，有时成群出成群出现；亦可；亦可见排列排列紧密的密的导管上皮管上皮细胞或大汗腺化生的胞或大汗腺化生的导管上皮管上皮细胞。胞。 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。乳头溢液常为血性，有时为浆液性。涂涂片片中中细细胞胞排排列列呈呈分分枝枝状状或或乳乳头头状状，细细胞胞相相互互挤挤压压，排排列列紧紧密密，核核轻轻度度异异型型，形形成成镶镶嵌嵌状状
32、；可可见见泡泡沫沫细细胞胞及及大大吞噬细胞吞噬细胞。乳腺导管内乳头状瘤乳腺导管内乳头状瘤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 肿块为圆形形结节，有有包包膜膜，可可活活动，多无乳多无乳头溢液，溢液，涂涂片片中中可可见淡淡红或或淡淡兰色色云云雾状状无无结构构粘粘液液物物质，可可见梭梭形形的的成成纤纤维维细细胞胞，和成和成团脱落的脱落的导管上皮管上皮细胞。胞。乳腺纤维腺瘤乳腺纤维腺瘤 FibroadenomaTissue showing loose myxoid stroma Epithelial proliferation with sharp demarcation from s
33、urrounding dense stroma. 乳腺纤维腺瘤乳腺纤维腺瘤 FibroadenomaThe cytologic studies of fibroadenomanumerous epithelial cells, naked oval nuclei, stromal fragments 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 fragmen
34、t, arrow). (Pap) 乳腺纤维腺瘤乳腺纤维腺瘤 FibroadenomaThe three classic findings in fibroadenoma Epithelial cellsNaked, oval nucleiStroma (arrow)乳腺纤维腺瘤乳腺纤维腺瘤 FibroadenomaFibroadenoma. Large, honeycombed sheets are also a common finding in fibroadenoma (Pap). 乳腺纤维腺瘤乳腺纤维腺瘤 FibroadenomaFibroadenoma. Antler-like pa
35、pillary fronds are particularly characteristic of fibroadenoma. 乳腺纤维腺瘤乳腺纤维腺瘤 Fibroadenoma乳腺癌针吸细胞检查乳腺癌针吸细胞检查乳乳腺腺癌癌是是妇妇女女最最常常见见的的恶恶性性肿肿瘤瘤，发发生生于于20207070岁，以岁，以40405050岁最多。岁最多。目目前前认认为为乳乳腺腺癌癌最最有有效效的的诊诊断断办办法法是是X X线线检查和针吸细胞学检查。检查和针吸细胞学检查。临临床床表表现现为为：乳乳房房肿肿块块质质地地坚坚硬硬，固固定定不不活活动动，界界限限不不清清。当当肿肿瘤瘤转转移移至至淋淋巴巴结结时时，
36、腋下可触及肿块。腋下可触及肿块。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：涂涂片片中中细细胞胞数数量量丰丰富富，细细胞胞排排列列紊紊乱乱无无极极性性，细细胞胞及及细细胞胞核核明明显显增增大大，大大小小不不等等，异异型型明明显显，核核深染，有核仁。深染，有核仁。乳乳腺腺癌癌类类型型有有髓髓样样癌癌、硬硬癌癌、单单纯纯癌癌、导导管管内内癌癌、黏黏液液癌癌、大大汗汗腺腺样样癌癌、小小管管癌癌或或称称腺腺管管癌癌、小小叶叶癌、炎性乳癌和佩吉特病（癌、炎性乳癌和佩吉特病（PagetsPagets Disease Disease）。）。乳腺癌乳腺癌 Breast CancerTwo ke
37、y 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) 乳腺癌乳腺癌 Breast CancerTo be completely diagnostic, the cells should show obvious cytologic atypia Note the
38、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. 乳腺癌乳腺癌 Breast CancerLoose aggregation of cells, with single cells falling away from groups. N
39、ote the nuclear enlargement, which is greater than two RBC diameters, and the absence of naked, bipolar nuclei. 乳腺癌乳腺癌 Breast Cancer乳腺癌形态特点乳腺癌形态特点乳腺癌形态特点乳腺癌形态特点乳腺癌腋下淋巴结转移乳腺癌腋下淋巴结转移乳腺癌腋下淋巴结转移乳腺癌腋下淋巴结转移乳腺癌乳腺癌 Breast CancerThe presence of intracytoplasmic lumens, which are sharply demarcated, secretory
40、 vacuoles containing inspissated mucin, is highly suggestive of breast cancer. Lobular carcinoma is illustrated. (Pap) 乳腺癌乳腺癌 Breast CancerThe presence of intracytoplasmic lumens, which are sharply demarcated, secretory vacuoles containing inspissated mucin, is highly suggestive of breast cancer (Diff-Quik, oil). The mucin tends to stain metachromatically (pink) in Diff-Quik. 胰腺针吸细胞检查胰腺针吸细胞检查正常正常胰腺细胞学胰腺细胞学胰腺炎细胞学检查胰腺炎细胞学检查胰腺癌细胞学检查胰腺癌细胞学检查思考题思考题试述霍奇金淋巴瘤试述霍奇金淋巴瘤R-SR-S细胞形态特点细胞形态特点 试述结核性淋巴结炎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纤维腺瘤形态特点 试述乳腺癌形态特点试述乳腺癌形态特点
