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Maternal contamination

The blood in this amniotic fluid specimen is MOST likely due to:

Both AChE and AFP

Which of the following tests on amniotic fluid can be used to help detect an open neural tube defect?

Reducing surface tension in the lung's alveoli

Surfactant is important for:

Malignant Cell --> large cell w/large round nucleus + abundant pale, vacuolated cytoplasm. While the cytoplasm is reminiscent of a macrophage, the round, large nucleus makes this unlikely. The cell is also too large to be a normal lymphocyte.

In this CSF specimen, identify the cell pointed to by the arrow.

Viral Meningitis --> a mixed population of LYMPHS and MACROPHAGES with a rare neutrophil is most typical of VIRAL meningitis. Bacterial meningitis would have a predominance of neutrophils, and HEMORRHAGE would show large numbers of red blood cells.

What process might give rise to the population of cells seen in this image of CSF?

Macrophage --> it has a large, folded nucleus with ABUNDANT pale blue to pink cytoplasm containing a VACUOLE without granularity. The large size, abundant cytoplasm and folded nucleus would be unusual for a lymphocyte, and the absence of a segmented nucleus and cytoplasmic GRANULARITY argue against a neutrophil.

The arrow is pointing to which type of cell in this CSF specimen?

Intraventricular Shunt --> A marked increase in eosinophils is most characteristic of a malfunctioning interventricular shunt, and is not typical of bacterial, viral, or cryptococcal meningitis.

This CSF infiltrate is likely a result of what process?

Blast - The pictured cell has fine, uniform chromatin and scant pale blue cytoplasm, most consistent with a blast. A reactive lymphocyte would typically have more abundant pale to blue cytoplasm and more coarse, heterogeneous chromatin. The cell lacks the segmented nucleus and cytoplasmic granules of a neutrophil, and lacks the folded nucleus and abundant cytoplasm of a macrophage.

Identify this cell from a CSF specimen.

Hemorrhage --> it's frankly bloody and has a blood CLOT. If it were inflammation/infx, it would be cloudy due to WBC & cellular debris (and probably not bloody)

The gross appearance of this fluid suggests which process?

Mesothelial cells --> we see multiple LARGE cells having very ROUND nuclei and ABUNDANT blue cytoplasm with peripheral vacuolation and PERINUCLEAR HALOS. These findings are most characteristic of mesothelial cells. The cells are too LARGE and the CYTOPLASM too ABUNDANT for even reactive lymphocytes or lymphoma. The absence of significant nuclear FOLDING, and the presence of perinuclear halos argue against macrophages.

Identify these cells in serous fluid

Carcinoma --> Large cells w/ round-oval nuclei and abundant light blue cytoplasm w/ single large vacuoles. The cells group in a LOOSE cluster. Not mesothelial cells, due to ABSENCE of perinuclear clearing and blebbing/irregularity of cytoplasmic borders. Not macrophages, due to round nuclei w/o nuclear folding, and not lymphs (not even reactive) bc cells are too large.

Identify the cells from this serous fluid.

It's dark green, likely contains BILE, often a result of intestinal perforation.

What's wrong with this serous fluid and what could be causing it?

Macrophages --> round to folded nuclei and abundant, pink, vacuolated cytoplasm.
Not mesothelial cells or lymphocytes, due to prominent cytoplasmic VACUOLIZATION and PINK color.

Identify the predominant cell population in this serous fluid.

Lymphoma --> They're enlarged with markedly IRREGULAR NUCLEAR contours and moderate amounts of light blue, variably vacuolated cytoplasm. Not macrophages, bc of degree of nuclear irregularity. These cells appear to be neoplastic with the marked nuclear irregularity and blue cytoplasm favoring lymphoma over carcinoma.

Identify the cells in this pleural fluid.

Lymphocytes --> small with scant light blue cytoplasm and mostly round nuclear contours. Not mesothelials bc not enough cytoplasm.

Identify the predominant nucleated cells in this serous fluid.

Signet Ring Macrophage --> single large vacuole which has compressed the nucleus to one side of the cell (macrophages which have taken in excess fluid). A common finding in serous fluids. Carcinomas can infrequently have a similar morphology which can make their identification difficult.

What cell type is this in serous fluid?

RBC (red), Bacteria (blue)

Yeast without budding

Squamous epi, WBCs, RBC

Transitional epi

Granular cast

Renal epithelial cast

Renal epithelial cast

Renal epithelial cell

Renal epithelial cell

Oval fat body

Waxy casts (dark), Hyaline casts (light)

Waxy cast (dark) - look for creases in sides; with Hyaline casts (light)

Granular cast

Acid urates, old urine

Amorphous urates, acid or neutral pH, pinkish ppt, common

Uric acid, barrel

Uric Acid, diamond

Uric Acid Crystal (band form) w/Ca Oxal

Calcium Oxalate, any pH, common

Tyrosine crystals, acid pH

Cholesterol crystals, acid or neutral pH, lipiduria

Leucine crystals, acid pH

Cystine crystals, acid or neutral (sometimes alkaline) pH

Bilirubin crystals, acid pH

Ammonium buirate, neutral to alkaline pH, thorny apple (WITH thorns)

Ammonium buirate, neutral to alkaline pH, thorny apple (w/o thorns)

Triple phosphate, alkaline pH

Cellular cast, waxy matrix

Waxy cast with icterus

Granular cast, waxy matrix

Granular cast, waxy matrix

Granular cast, waxy matrix

Hyaline cast, near waxy

Fatty cast

Granular cast

Hyaline cast

Uric acid crystals

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