Canine and Feline Cytology: A Color Atlas and Interpretation Guide

456 Pages·2009·182.84 MB·English

by  Rose E. Raskin DVM PhD DACVP

11830 Westline Industrial Drive
St. Louis, Missouri 63146
CANINE AND FELINE CYTOLOGY: A COLOR ATLAS AND INTERPRETATION
GUIDE, SECOND EDITION ISBN: 978-1-4160-4985-2
Copyright © 2010, 2001 by Saunders, an imprint of Elsevier Inc.
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Notice
Neither the Publisher nor the Authors assume any responsibility for any loss or injury and/or damage
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the responsibility of the treating practitioner, relying on independent expertise and knowledge of
the patient, to determine the best treatment and method of application for the patient.
The Publisher
ISBN: 978-1-4160-4985-2

Vice President and Publisher: Linda Duncan
Senior Acquisitions Editor: Anthony Winkel
Developmental Editor: Maureen Slaten
Publishing Services Manager: Julie Eddy
Senior Project Manager: Andrea Campbell
Designer: Margaret Reid
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Contributors
A. Rick Alleman, DVM, PhD, DABVP, DACVP Mary Jo Burkhard, DVM, PhD, DACVP
(Companion Animal Practice) Associate Professor
Professor, Clinical Pathology Department of Veterinary Biosciences
Department of Physiological Sciences College of Veterinary Medicine
College of Veterinary Medicine The Ohio State University
University of Florida Columbus, Ohio
Gainesville, Florida Chapter 5: Respiratory Tract
Chapter 16: Endocrine System
Ul Soo Choi, DVM, PhD
Claire B. Andreasen, DVM, PhD, DACVP Instructor
Professor and Chair Department of Veterinary Clinical Pathology
Department of Veterinary Pathology College of Veterinary Medicine
College of Veterinary Medicine Chonbuck National University
Iowa State University Jeonju, Korea
Ames, Iowa Chapter 16: Endocrine System
Chapter 7: Oral Cavity, Gastrointestinal Tract, and
Associated Structures Sara L. Connolly, DVM
Department of Comparative Pathobiology
Anne C. Avery, VMD, PhD School of Veterinary Medicine
Associate Professor Purdue University
Department of Microbiology, Immunology and West Lafayette, Indiana
Pathology Chapter 1: The Acquisition and Management of
College of Veterinary Medicine & Biomedical Sciences Cytology Specimens
Colorado State University
Fort Collins, Colorado Keith DeJong, DVM
Chapter 17: Advanced Diagnostic Techniques Department of Pathology, Microbiology & Immunology
School of Veterinary Medicine
Paul R. Avery, VMD, PhD, DACVP University of California, Davis
Assistant Professor Davis, California
Department of Microbiology, Immunology and Chapter 10: Urinary Tract
Pathology
College of Veterinary Medicine & Biomedical Sciences Davide De Lorenzi, DVM, DECVP
Colorado State University Specialist, Clinic and Pathology of Companion Animals
Fort Collins, Colorado San Marco Veterinary Clinic
Chapter 17: Advanced Diagnostic Techniques Padua, Italy
Chapter 14: The Central Nervous System
Anne M. Barger, DVM, MS, DACVP
Clinical Associate Professor, Pathobiology Hock Gan Heng, DVM, MVS, MS, DACVR, DECVDI
Clinical Associate Professor, Veterinary Diagnostic Clinical Assistant Professor
Laboratory Department of Veterinary Clinical Sciences
College of Veterinary Medicine School of Veterinary Medicine
University of Illinois at Urbana-Champaign Purdue University
Urbana, Illinois West Lafayette, Indiana
Chapter 13: Musculoskeletal System Chapter 1: The Acquisition and Management of
Cytology Specimens
Dori L. Borjesson, DVM, PhD, DACVP
Associate Professor Albert E. Jergens, DVM, MS, PhD, DACVIM
Department of Pathology, Microbiology & Associate Professor and Section Head
Immunology Professor, Small Animal Medicine
School of Veterinary Medicine Department of Veterinary Clinical Sciences
University of California, Davis College of Veterinary Medicine
Davis, California Iowa State University
Chapter 10: Urinary Tract Ames, Iowa
Chapter 7: Oral Cavity, Gastrointestinal Tract, and
Associated Structures
v
vi CONTRIBUTORS
Maria Teresa Mandara, DVM Laia Solano-Gallego, DVM, PhD, DECVCP
Associate Professor, Neuropathology Laboratory Lecturer, Veterinary Clinical Pathology
Department of Biopathological Science and Hygiene Department of Pathology and Infectious Diseases
of Animal and Food Production The Royal Veterinary College
School of Veterinary Medicine North Mymms
University of Perugia Hatfi eld, Hertfordshire, United Kingdom
Perugia, Italy Chapter 12: Reproductive System
Chapter 14: The Central Nervous System
Craig A. Thompson, DVM, DACVP
Laurie M. Millward, DVM Clinical Assistant Professor of Clinical Pathology
Goss Laboratory Department of Comparative Pathobiology
Department of Veterinary Biosciences School of Veterinary Medicine
College of Veterinary Medicine Purdue University
The Ohio State University West Lafayette, Indiana
Columbus, Ohio Chapter 6: Body Cavity Fluids
Chapter 5: Respiratory Tract
Heather L. Wamsley, DVM, DACVP
José A. Ramos-Vara, DVM, PhD, DECVP Assistant Professor, Clinical Pathology
Associate Professor of Veterinary Pathology Department of Physiological Sciences
Animal Disease Diagnostic Laboratory College of Veterinary Medicine
School of Veterinary Medicine University of Florida
Purdue University Gainesville, Florida
West Lafayette, Indiana Chapter 8: Dry-Mount Fecal Cytology
Chapter 17: Advanced Diagnostic Techniques
Alan H. Rebar, DVM, PhD, DACVP
Executive Director of Discovery Park
Senior Associate Vice President for Research
Professor of Veterinary Clinical Pathology
School of Veterinary Medicine
Purdue University
West Lafayette, Indiana
Chapter 6: Body Cavity Fluids
From Rose:
To my parents who always supported my career goals and provided
a loving environment, I will never forget them.
To my teenage daughter Hannah, who endured my absence many evenings and weekends
during the creation of this second edition and I hope understood the passion I had for this
project, you are still the love of my life.
To my brother Richard, other family members, and my lifetime best friends (you know
who you are), I am eternally grateful for your love and understanding.
From Denny:
To my dad, who instilled in me by his example a work ethic and lifestyle founded on fi rm
principles. Whenever thoughts of him fl oat through my memory, a smile appears on my
face . . . and to Mary, his walking and prayer partner in life.
To my wife, who reminds me that a successful life is a balance of personal well-being
and professional obligations . . . although I am not always a good listener.
To my son, Christopher, and daughter-in-law, Claudia, who amplifi ed our family love between
the fi rst and second editions with the sequential arrival of Alexander and Alexis.
To my daughter, Jeni, and son-in-law, Ross, who infused me
with added joy with the birth of Bianca Jenifer.
To my brother, Michael, who is . . . well . . . a great brother to me and extended family.
From Both:
To all the veterinary students, residents, and practitioners who have touched our lives
and made us feel that what we do is worthwhile, we thank you.
Preface
“Another source of fallacy is the vicious circle of illu- who injected their pragmatic microscopic expertise into
sions which consists on the one hand of believing what expanded existing chapters, and adding a new chapter
we see and, on the other, seeing what we believe.” on fecal cytology. The enhanced portfolio of images has
– Sir Clifford Allbutt, M.D. (1836-1925). He introduced also been made possible by the helpful assistance of
the diagnostic use of the microscope other benevolent cytopathologists, who generously con-
to the hospital ward. tributed photomicrographs from their collections.
A signifi cant expansion involved the chapter on ad-
The objective of the fi rst edition of the Atlas was to com- vanced techniques to include more methodology and
pile a practical guide to cytopathology that focused application of some current tools such as immunochem-
primarily on the types of lesions that clinicians faced in istry, electron microscopy, fl ow cytometry, and molecular
routine practice, yet be a user-friendly teaching tool for testing. The challenge was to accommodate the recom-
the soon-to-be practitioner. We used tables, brief descrip- mended changes without obfuscation of the Atlas’ in-
tions, and carefully selected photomicrographs accumu- tended objective of a practical, user-friendly cytologic
lated over decades of diagnostic cytology with concise, compilation, which was the successful foundation of the
informative fi gure legends to support the microscopic fi rst edition. It is our hope that, by careful editing to en-
examination of the cytology specimen. We attempted sure a clear and concise narrative, seamless integration of
to organize the presentations into logical and uniform new and updated information into the existing text, judi-
approaches, thereby facilitating readability, comprehen- cious selection of new and enhanced photomicrographs,
sion, and learning. Based on the robust positive feedback and the use of lists that highlight criteria for differential
we received, we are pleased to surmise that we have diagnosis, we have produced a second edition that will
generally achieved that objective. continue to fi nd preferred residence beside the micro-
Constructive suggestions indicated that the cytopa- scope because of its usefulness.
thologist desired additional lesions be covered, including We present the second edition with considerable ex-
those less commonly encountered, more histopathology citement and hope that we have succeeded in transmit-
correlates, and a broader use of stains and immunocyto- ting to the user the beauty of the expanded application
chemistry for differential cytologic characterization. The of diagnostic cytology. We share in the exhilaration of the
encouragement incentivized us, in this new edition, to microscopist when the unknown cytologic specimen is
expand the photomicrograph portfolio, including more translated into a cytologic diagnosis, i.e., “believe in
comparative histology, and the attendant text and refer- what they see,” with the guidance of this Atlas.
ences. This was accomplished by adding new authors Rose & Denny
ix
Acknowledgments
Teamwork (cid:3) Cooperative effort by the members of a • Dr. Kristin Henson – Reproductive System
group or team to achieve a common goal. • Dr. Kathleen Freeman – Central Nervous System
Achievement (cid:3) Something accomplished successfully, • Drs. Janice Andrews and David Malarkey – Advanced
especially by means of exertion, skill, practice, or per- Diagnostic Techniques
severance. We also wish to extend our appreciation to those cy-
—American Heritage Dictionary, 4th edition tologists who selfl essly contributed photomicrographs
and are acknowledged in the fi gure legends. Notably,
An Atlas that successfully covers the broad scope of cyto- Denny thanks his longtime friend and colleague, Dr. Dave
logic fi ndings described and illustrated in the second edi- Edwards, for his impressive contributions to the liver
tion cannot be completed without the assistance of many chapter. Denny also takes the opportunity to acknowl-
individuals, most of whom are transparent to us. You edge Rose. She was clearly the indefatigable driving force
know who you are and thanks and gratitude are owed to of the second edition and her passionate commitment to
all of you for help in various ways. Noteworthy recogni- exhaustive completeness, accuracy, and detail translated
tion of folks at Elsevier is extended to Dr. Anthony Winkel into differentiating excellence of the second edition.
for believing in us one more time, and Maureen Slaten, Lastly, we wish to express our sincere appreciation to
who exhibited remarkable patience as we missed time- the contributing authors of the second edition. They al-
lines, and administered respectful, tenacious encourage- truistically added one more burden to their primary
ment and prodding to keep the process in motion. Lastly, professional duties to share their cytologic expertise for
Andrea Campbell, who in the fi nal stages of the project betterment of veterinary patient care. They are repre-
was technically terrifi c, conscientious, attentive to details, sented both by the seasoned and the newer, most prom-
and responsive. ising purveyors of cytology today. Their collective exper-
We wish to salute the authors who contributed to the tise has markedly extended the range of information that
fi rst edition but were not involved in the second edition. is embedded in the second edition. We could not have
Their cytologic expertise contributed to its success and worked with a better group of professionals. Thanks for
provided a healthy foundation for the expansion of the successfully partnering with us; we hope you share in
second edition. The authors, a list that reads like recom- our pride with the fi nal product.
mended inductees into a Cytology Hall of Fame, include: Rose & Denny
• Drs. Amy Valenciano and Anne Barger – Respiratory
System
• Dr. Sonjia Shelly – Body Cavity Fluids
xi
1
C H A P T E R
The Acquisition and Management
of Cytology Specimens
Denny J. Meyer, Sara L. Connolly, and Hock Gan Heng
The classifi cation of events that depend on the accuracy of observation is limited by the ability of
the observer to describe and of the interpreter to decipher.
—Michael Podell, M.Sc., D.V.M.
For the microscopic examination of tissue, one impor- during the “searching” process of locating the tissue of
tant factor that affects the accuracy of observation is sampling interest. Coating the needle and syringe hub
specimen management. The successful use of aspiration with sterile 4% disodium EDTA before aspiration biopsy
cytology depends on several interrelated procedures: sampling of vascular tissues, notably bone marrow, re-
acquisition of a representative specimen, proper appli- duces the risk of clot formation that will compromise
cation to a glass side, adequate staining, and examina- the quality of the cytologic specimen. For the relatively
tion with a high-quality microscope. A defi ciency in one inexperienced, this may be a practice to consider rou-
or more of these steps will adversely affect the yield tinely when sampling any tissue. Clotted specimens are a
of diagnostic information. The objective of this chapter frequent cause of cytologic preps of poor quality.
is to provide general recommendations for managing The general steps for obtaining a cytologic specimen
samples in a way that ensures they are diagnosed are illustrated in Figure 1-1A. The tip of the needle is in-
accurately. serted into the tissue of interest, the plunger is retracted
slightly (1⁄2 to 1 cc of vacuum), the needle advanced and
retracted in several different directions, the plunger re-
GENERAL SAMPLING GUIDELINES
leased, the needle withdrawn, and the specimen placed
Before executing any sampling procedure, a cytology kit on a glass slide or in an EDTA (purple-topped) tube as
should be prepared and dedicated for that purpose. An appropriate. Commercial aspiration guns (Fig. 1-1B) are
inexpensive plastic tool caddie works well. Suggested con- available that can be loaded with various size syringes
tents are listed in Box 1-1. Six or more slides are placed on (Fig. 1-1B). The syringe plunger sits within the trigger,
a fi rm, fl at surface such as a surgical tray immediately be- which allows for easier and more stable retraction. If
fore initiating the sampling procedure. The surface of the fl uid is obtained from a mass lesion, the site is com-
glass slide should be routinely wiped with a paper towel, pletely drained, the needle withdrawn, the fl uid placed
or at least on a shirtsleeve, to remove “invisible” glass par- in an EDTA tube, and the procedure repeated with a
ticles that interfere with the spreading procedure. new needle directed at fi rm tissue. Both specimens are
Box 1-2 lists suggested indications for the application examined microscopically. To enhance operator fl exibil-
of diagnostic cytology. The collection of specimens for ity, intravenous extension tubing (Extension Set, Abbott
cytologic evaluation from cutaneous and subcutaneous Laboratories) can be used to attach the needle and sy-
tissues and abdominal organs and masses in smaller ani- ringe. Positioning and redirection of the needle is easier
mals is generally accomplished with a 20- or 22-gauge, and accommodates patient movement (Fig. 1-1C).
1- to 11⁄2-inch needle fi rmly attached to a 6- or 12-cc sy- Aspiration is not a prerequisite for obtaining a cyto-
ringe. For more diffi cult to reach internal organs, a 21⁄2- to logic specimen. A technique based on the principle
31⁄2-inch spinal needle is used. The added length amplifi es of capillarity, referred to as “fi ne-needle capillary
the area for cell collection and enhances the diagnostic sampling,” can be performed by placing a needle into
yield. Literally, cores of hepatic tissue can be obtained the lesion with or without a syringe attached (Mair
with the use of a longer needle. The stylet can be left in et al., 1989; Yue and Zheng, 1989). The technique
place as the cavity is entered to avoid contamination has been shown to have diagnostic sensitivity similar
1
2 CHAPTER 1 • The Acquisition and Management of Cytology Specimens
DIAGNOSTIC IMAGING GUIDED SAMPLE
BOX 1-1 Contents of the Cytology Kit
COLLECTION
Syringes: 6 to 12 cc Cytology sample collection can be performed via the
Needles: 1- and 11⁄2-inch—20- to 22-gauge; 21⁄2- or 31⁄2-inch guidance of fl uoroscopy, ultrasound, and computed to-
spinal needle with stylet mography. Ultrasound guidance is the preferred method
Scalpel blades: #10 and #11
of sampling collection because of its widespread avail-
Box of precleaned glass slides with frosted end
ability and portability. In addition, ultrasound provides
Tubes: EDTA (purple top) and serum (red top without
real-time monitoring of precise needle placement.
separator)
The technique and indications are detailed elsewhere
Rigid, fl at surface on which 6 to 10 slides can be spread out
Butterfl y catheters 21- to 23-gauge and intravenous (Nyland et al., 2002a). Ultrasound-guided fi ne-needle as-
extension tubing piration biopsy (FNAB) is indicated for cytologic evalua-
Pencil, permanent black marker (Sharpie), or slide-specifi c tion of nodules and masses detected on ultrasound
marker and to evaluate organomegaly when a diffuse cellular
4% sterile EDTA infi ltrate such as lymphoma and mast cell tumor is sus-
Hair dryer pected. Most sarcomas exfoliate sparsely or not at all.
A surgical or ultrasound-guided cutting needle biopsy
is recommended if the FNAB sample is not diagnostic.
Ultrasound-guided FNAB can be performed in most
patients without chemical restraint or local anesthesia.
BOX 1-2 General Indications for the Use
If chemical restraint is needed, agents that promote pant-
of Diagnostic Cytology
ing should be avoided because this will lead to excessive
movement and gas ingestion (Nyland et al., 2002a).
Effusions—thoracic, abdominal, and pericardial
Urine sediments, urinary bladder washing
Prostate—direct aspirate, washing Biopsy Guidance
Lymphadenopathy—focal, generalized
Examination for metastatic disease Ultrasound-guided FNAB can be performed by freehand
Diffuse organomegaly—liver, kidney, spleen technique or with the aid of a biopsy guide fastened
Cutaneous/subcutaneous mass, ulcerative lesion to the transducer. Freehand technique consists of hold-
Conjunctival/vitreous/aqueous cytology ing the transducer in one hand and inserting the needle
Pulmonary/nasal aspirates/brushings, bronchoalveolar/
with the other at an oblique angle to the long axis of
nasal washing/lavage
the transducer but still within the scan plane (Fig. 1-1D).
Unidentifi ed abdominal mass
This technique requires more skill but allows greater
Evaluation of a mass or lesion discovered intraoperatively
fl exibility. If the needle cannot be seen during the proce-
dure, slightly moving the transducer into the path of
the needle and gently agitating the needle or injecting
to that of aspiration biopsy when used to sample a microbubbles in saline solution through needle will usu-
variety of tissues. Its major advantage is to reduce ally allow the needle’s position to be determined. Better
blood contamination from vascular tissues such as visualization of the needle can be achieved by ensuring
liver, spleen, kidney, and thyroid. Cells are displaced needle placement within the focal zone of the trans-
into the cylinder of the needle by capillary action as ducer. The biopsy guide holds the needle fi rmly and
the needle is incompletely retracted and redirected directs the needle along a predetermined course within
into the tissue three to six times. Personal preference the scan plane of the ultrasound transducer (Fig. 1-1E).
is justifi ed when deciding between aspiration and This may be easier for the beginner as the lesion is more
nonaspiration sampling for collection of the specimen. easily and reliably sampled; however, the biopsy guide
Through trial and error the operator may determine limits transducer movement.
that each has value for sampling different tissues.
Equipment and Technique
KEY POINT Acquisition of the cytology specimen Sterility is maintained during the procedure. The trans-
is an art that can be honed only by practice. Select- ducer can be sterilized with transducer-compatible disin-
ing an appropriate mode of sampling enhances fectant and sterilizing solutions (a list of which can be
the probability of obtaining accurate diagnostic found in the user manual of the ultrasound machine).
information. Following the diagnostic ultrasound evaluation of the
site of interest, the coupling gel is wiped off and alcohol
or sterile water is used as the coupling media during the
FNAB procedure. The use of a coupling gel is avoided
KEY POINT Routinely dry-wipe the surface of the
because it can introduce potentially misleading artifact
glass slide to remove “invisible” glass particles that
into the cytologic specimen. Routine skin preparation
cause spreading defi ciencies. Never reuse washed
should be performed before the needle puncture through
glass slides.
the skin.
CHAPTER 1 • The Acquisition and Management of Cytology Specimens 3
B
A
C D
■ FIGURE 1-1. A, Aspiration biopsy technique. The needle
is inserted into the tissue and redirected three or four times
using either an aspiration or a nonaspiration technique. The
same concept generally applies to the use of the technique for
sampling sites within the thorax or abdomen. B, Aspiration
gun. The use of the aspiration gun facilitates better control
and more deliberate retraction during the aspiration process.
C, Butterfl y needle. Using a butterfl y needle attached to the
syringe will allow more fl exibility with fractious patients when
removing fl uid. A three-way stop-cock can be placed between
the butterfl y tubing and syringe to facilitate removal of large
amounts of fl uid. D, Ultrasound guidance. Free-hand tech-
nique for ultrasound-guided fi ne needle aspiration biopsy.
E, Ultrasound guidance. Biopsy guide is attached to a linear
transducer that holds a needle fi rmly for ultrasound-guided
fi ne needle aspiration biopsy. (A from Meyer DJ: The manage-
E ment of cytology specimens, Compend Contin Educ Pract Vet
9:10-17, 1987. B, Courtesy of Delasco.)
The most commonly used needles are 20- to 23-gauge before removing the needle from the lesion. When pos-
hypodermic and spinal needles. These are inexpensive sible, two or three samples should be obtained from each
and long enough to pass through the biopsy guide and biopsy site; a new needle is used for each sample taken.
still reach most lesions. Larger-bore needles are easier to A large lesion may have a necrotic center; therefore
visualize, and they generally increase the reliability of samples should also be collected from the margins.
sample collection but increase the risk of hemorrhage. A
larger-bore needle is used when aspirating viscous fl uids.
Complications
Once the needle is in placed in the lesion, the stylet is
removed and the needle is moved up and down within Complications associated with ultrasound-guided FNAB
the lesion until a small amount of fl uid is seen within the are uncommon and depend on the experience of the
hub of the needle (Fagelman and Chess, 1990). This operator, size of needle, and type of lesion aspirated
method generally produces a sample with less blood (Léveillé et al., 1993). Patients should be evaluated for
contamination. Alternatively, a syringe can be attached to bleeding disorders before FNAB, especially when highly
the needle for better handling—a few milliliters of nega- vascular tissues are sampled. Occasional needle tract tu-
tive pressure can be applied while moving the needle mor implantation has been reported in animals (Nyland
up and down. The negative pressure should be released et al., 2002b; Liu et al., 2007). In humans, implantation is