脱落细胞检查基本知识

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。
未分化小细胞癌
未分化小细胞癌
Small cell carcinoma
• Small cell carcinoma (brushing specimen) • The cells obtained by direct brushing appear "fresher." well-preserved material
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, • They can also be seen in apparently healthy people,
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.
痰液鳞状细胞癌
腺癌：占积液中转移癌的80%以上，腺癌细
胞形态多样，排列构成腺腔样、乳头状，洋葱
皮和桑葚形状等等，腺癌细胞形态多样，细胞
大小相差数倍，癌细胞呈圆或椭圆形，核偏位， 核边不规则，核仁明显增大或多个核仁，胞浆 中常含空泡，常见异常分裂象。。
腺癌 Adenocarcinoma
• Adenocarcinoma is the most common cause of a malignant effusion. • Among the most useful features in the diagnosis of adenocarcinoma are increased N/C ratio, irregular nuclear membranes, large nucleoli, secretory vacuoles, and three-dimensional aggregates
肺腺癌 Adenocarcinoma
• Adenocarcinoma • Three-dimensional cell balls or papillary clusters of malignant cells are characteristic architectural features of adenocarcinoma.
浆膜腔积Hale Waihona Puke Baidu脱落细胞学检查
良性病变脱落细胞：
• 脱落间皮细胞：圆形或椭圆形，胞浆厚实，胞 核居中，胞核亦为圆形或椭圆形，核染色质细 颗粒状，分布均匀。 • 退化变性的间皮细胞：肿胀性退变表现为细胞 增大，胞浆出现大小不等的液化空泡，胞核肿 胀，偏位。
间皮细胞 (Mesothelial Cells)
• Mesothelial cells in an effusion always show reactive changes of various degrees. • Note nuclear enlargement and a prominent nucleolus but fine chromatin and a smooth nuclear membrane.
肺腺癌 Adenocarcinoma
肺腺癌 Adenocarcinoma
• Note that intracytoplasmic secretory vacuole containing mucin (arrow).
痰液脱落细胞学检查
未分化小细胞癌：
• 恶性度较高，多为中央型，较早发生转移。
• 癌细胞单个或成团脱落，胞体小，比淋巴细
浆膜腔积液脱落细胞学检查
恶性病变脱落细胞：
• 浆膜腔积液中肿瘤细胞的来源：积液中９８％ 以上的癌细胞是转移性的，原发性的恶性间皮 瘤较少见。 • 肿瘤性的胸水和心包水常见于肺癌、乳腺癌等， 肿瘤性的腹水常见于卵巢癌、胃癌、肠癌、肝 癌、胰腺癌等。原发性的恶性间皮瘤，恶性淋 巴瘤较少见。
浆膜腔积液脱落细胞学检查
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
肺腺癌 Adenocarcinoma
• Microacinar or rosette-like structures indicate glandular differentiation. • Microacinar complexes are a cytologic equivalent of the "gland-in-gland" histologic growth pattern of adenocarcinoma.
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。
• 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。
胞稍大，常为不规则的圆形或卵圆形，胞浆
少，呈裸核样；细胞核相互挤压呈镶嵌状结
构。
Small cell carcinoma
• Small cell carcinoma (brushing specimen) • The tumor cells have very little cytoplasm, relatively fine but very hyperchromatic chromatin, and inconspicuous nucleoli • Note the similarity of bronchial cell nuclear chromatin to that of the tumor cells.
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. • "dust cells"
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.
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； • 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．
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。
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)
未分化小细胞癌
Small cell carcinoma
浆膜腔积液脱落细胞学检查
• 浆膜腔，又称体腔，包括胸膜腔、腹膜腔和心 包膜腔。在正常生理情况下，体腔脏层和壁层 间有少量液体，起润滑作用。在炎症刺激、肿 瘤转移或循环障碍等情况下，可形成胸水、腹 水和心包积液。 • 浆膜腔积液脱落细胞学检查主要用于判断积液 中有无癌细胞。
良性病变脱落细胞 结核性病变 (Tuberculous effusion)
• Abundance of lymphocytes and virtual absence of mesothelial cells are characteristic of tuberculous pleural effusions.
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.
间皮细胞 (Mesothelial Cells)
• Gland-like cluster of benign mesothelial cells mimicking adenocarcinoma. • Note that the component cells are identical to the other reactive mesothelial cells, and do not constitute a foreign population.
组织细胞 (Histiocyte)
• Hemosiderin-laden histiocyte.Hemosider in is a refractile golden brown pigment. • The presence of hemosiderin indicates old bleeding.
Goblet cells
• Goblet cell hyperplasia • Normally, 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.
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