Description: Cellularity is high in a background of mild blood. There are numerous medium to large lymphocytes with slight anisocytosis and anisoakryosis. These cells have a high N:C ratio, round nuclei, fine chromatin and occasionally prominent nucleoli. They also have small amounts of basophilic cytoplasm, which is rarely vacuolated. Occasional mitotic figures are noted. These cells are interpreted as neopalstic lymphocytes. Rare neturophils are noted and are interpreted as within normal limit, most likely from blood contamination. No etiologic agents are seen.
Impression: Lymphoma. Recommend biopsy, flow cytometry or PCR clonality to determine cell lineage.
WEll, guys, do not worry about that you cannot recognize it. I will have a class " Cytology for dummies" pretty soooon. Will teach you read the slide step by step.
Large cell lymphoma is not very difficult to diagnose. But how could we do when in face of small cell (lymphocytic) lymphoma? We may miss that and fail to recommend lymph node biopsy.
Oh...how do you recognize it as a neutrophil with secondary granules? Any tips for you cytopathologists? I can't find it in my cytology atlas.
Samll cell lymphoma is hard. I think clinical presentation will be a big clue, (ex. generalized lymphoadenopathy). Otherwise,in cats, GI lymphoma may be samll cell, which is hard to rule out based on cytology.
Other cytological tips:1. the cells are "too uniform" 2. psudopodia formation. -->所以我的報告通常會加上一句話，if there is a clinical concern, recommend biopsy.
不過馬不羅你的確說到一個重點，這種clear cut的東西(ie lymphoblastic type lymphom) 臨床獸醫會就夠了，borderline的就交給我們吧:P
至於neutrophil，我是因為在猜你為啥會說他是Eos，可能是因為看起來粉紅粉紅顆粒狀，所以我就說那其實是neutrophl,看到的粉紅顆粒是他的2nd granules作為解釋而已 This is for your own benefit : )沒有啥tip耶，阿不就長的跟血片的neutrophil一樣??
11 則留言:
引導問題
1. 在圖形中間那個粉紅色的細胞是什麼?
2. 其他的細胞看起來像是同一種細胞還是mixed的細胞??
3. 這些細胞有什麼共同特徵以及不同的特徵??
媽壓 好吧...那我寫個專業文好了..拉拉拉...
Description:
Cellularity is high in a background of mild blood. There are numerous medium to large lymphocytes with slight anisocytosis and anisoakryosis. These cells have a high N:C ratio, round nuclei, fine chromatin and occasionally prominent nucleoli. They also have small amounts of basophilic cytoplasm, which is rarely vacuolated. Occasional mitotic figures are noted. These cells are interpreted as neopalstic lymphocytes. Rare neturophils are noted and are interpreted as within normal limit, most likely from blood contamination. No etiologic agents are seen.
Impression:
Lymphoma. Recommend biopsy, flow cytometry or PCR clonality to determine cell lineage.
Cindy~妳也太快了吧..
我故意過幾天才回的啊..
中間那個是eosinophil嗎..
well...that is a neutrophil. the pinkish stuff is secondary granules. I know, they should not so prominent.
WEll, guys, do not worry about that you cannot recognize it. I will have a class " Cytology for dummies" pretty soooon. Will teach you read the slide step by step.
Large cell lymphoma is not very difficult to diagnose. But how could we do when in face of small cell (lymphocytic) lymphoma? We may miss that and fail to recommend lymph node biopsy.
Oh...how do you recognize it as a neutrophil with secondary granules? Any tips for you cytopathologists? I can't find it in my cytology atlas.
Samll cell lymphoma is hard. I think clinical presentation will be a big clue, (ex. generalized lymphoadenopathy). Otherwise,in cats, GI lymphoma may be samll cell, which is hard to rule out based on cytology.
Other cytological tips:1. the cells are "too uniform" 2. psudopodia formation. -->所以我的報告通常會加上一句話，if there is a clinical concern, recommend biopsy.
不過馬不羅你的確說到一個重點，這種clear cut的東西(ie lymphoblastic type lymphom) 臨床獸醫會就夠了，borderline的就交給我們吧:P
至於neutrophil，我是因為在猜你為啥會說他是Eos，可能是因為看起來粉紅粉紅顆粒狀，所以我就說那其實是neutrophl,看到的粉紅顆粒是他的2nd granules作為解釋而已
This is for your own benefit : )沒有啥tip耶，阿不就長的跟血片的neutrophil一樣??
Eosinophil一般較大,和分葉比較少. 而且通常會有一點空泡.
除了greyhound外,一般canine eosinophil的granules都會在常用血液染色染成紅色(eosinophilic).
因為型態上差異, 所以在型態上判定是neutrophil, 再推斷那些granules屬於secondary granules? 就是說判讀granulocyte系列, 型態學比較準確?
血片上的neutrophils沒有那些像是eosinophilic granules的啊..
在我的筆記和圖譜找到答案了..
謝謝啊...臨病大美女
看到你的解釋我其實有點大驚，如果要我這麼解釋還真的很難，因為可能是我看習慣了吧，普通的細胞大致一眼就可以判定，要是問我如何判定，我可能還要想一下，看來我得重新思考如何教cytology了...
必須要注意的是，有些種類的secondary granules會染的比較明顯，比如說馬。 狗相對比較不明顯，貓有時候Neutrophil還會染的淡淡的blue。 Eso在各個動物也長的不太一樣，狗的紅顆粒就是圓的，而且會fusion在一起，偶爾可見vacuoles，貓的就是rods形狀，馬的就是超大顆的粉紅granules... Anyway, 有需要教到這麼多嗎??
啊..其實也是需要的..
因為一般GP看血片/細胞抹片一般不到專科/住院醫師的百分之五的量, 不可能養成那種"本能". 而且有一些guideline的話, 會比較容易培養"本能".
第二, granules的問題, 我找過Cowell及Canfield的cytology, Willard和Duncan的臨病都沒有; 只有Harvey血液學有提到..只有少翻一本書都可能會miss掉, 所以有提點的價值啊!
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