Bibbo Marluce; Hoda, Rana S. M.D.. International Journal of Gynecological Pathology: January - Volume 17 - Issue 1 - ppg Book Reviews: PDF Only. The second edition of Bibbo's Comprehensive Cytopathology is now available. The first edition was a fine, modern text on cytology. However, it is always. The Journal of Clinical Cytology and Cytopathology . Continued – by Marluce Bibbo .. ceptable files and formats are: Word or PDF files, Excel.
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Bibbo M., Wilbur D. Comprehensive Cytopathology. Part 1. Файл формата pdf; размером ,92 МБ. Добавлен пользователем Евгений Comprehensive Cytopathology. 4th Edition. Authors: Marluce Bibbo David Wilbur . eBook ISBN: eBook ISBN: Hardcover. beginnings of clinical cytopathology thus date to. .. Marluce Bibbo, of the third edition of Compre- hensive .. routine manual practice.
Discussion Our study assessed the morphological differences between the conventional Pap smear and LBC smear and their impact on their interpretation. Twelve of the parameters were analyzed, out of which the parameters that showed statistical significance were: Representativeness, Hemorrhagic background and RBCs, and Organisms. There was no significant difference in the remaining parameters between the two techniques. With regard to satisfactoriness of the smears, most studies claim a reduced number of unsatisfactory smears with LBC. Hemorrhage, dense inflammation, drying artefact, and scanty cellular elements were the unsatisfactory features noted in our CPS while a scanty cellular component was the only unsatisfactory feature in LBC.
The MNGCs were of variable sizes and forms, contained a cytoplasmic content and were generally large. They had a high number of nuclei and dense and angulated cytoplasm. Phagocyted colloid and neutrophils appeared in the cytoplasm of some MNGCs.
In rare cases, there were also some smaller, round, vacuole-cytoplasm MNGCs that contained less nucleus. Though there were epitheloid histiocytes and clusters of epitheloid histiocytes, which were believed to be granulomas, in 10 cases, the epitheloid cells were isolated or formed loose cohesive clusters in 3 cases.
There were no granulomas or epithelioid cells in any of the remaining cases. The granulomas that were assessed appeared similar to those in other granulomatous diseases, specifically, to be derived from bare-foot or carrot-shaped nucleus cells constituting tight syncytial groups of variable sizes [Figure 1] and [Figure 2] b-e.
Colloid was observed occasionally in 8 cases. This colloid generally appeared in thick, small and large masses inside epithelioid histiocytes, some of which occurred in a phagocytosed manner. All cases had a dirty background that was composed of cellular debris, blood elements and pink amorphous acellular material, and this was accompanied by neutrophil leukocytes in 2 cases and mixed types of inflammatory cells with dominant lymphocytes in the remaining cases.
However, imaging methods may be helpful for the diagnosis.
Additionally, most of our cases were unilateral. The key cytological characteristics for SGT are as follows: i A high number of MNGCs, ii epithelioid cells with a tendency for clustering, iii epithelioid cell granulomas, iv lymphocytes, macrophages and neutrophils, v frequently degenerated follicular epithelial cells displaying mild-moderate cellularity, and vi a dirty background that is composed of cellular debris, naked, degenerated nuclei and thick colloids.
However, these cells are not specific to SGT. MNGCs may be seen inflammatory conditions of the thyroid granulomatous diseases, Hashimoto's thyroiditis, Graves disease and palpation thyroiditis , hyperplastic conditions MNG displaying degenerative changes and neoplastic conditions papillary carcinoma, anaplastic carcinoma.
MNGCs with foamlike cytoplasm are round cells with less diagnostic importance and are generally seen in cystic degeneration. They are usually composed of multinuclear forms of histiocytes, flat cytoplasmic contours, foamlike, vacuole and hemosiderin cytoplasms [Figure 3] a. Further, MNGCs with dense cytoplasm have angular cytoplasm and irregular shapes, are larger and contain a higher number of nuclei. The presence of tumor cellularity and PC nuclear characteristics powdery chromatin, nuclear groove and intranuclear inclusions , overlapping syncytial tissue fragments, real papillary fragments, if any, and psammoma bodies are characteristics in favor of PC.
These cells are called "bizarre giant cells" [Figure 3] b.
The MNGCs that are present have a tendency to be more frequent and larger in size and to contain more nuclei. The main cells in the granulomatous diseases of the thyroid are epithelioid histiocytes, and the granulomas observed are generally well formed, comprise fewer lymphocytes and acute inflammatory components and do not contain a dirty background. However, the patient was diagnosed as SGT due to the absence of cellular and structural malignant characteristics, despite the presence of a high number of MNGCs and epithelioid cells accompanied by a dirty background.
Taniguchi et al. The scores were summed to arrive at a total cumulative score for a given case [Table 6]. Khan et al.
The final tumor grade was assigned by adding the different scores obtained [Table 7]. Fan et al. A low cytoprognostic score predicted a low to intermediate grade carcinoma and a high score predicted an intermediate to high-grade carcinoma.
But, research results showed that the most important histomorphological prognostic factors for breast carcinoma patients were histologic type and nuclear grade. These are independent prognostic indicators that can predict overall and metastasis-free survival for local and regionalized breast carcinoma.
Today, the value of breast carcinoma histological grading is well-established and assigning the tumor grade has prognostic implication which helps in guiding appropriate therapy. Elston's modified Bloom and Richardson MRB method to grade breast carcinoma scores tubule formation, cellular pleomorphism, and mitotic rate.
Score varies from 3 to 9 and is summed up to assign one of the three histological grades [Table 8]. For neoadjuvant therapy, it can be utilized by estimating tumor diameter radiologically, tumor grade by cytology, and lymph node status by staging lymphadenectomy while the primary tumor is left in situ.
Assessment of biological aggressiveness of the cancer without removing it would, therefore, be valuable. International consensus conferences on breast carcinoma have directed time and again to include prognostic factors in histopathology and cytology reports.
Evaluation of cytological tumor grade is quick, easy to perform, and correlates well with tissue nuclear grade.
It is a fundamental cytologic parameter which should be included in the FNA report. FNA with cytoprognostic score can be used as a semi-quantitative alternative or additional tool in continuous monitoring of therapy effect during treatment. FNA can provide information about intrinsic features of the tumor as well as its prognosis.
Considerable limitation of FNA is to differentiate between intraductal and invasive carcinoma, as a diagnosis of intraductal neoplasia requires the careful study of overall architecture and basement membrane integrity that only histopathology can provide.
Cytopathologists have investigated the potential of useful prognostic indicators on breast aspirates. The various features taken into consideration are: Cellular morphology and arrangement, nuclear character, number of mitosis, and background. Hence, it was simplified by Fisher into three nuclear grades, with Grade 1 representing the highest level of differentiation and Grade 3 equivalent to anaplasia. Dabbs  used Fisher's modification in their study by grouping together of Grades 1 and 2 as "favorable nuclear grade," for they were prognostically similar and favorable , while Grade 3 as "unfavorable nuclear grade" with poorer prognosis.
The strengths of this system were: 1 Nuclear grade was the most powerful predictor of tumor aggressiveness, when combined with histologic tumor type and race of the patient.
Robinson et al. The only weakness was that the mitotic count was not considered.