Methods of cytologic smear preparation and fixation. Effect on the immunoreactivity of commonly used anticytokeratin antibody AE1/AE3

OBJECTIVE: To evaluate the effect of fixation and methods of cytologic smear preparation on the immunoreactivity of commonly used anticytokeratin antibody AE1/AE3. STUDY DESIGN: Scrape cytology smears and formalin-fixed, paraffin-embedded tissue sections (FPTS) of 20 unfixed, fresh specimens submitted for intraoperative consultation were studied by the immunoperoxidase method. In addition to the morphologic examination, the smears and FPTS were evaluated for intensity and proportion scores. For each specimen, two scrape cytology smears were wet fixed in 95% ethanol, and 12 smears were air dried without fixation. Air-dried smears were either postfixed after rehydration in saline or fixed directly without rehydration by one of the three fixatives: alcoholic formalin, 95% ethanol with 5% acetic acid or 95% ethanol. RESULTS: Both intensity and proportion scores were higher with rehydrated, air-dried smears as compared to those without rehydration and were comparable to those with wet-fixed smears and FPTS. In the rehydrated group, the optimum results were achieved when the smears were postfixed with alcoholic formalin. CONCLUSION: The method of preparation and fixation had variable effects on the immunoreactivity of anticytokeratin antibody AE1/AE3. The optimum results were achieved with saline-rehydrated, air-dried smears post-fixed in alcoholic formalin. To evaluate the role of inter-sample variation, further, larger studies are recommended on this and other antibodies before applying them to different types of cytologic smears.     

Liquid-based vs. conventional smears in fine needle aspiration of bone and soft tissue tumors

OBJECTIVE: To compare the accuracy of fine needle aspiration cytology of bone and soft tissue tumors utilizing ThinPrep (TP) (Cytyc Corporation, Boxborough, Massachusetts, U.S.A.) vs. conventional smears (CS). STUDY DESIGN: Fine needle aspiration cytology from bone and soft tissue tumors was processed and assessed for cellularity, nuclear and cytoplasmic preservation, cellular architecture and stromal background with both the TP liquid-based smear technique and conventional methods. RESULTS: An accurate diagnosis was made in 13% of TP cases as compared to 64% in CS cases. CONCLUSION: CS of fine needle aspiration sample is far superior to TP in diagnosing tumors of bone and soft tissues. Preservation of cytoplasmic features and cellular architecture was superior in conventionally prepared smears.     

Effect of fixation on the antigenicity of human lactoferrin in paraffin-embedded tissues and cytocentrifuged cell smears.

Immunoperoxidase techniques were used to study the preservation of the antigenicity of human lactoferrin (LF) of polymorphonuclear neutrophils (PMN) and various exocrine glandular cells in paraffin-embedded tissue blocks and cytocentrifuged cell smears. Tissues fixed in Carnoy's fluid in contrast to other fixatives used, showed good preservation of LF antigenicity irrespective of the fixation time. Cell smears fixed in Carnoy's fluid showed diffuse nuclear and cytoplasmic staining for LF, although morphologic integrity was poorly preserved. Granular cytoplasmic staining for LF with no staining of nuclei was seen in cell smears fixed in buffered formol acetone for 2--10 min. The nature of nuclear LF staining and future applications of the present methods are discussed.     

Effect of fixation on the antigenicity of human lactoferrin in paraffin-embedded tissues and cytocentrifuged cell smears

Summary Immunoperoxidase techniques were used to study the preservation of the antigenicity of human lactoferrin (LF) of polymorphonuclear neutrophils (PMN) and various exocrine glandular cells in paraffin-embedded tissue blocks and cytocentrifuged cell smears. Tissues fixed in Carnoy's fluid in contrast to other fixatives used, showed good preservation of LF antigenicity irrespective of the fixation time. Cell smears fixed in Carnoy's fluid showed diffuse nuclear and cytoplasmic staining for LF, although morphologic intergrity was poorly preserved. Granular cytoplasmic staining for LF with no staining of nuclei was seen in cell smears fixed in buffered formol acetone for 2–10 min. The nature of nuclear LF staining and future applications of the present methods are discussed.     

Computerized morphometric discrimination between normal and tumoral cells in oral smears

The oral exfoliative cytology allows a quick and fairly accurate assessment of suspicious lesions of the oral cavity. Within this context, our paper proposes a quantitative approach, focusing on the construction of a classifier for detecting the presence of the tumoral cells on oral smears. The design of the classifier relies on a detailed computerized analysis of the individual morphometric features exhibited by two large known populations of normal and tumoral cells, respectively; the digital image processing was performed in the Zeiss KS400 environment. The classifier was implemented as a neural network with step activation function, whose parameters were obtained from an adequate training, based on the nuclear and cytoplasmic areas of the cells belonging to the two populations. Our procedure based on this classifier was meant to operate by identifying the tumoral or normal nature of any cell randomly selected from a smear. To identify the nature of an arbitrary cell, its nuclear and cytoplasmic areas are presented at the input of the classifier. The classification procedure was tested on several smears, and the results coincided with the pathological diagnosis in all the considered cases. The performances of our approach are discussed in comparison with other analytical methods previously reported in oral exfoliative cytology. These discussions emphasize the role of numerical information exploited for the classifier design, concluding that the individual morphometric features are more meaningful than the global characterization of smears by mean values.     

Reclassification of "atypical" diagnoses in endoscopic retrograde cholangiopancreaticography-guided biliary brushings

OBJECTIVE: To evaluate the usefulness of reclassifying "atypical" diagnoses in reporting biliary cytology using strict morphologic criteria. STUDY DESIGN: Cytologic specimens from 139 patients (direct, alcohol-fixed smears or cytocentrifuge preparations) were evaluated. Diagnoses were benign (70), atypical (36) and malignant (33). Using strict criteria--major (nuclear contour, chromatin pattern) and minor (polarity, cell types, nuclear size, nuclear grooves, nucleoli, mitosis, nuclear/cytoplasmic [N/C] ratio)--atypical cases were reevaluated and reclassified. Follow-up (F/U) was available on all cases. RESULTS: Atypical cases, (36) were reclassified as malignant (26), atypical favor benign (2)/reactive (3) and atypical, not otherwise specified (NOS) (5). Cases reclassified as malignant showed irregular nuclear contours, chromatin irregularities and rare mitosis. Nuclear enlargement, nucleoli and cellularity varied widely in all groups. N/C ratio was increased in most reclassified malignant cases. All 26 malignant reclassifications correlated with F/U of malignancy. Benign and reactive cases (5) were negative for malignancy on F/U (4), and in 1 case a metastatic carcinoma involving the biliary tree was found. In the 5 atypical (NOS) cases, F/U showed malignancy (3) and pancreatitis (2). Cytocentrifuge preparations made in our laboratory were of superior quality when compared to other methods of cell preparation. CONCLUSION: Irregularities in nuclear membrane and abnormal chromatin pattern were the most consistently useful features correlating with malignancy. The sensitivity and specificity of biliary brush cytology can be enhanced by using strict cytomorphologic criteria and proper collection and fixation, all of which decrease atypical diagnoses.     

Quantitative cytomorphologic analyses of Papanicolaou-stained smears from oral lichen planus

OBJECTIVE: To apply quantitative techniques to cytologic smears in order to improve the diagnostic sensitivity of cytology in the detection of malignant change in the oral cavity. STUDY DESIGN: Eighty-two patients with lesions of oral lichen planus were investigated. A total of 247 Papanicolaou-stained buccal smears underwent nuclear and cytoplasmic area measurements using a TV image analyzer. RESULTS: The cytomorphologic results of this study suggest that lesions of oral lichen planus contain smaller cells and nuclei than those observed in clinically normal oral mucosal smears. There was a statistically significant reduction in nuclear area (P < .001) and cytoplasmic area (P < .05) for the oral lichen planus smears. CONCLUSION: The TV image analysis system could provide a valuable method of quantifying cell changes in oral smears collected from oral mucosa as a method of monitoring lesions of oral lichen planus.     

Electron microscopic observations of the influence of different fixatives on the appearance of cellular ultrastructure

Summary The cells of the proximal convoluted tubules of the rat kidney, mouse hepatic parenchymal cells, and the juxtaglomerular cells (J. G. cells) of the afferent arteriole in rabbit kidney served as test tissues for a study of the modifications of structure produced by 14 different fixation procedures using osmium tetroxide, a chrome-osmium solution, glutaraldehyde, and formaldehyde as fixatives. The fixative solutions containing various buffers were used either alone (osmium tetroxide-containing compounds) or in various combinations (aldehyde fixation with postfixation in osmium tetroxide). The most conspicuous differences in appearance following different fixation procedures were noted in the cytosomes of renal proximal tubular cells and the granules in the J. G. cells. However, virtually all cytoplasmic organelles showed some modification of structure with different fixatives. The evidence indicated that the chemical composition of the buffer used with OsO₄ was an important factor which particularly affected the density of the cytosomal matrix in renal proximal tubular and J. G. cells. The density of the matrix of the cytosomes was, however, also influenced by the fixative itself as indicated by studies of aldehyde-fixed tissues. With these fixatives the ultrastructural appearance was not modified by the buffer. Clumping of nuclear chromatin along the nuclear membrane and around the nucleolus occurred following fixation in aldehyde and Dalton's chrome-osmium solution, whereas the chromatin was evenly distributed in the nucleus when buffered osmium tetroxide was utilized for fixation. A specific reaction of dichromate with the granule of the J. G. cells seemed to take place rendering these granules electron opaque, thereby facilitating their identification in the light and electron microscope. The findings were discussed with particular attention to the interaction of fixatives and buffers with various tissue components.Supported by grants from the Board of Swedish Life Insurance Companies, the Stiftelsen Therese och Johan Anderssons Minne, and grant No. AM-7919 from the National Institutes of Health, Bethesda, Maryland (USA).     

Detection of sexually transmitted diseases by urethral cytology, the ignored male counterpart of cervical cytology

The detection of sexually transmitted diseases by urethral cytology was investigated in 270 men examined by urethral swabbing smears. Each sample was used to prepare a wet mount smear and smears for staining by the Papanicolaou, Gram and methylene blue techniques. A fifth smear was used for direct staining with fluorescein-conjugated monoclonal antibodies for the detection of Chlamydia trachomatis. The smears were examined for cytoplasmic and nuclear changes as well as for pathogenic organisms and inflammatory changes. Infections with Chlamydia trachomatis, Neisseria gonorrhoeae and human papillomavirus (HPV) produced distinctive cytologic patterns similar to those seen in cervicovaginal smears from women. The patterns in candidiasis, trichomoniasis and herpes simplex virus infection were not as diagnostic. Particularly noteworthy were the nuclear alterations, which appeared to be proplastic in HPV infection but retroplastic in Chlamydia infection. The results of this study indicate that urethral cytology would be an invaluable addition in diagnosing sexually transmitted diseases in men, particularly in the case of Chlamydia and HPV infections. The monomorphic structure of urethral columnar epithelium, as compared to the cervical epithelium, seems to result in a clearer and more constant response to pathogenic infections, as seen in the resulting smears.     

Nuclear pore distribution and relation to adjacent cytoplasmic organelles in cotyledon cells of developing Vicia faba

Following a zinc iodine-osmium tetroxide fixation, nuclear pore distribution was studied in 0.3-m sections from cotyledons of developing Vicia faba L. Localised absence of nuclear pores was found to be associated with proximity of organelles to the nucleus. Golgi cisternae and mitochondria are associated with areas of pore absence while cisternal endoplasmic reticulum and tubular endoplasmic reticulum are linked with areas showing reduction in pore density. Pores were seen in the nuclear membrane adjacent to vacuoles. Pattern analysis of pore distribution indicated possible clustering within an overall regularity.Abbreviations ER endoplasmic reticulum - ZIO zinc iodine-osmium tetroxide     

Standardized thionin-eosin stain in bronchial cytology. A substitute for hematoxylin-eosin Y staining

A standardized thionin-eosinic acid stain was developed as a quick and highly reproducible staining method for bronchial cytology. Bronchial smears and paraffin-embedded sputum samples were stained with thionin-eosin and with the conventional hematoxylin-eosin Y. Spectral absorption characteristics and staining intensity of thionin-eosin-stained cells were investigated by means of cytophotometry. The staining pattern of thionin-eosin is very close to that of the hematoxylin-eosin stain; the contrast between nucleus and cytoplasm is significantly higher for thionin-eosin. Thionin-eosin can be used for "dye-fixation" of cytologic smears and tissue imprints. Blueing and differentiation (as for hematoxylin-eosin) is not required for thionin-eosin; thus, fixation and staining can be performed within two minutes. The spectral absorption characteristics of thionin-eosin allow reliable automated cytophotometric discrimination of cell nuclei and cytoplasm. The standardized thionin-eosin stain is recommended as a substitute for the hematoxylin and eosin stain in bronchial cytology.     

Dispersed and compact chromatin demonstrated with a new EM method: Phosphotungstic acid hematoxylin block-staining

Summary Glutaraldehyde/KMnO₄ double fixation and phosphotungstic acid hematoxylin (PTAH) block-staining, before dehydration were found to reveal, with great detail and sharpness, the nuclear distribution of compact heterochromatin masses as electron-lucent patches. By contrast the areas of decondensed and dispersed chromatin acquired a high electron density due to the binding of the large PTAH molecule to basic groups in the loosened chromatin network. The method was tested on human blood leukocytes, on the thymus gland from immature rats, containing mitotic figures, and on mature avian erythrocytes. The results indicated that each cell type acquires a specific pattern of electron densities in the nucleus which depends upon the relative amounts of compact and dispersed chromatin present in that nucleus. Since the tissues are stained in-block immediately after fixation, artifacts of stain localization, due to alcohol dehydration, are avoided. Thus, PTAH block-staining translates the state of aggregation of the chromatin into characteristic and specific density patterns of the nuclei. This method may prove useful in differentiating active from inactive portions of the genome, at the ultrastructural level.     

Evaluating the diagnostic significance of nuclear grooves in thyroid fine needle aspirates with a semiquantitative approach

OBJECTIVE: To clarify the diagnostic significance of nuclear grooves in thyroid fine needle aspirates, to search for other associated nuclear features and to identify possible diagnostic pitfalls. STUDY DESIGN: In total, 67 fine needle aspiration cases were retrospectively reviewed for selected nuclear features, including grooves, intranuclear cytoplasmic invaginations, enlargement, pleomorphism and status of nucleoli. A semiquantitative method was used to estimate the percentage of nuclear grooves in 5 high-power fields with the most frequent nuclear grooves. RESULTS: Unequivocal intranuclear cytoplasmic invaginations were a specific diagnostic feature of papillary carcinoma. In the absence of intranuclear cytoplasmic invaginations, the presence of > or = 20% nuclear grooves was virtually diagnostic of thyroid neoplasms, predominantly papillary carcinoma. Less than 10% of nuclear grooves virtually eliminated the possibility of papillary carcinoma. However, 10-19% of nuclear grooves may be seen in papillary carcinoma and benign lesions; therefore, such cases fell into the diagnostic category of "atypical cytology" or "indeterminate" cytology. Nuclear enlargement with elongation was a readily identifiable feature usually associated with nuclear grooves. Significant pleomorphism was more commonly seen in papillary carcinoma than in benign lesions. CONCLUSION: A semiquantitative method is helpful when nuclear grooves are encountered in thyroid cytology in the absence of other diagnostic features. It can significantly improve the diagnostic specificity of nuclear grooves for papillary carcinoma.     

Atypical glandular cells of undetermined significance in cervical smears after conization. Cytologic features differentiating them from adenocarcinoma in situ

OBJECTIVE: To evaluate the cytologic features of atypical glandular cells of undetermined significance (AGUS) smears following conization through a comparison with adenocarcinoma in situ (AIS) smears. STUDY DESIGN: Fifty cervical smears, diagnosed as AGUS based on groups of crowded glandular cells that raised the possibility of AIS, from 38 patients who had conization and 24 AIS smears, histologically confirmed, from 17 patients were reviewed. Subsequent follow-up biopsies or hysterectomies in 38 patients were evaluated. RESULTS: Nuclear atypia was a more reliable feature than architectural structure in differentiating postcone effect from AIS on cytology. The predominant cytologic features of the postcone smears were crowded glandular cells with a high nuclear/cytoplasmic ratio and relatively small, hyperchromatic nuclei with rather finely granular and uniformly dispersed chromatin, less distinct nuclear membranes, less frequent mitosis and presence of endometrial-type stromal cells in the background. The architecture of the crowded cells in the postcone smears was sometimes similar to that of AIS. No AIS or high grade squamous intraepithelial lesion histology was encountered in follow-up biopsies or hysterectomy specimens. CONCLUSION: The cytologic features distinguishing AGUS from AIS may be helpful in identifying the postcone effect. Since it is important to avoid miscalling the postcone effect as AIS, it is recommended that one check for a previous history of a cone biopsy.     

Cytopathology of non‐invasive follicular thyroid neoplasm with papillary‐like nuclear features: A comparative study with similar patterned papillary thyroid carcinoma variants

Objective

Noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) is a recently described, indolent thyroid tumor, with well‐defined histopathological diagnostic criteria. Cytology features are not well documented. We reviewed cytology of histologically proven cases of NIFTP and some of its common differentials to look for salient diagnostic features.

Methods

Cases reported on histopathology as follicular variant of papillary thyroid carcinoma (FVPTC), or NIFTP between July 2015 and April 2017 having available cytology smears were retrieved and reclassified as NIFTP, FVPTC, and classical papillary thyroid carcinoma with predominant follicular pattern (PTC‐FP). Cytological features were assessed, classified as per The Bethesda System for Reporting Cytopathology and compared.

Results

There were 23 NIFTP cases, 18 FVPTC and 8 PTC‐FP. A microfollicle‐predominant pattern was seen in all. Nuclear score was 2 in most NIFTP cases (61%). Pseudoinclusions were absent. NIFTP showed features of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (III) in 61%, follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN) (IV) in 35% and suspicious for malignancy (SFM) (V) in 4%. Most of the FVPTCs were also called FN/SFN (IV) (56%) or AUS/FLUS (III) (22%). Nuclear features did not statistically differ from NIFTP. PTC‐FP showed high‐grade cytology in 75%, and higher nuclear score (3 in 75%) in contrast to NIFTP (P = .003).

Conclusion

NIFTP and FVPTC show a similar distribution among the Bethesda categories hence precluding conclusive distinction on cytology. PTC‐FP, in contrast, was found to have a statistically significant higher nuclear score and more commonly showed malignant cytology.

     

Oligodendrocytes in the normal and chronically de-afferented lateral geniculate body of the monkey

Summary Electron microscopical examination of the norma and de-afferented laterall geniculate body of the monkey following paraformaldehyde-glutaraldehyde vascular perfusion revealed distinctive morphological features of different types of oligodendrocyte. These cells were normally situated as perineuronal satellites or in relation to axons and capillaries. A wide range of nuclear and cytoplasmic densities were displayed by both satellite and interfascicular oligodendrocytes. The following distinctive features for the identification of ligodendrocytes were utilised: the presence of large quantities of free ribosomes and ribosomal rosettes, microtubular profiles, dense marginal aggregation of nuclear chromatin together with light patches and numerous nuclear pores; but the absence of broad cytoplasmic processes, glycogen and gliofibrils. Circumferential perinuclear organization of the cytoplasmic organelles was typical of oligodendrocytes. Particular attention was paid to perineuronal satellite cells in view of the known transneuronal atrophy in the de-afferented geniculate body. Some cells having a nuclear pattern of oligodendrocytes but showing hyalinisation of perikaryon were seen in de-afferented laminae. A notable feature was the presence of variegated osmiophilic bodies in the perikaryon of oligodendrocytes also situated in the de-afferented laminae. A cell type combining the features of oligodendrocytes and astrocytes was classified as intermediate neuroglia.Fellow of the Alexander von Humboldt Foundation, on Sabbatical leave from J. Nehru Medical College Aligarh, India.Recipient of the Deutsche Forschungsgemeinschaft Grant No. G./28/15.     

In vitro propagation of cassava (Manihot esculenta Crantz)

A method is presented for the rapid in vitro propagation of cassava (Manihot esculenta Crantz). Nodal explants were induced to grow as multiple-shoot cultures on a medium containing 1.0 M 6-benzylamino purine (BAP), supplemented with 0.25 M -naphthaleneacetic acid (NAA). Nodes were removed from the shoots after three weeks of growth and subcultured on fresh culture medium. An average of 7.0 nodes were produced from each explanted node after three weeks in culture. Nodal explants were transferred to a medium containing 2.5 M indole-3-butyric acid (IBA) to improve root initiation on the developing plantlets. Plant establishment was possible upon transfer to soil. In vitro propagation offers enhanced rates of multiplication over more conventional methods of propagation. In addition, in vitro propagation facilitates the storage and international exchange of cassava germplasm.     

Ultrastructural studies of normal skin and epidermal papillomas of the flathead sole,Hippoglossoides elassodon

Summary Epidermal cells of normal fin web and of the epidermal papilloma of the flathead sole, Hippoglossoides elassodon, were compared by light and electron microscopy. The predominant cells of normal epidermis are squamous and are characterized by complex microvillous interdigitations between adjacent cells, numerous desmosome-like structures, terminal bars, prominent cytoplasmic filaments, and blunt, broad-based microvilli on the outer (free) surfaces of the superficial cells. The less numerous mucous cells of normal epidermis possess abundant ergastoplasm and mucus-filled vacuoles, but lack desmosome-like structures and cytoplasmic filaments.In contrast, in the epidermal papilloma, mucous cells are absent; and the tumor cells are without microvilli, desmosome-like structures, cytoplasmic filaments, and conspicuous ergastoplasm. The papilloma cells are in addition characterized by certain features not seen in normal epidermis, including prominent nuclear pores, very large nucleoli, nuclear dense bodies, vesicular mitochondria with few cristae and dense internal granules, and three types of distinctive cytoplasmic particles of possible viral nature.This investigation was supported by Public Health Service research grant CA 08158 from the National Cancer Institute, and American Cancer Society Institutional Grant No. IN-53 E.We are indebted to Miss Mary Bens for her indispensable technical assistance.     

Quantitative cytology of oral smears. A comparison of two methods of measurement

Previous quantitative cytologic studies employing planimetry to assess oral smears established a "discriminant line" for separating normal and abnormal cases. The use of the Vids V semiautomatic image analysis system to make these measurements was analyzed to determine whether the results obtained by the two methods were comparable. In measuring the same cells by both methods, no significant variation in nuclear size was detected; however, there was a statistically significant variation in the measurements of cytoplasmic area. Further analysis suggested that the cytoplasmic areas differed by a constant amount, not a constant proportion, between the two methods; this may be due to the ability of the Vids V system to more clearly display the cell boundaries. The appropriateness of techniques for comparing different methods is discussed.     

Effect of method and clinician on stallion sperm morphology evaluation

The objective of this study was to determine the effects of method and clinician on stallion sperm morphology evaluation. Five clinicians evaluated 60 semen samples using wet-mount preparations with phase-contrast, eosin/nigrosin-stained semen smears, and Papanicolaou-stained semen smears. There were significant differences among methods for all sperm morphology categories and most intra-class correlation coefficients were only fair to moderate. The use of wet-mount preparations facilitated detection of acrosome defects, nuclear vacuoles, and cytoplasmic droplets when compared to stained smears. Smearing stallion semen samples onto slides increased the proportion of detached sperm heads. In addition, acrosome defects, nuclear vacuoles, rough/swollen midpieces, and cytoplasmic droplets were difficult to observe with Papanicolaou stain; this method resulted in overestimation of normal sperm when compared to other methods. There were significant differences among clinicians for all sperm morphology classification categories. In conclusion, this study demonstrated that sperm morphology evaluation results varied, depending on the evaluation method and clinician. Wet-mount preparation with phase-contrast microscopy appeared to be more sensitive for identification of abnormal stallion sperm when compared to stained smears. Veterinary andrology laboratories should invest in training, continuing education, proficiency testing, and other quality control measures to minimize the variation of sperm morphology evaluation results among clinicians.