脱落细胞检查基本知识-上海第二医科大学资料文档

痰液肺泡吞噬细胞
Alveolar macrophages in sputum
• Alveolar macrophages are key cells to look for in a sputum specimen.
• The presence of alveolar macrophages indicates that the "deep lung" has been sampled.
痰液鳞状细胞癌
痰液鳞状细胞癌
非角化鳞状细胞癌
Non-keratinizing squamous cell carcinoma
• The groups of malignant cells tend to be more cohesive and the cells more uniform
• Pearls, extensive keratinization, and bizarreshaped cells are not present.
Goblet cells
• Goblet cell hyperplasia • lly, the ciliated cells far
outnumber the secretory cells (by at least 5 to 1). • However, in asthma, for example, the goblet cells may actually outnumber the ciliated cells.
肺癌脱落细胞
• 痰液涂片检查主要用于检查癌细胞，肺 癌患者痰内癌细胞检出率可达90%。根据 细胞学形态，肺癌主要分为鳞癌，腺癌， 未分化癌，混合型癌及类型未明癌。
痰液脱落细胞学检查
肺鳞状细胞癌：
• 最常见，男性远多于女性，主要发生于大支气 管，多数为中央型。
• 细胞形态和大小异常：癌细胞单个散在，多形 性明显，可以呈圆形、蝌蚪形、梭形及不规则 形；
临床检验基础
脱落细胞学检查
上海第二医科大学附属瑞金医院 袁勤
痰液脱落细胞学检查
• 肺脱落细胞学检查是早期诊断肺癌的重 要手段之一。肺癌的早期诊断可根据临 床症状、X线检查、痰液涂片检查和纤维 支气管等多方面配合进行。
• 痰液标本采集：①痰液必须新鲜； ②痰 液必须是肺部咳出。
痰液脱落细胞学检查
正常的痰涂片中可见来自口腔的鳞状上 皮细胞、纤毛柱状上皮细胞和肺泡吞噬 细胞（后两者为确定痰液来自肺及支气 管深部的标志）以及中性白细胞、淋巴 细胞、浆细胞、嗜酸性白细胞等。
• 巴氏细胞（Papaniculaou cell): 因炎症刺激 造成，细胞体积较小，圆形或卵圆形，胞质深 红色，核小而圆形，致密深染，有轻度核异形, 可能是鳞状化生细胞。
痰液良性病变脱落细胞－巴氏细胞
• Squamous metaplasia can be seen in sputm smear, ie, rounded cells with dense, cyanophilic cytoplasm.
• They can also be seen in apparently healthy people, and therefore do not necessarily indicate the presence of disease.
痰液良性病变脱落细胞
• 炎症病变脱落细胞：支气管炎、肺炎和肺结核 等急、慢性呼吸道炎症引起上皮细胞发生细胞 核轻度固缩退变或细胞轻度肿大。
• 核的异型：癌细胞大而畸形，核染色质丰富深 染，成团块状或墨水滴样。核仁常不明显；
• 胞质的异常：癌细胞胞浆丰富红染，有角化倾 向；
• 癌细胞吞噬现象．
痰液鳞状细胞癌
Keratinizing squamous cell carcinoma (tissue)
• Note the presence of squamous eddies, or pearls, which are pathognomonic of keratinization.
痰液纤毛柱状上皮细胞
Ciliated columnar cells
纤毛柱状上皮细胞
Ciliated columnar cells
• Note the moderately coarse and hyperchromatic chromatin
• Also note the little tails where the cells were attached to the basement membrane and, of course, the presence of terminal bars and cilia (Oil)
• "dust cells"
痰液肺泡吞噬细胞
Alveolar macrophages in sputum
Giant Cell Histiocytes
• Giant cell histiocytes can be seen in a wide variety of pulmonary disorders,
痰液鳞状细胞癌
Keratinizing squamous cell carcinoma
• Pearls are characteristic of keratinizing lesions.
角化鳞状细胞癌
Keratinizing squamous cell carcinoma
• Bizarre keratinizing cells, often single, are a characteristic feature. Such cells are particularly associated with sputum specimens
痰液脱落细胞学检查
肺腺癌：
• 常发生于小支气管，以周围型肺癌多见，易发 生血道转移和侵犯胸膜引起的癌性胸水。
• 分化好的腺癌以成群脱落为主，细胞群大，且 细胞相互重叠呈立体结构，单个癌细胞一般为 圆形或卵圆形，胞质常有许多小空泡，偶见较 大空泡。核圆形或卵圆形，核膜染色质呈颗粒 状，有明显的核仁。