CYTOLOGY OF BODY
FLUID
Schematic representation of the three body cavities
Accumulation of fluids in body cavities
Transudates
• Increased hydrostatic pressure: Congestive heart
failure
• Decreased oncotic pressure (decreased albumin) :
liver cirrhosis, nephrosis, and malnutrition
Exudate
• Inflammation: Infection, infarction, hemorrhage
• Tumor
DIFFERENCES BETWEEN TRANSUDATE AND EXUDATE
Feature
Transudate
Exudate
Gross appearance
Watery, clear
Turbid or cloudy
Specific gravity
Less than 1015
More than 1015
Protein
Less than 3mg/dl
More than 3mg/dl
Clots
cells
No
Usually benign:
Few
Yes
More mesothelial cells,
mesothelial acute
or
cells, few histocytes inflammatory
and lymphocytes
chronic
cells,
RBCs, malignant cells
DIAGNOSTIC ROLE OF EFFUSION CYTOLOGY
 It
is very useful for diagnosis of premalignant and
malignant tumors, especially metastatic tumors.
 It
is very useful for diagnosis of inflammatory
conditions (septic effusion, or chronic specific
inflammation e.g. TB
Non-Gynecological Specimen Collection
 Respiratory
 Urinary
 Oral
Tract
Tract
Cavity
 Gastrointestinal
 Effusions
 Cerebral
(pleural, pericardial, joint)
Spinal Fluid
 Amniotic

Tract
fluid
Many other body sites
EXAMINATION OF BODY FLUID
 Gross
 Total
exam
cell count
 Microscopic
 Any
exam
other special test (Chemistry, Microbiology,
cytology(
 Test
are performed in various areas of lab based on what
the physician orders.
 Body
fluids sterile vs. non-sterile
SAMPLE COLLECTION

FNA of effusion fluids

Tapping
Collection and preparation of specimen
FIXATION
 1ml
of heparin + 100ml of effusion fluid to prevent
clotting
 N.B.:
do not use alcohol in fixation of fluid before
spread cytological smear on glass slides
TYPES OF STAINING SMEARS
 PAP
 Gram
 Hx
Stain
&E
 Cell
block for remnant sediment and histopathological
examination.
 Other
special stains for the most suspected diseases, to
confirm diagnosis.
Cell block
Adding plasma and thrombin
solution
Wrapped in filter paper
Heparinized
bottles (3 units
heparin/ml)
Unfixed
Cytocentrifuge preparation
Alcohol-fixed
Papanicolaou-stained
Placed in a cassette
Air-dried cytocentrifuge preparation
Embedded in paraffin
(Hematologic malignancy is
suspected)
Cut and H&E stain
1- CEREBROSPINAL FLUID
 Fluid
surrounding brain and spinal cord
 Sterile
 Specimen
 Collect
 Gross
count
collection: by Lumbar puncture
3-5 vials, each tube has a designated department.
exam: Turbidity, Color, microscopic exam, cell
CSF CELL DIFFERENTIAL
 Numerate
and differentiate cells seen
 Lymphocytes:
usually are few; increased with viral,
fungal, bacterial meningitis, or nervous system disease
 Monocytes:
Less than 2% of normal CSF, increased
with TB meningitis, viral encephalitis, subarachnoid
hemorrhage.

PMN: are few, associated with Viral and acute bacterial
inflammation.

Macrophages: are few in number associated with malignancy,
hemorrhage, inflammation
 Eosinophils/Basophils:
not normally seen in CSF

Plasma cells: not normally present; associated with viral disorders,
and Hodgkin's diseases.

Red Blood Cells: Few to none present

Mesothelial cells: not present

Malignant cells: will see with malignant disease and infiltrate.
2- Pleural Fluid: Lung fluid
•
Effusion:
•
Transudate
•
Exudates
•
Lab analysis: Gross exam, cell count, etc.
•
Differential: PMN, Lymph, Mono, etc.
•
Cells unique to the lungs: Mesothelial cells
•
RBCs and WBCs: are limited, if increased without
traumatic tap ----- indicates infarction
•
Cytology exam: useful in identifying malignancy or
abnormal morphological cells.
3- PERITONEAL FLUID
 Abnormal
accumulation of fluid (effusion) in peritoneal
cavity: Ascites
 Ascites:
a condition in which fluid accumulates within
the peritoneal space.

Must have an accumulation of > 100ml (several 100) before effusion
can be detected on physical exam.
paracentesis

Removal procedure-

Lab analysis: distinguish between transudate and exudates,
gross exam, cell count, sedimentation, chemical analysis
PHYSICAL CHARACTERISTICS
 Peritoneal

Fluid Appearance: Color and clarity.
Color and clarity can indicate certain infections and diseases.
 Total
Cell Count: Assist in diagnosis of certain
diseases by determining total RBC and WBC number.
 Lymphocytes:
 Mesothelial
 Malignant
CHF, liver cirrhosis, nephrotic syndrome
Cells: Associated with TB effusions
cells: seen with malignancy
4- Pericardial Fluid
 Pericardial
Fluid: accumulation of fluid of the lining of
the heart (effusion)
 Cause:
neoplasm, infections, collagen disease, renal
disease, Cardiovascular disease.
 Gross
Exam: Report appearance (bloody, clear, cloudy)

Measure pH: pH less than 7.0 associated with infection or
rheumatoid disorder.

Cell count: see limited RBCs and WBCs
Evaluate sedimentation
5- Seminal Fluid
•
Examine physical, chemical and microscopic detail
•
Count number of sperm, report morphology and
motility
•
Specimen must be a fresh collection-clean, sterile
container.
•
Gross Exam: Color, pH, Volume, and viscosity.
•
Agglutination study
6- Synovial Fluid:
•
Joint Fluid: normally clear, viscous
•
•
Functions as a lubricate and transports nutrient
Arthrocentesis: aspirate of the joint fluid, aseptic
technique
•
Lab Assay: Gross exam, microscopic exam, Gram
stain, cultures,...
•
•
Appearance: clear, transparent, viscous
•
Viscosity test
•
Mucin Clot test
•
Note crystals (intracellular vs. extra cellular)
Slide exam: usually performed on concentration of the fluid
using Giemsa or Papnicolaou
THANK YOU