Cytology: reactive lymph node or...?

RE: Cytology: reactive lymph node or...?

Adrian Caunter — Sat, 14 Nov 2015 18:28:11 GMT

I'm away from work for the next two weeks so I can't say for definate but I'm pretty sure it is the last one. Seem to remember it being an aqueous solution and the price matches too. I haven't filtered the stain once in the three years we've had it and it still seems to be working just fine! I'm actually secretly really pleased you've decided to have a go. If I can persuade any more people out there do the same then great! To that end I'd like to add that: 1. The £13 pot that I bought is not quite finished yet despite the fact that I have tested every new lump I've seen over the last 3 years so the cost involved here is minimal. 2. I don't actually charge people for this . It's absolutely fine if people do (-and I've had many a client surprised I didn't) and is less then sending away but rather like ear cytology I don't want people to refuse on cost grounds and it only takes minutes. In addition I am at well over 100 surgeries with histology on lumps in those three years that would have otherwise chosen to wait and monitor. 3. In ten years of taking off every mass that was positive over all my jobs I have never had one come back from the lab as anything other then a mast cell tumour ( bar one case of cutaneous mastocytosis) ie. You pretty much can't get this wrong! If you do go for it , let me know the first time you find one. I think that would pretty much make my week.

RE: Cytology: reactive lymph node or...?

Beats — Sat, 14 Nov 2015 17:07:19 GMT

Thanks Adrian! think I'm sold unless someone else comes along with new H&S warnings to scare me off again. Final questions then: I take it you don't bother to filter the stain regularly as I was also advised I would need to do and just use a readymade solution rather than reconstituting your own powder? Also, any idea which of these I'm best with:

Toluidine blue 1% in 50% isopropanol

Toluidine blue 1% in 1% sodium tetraborate

Toluidine blue 1% aqueous solution

The final one comes in 500ml bottles for £13 (and possibly 100ml bottles also) with a safety datasheet (http://www.clin-tech.co.uk/msds/64086X.pdf) that looks no more concerning than the toilet cleaner, so I think that one should be OK by COSHH

RE: Cytology: reactive lymph node or...?

Adrian Caunter — Sat, 14 Nov 2015 13:18:10 GMT

Ha, now I'm even less of a Health and safety guru that a cytology one!

The bottle of Toluidine blue has no specific warnings or hazard labels and the material data sheet that we have indicates only a low level of risk with skin irritation or dust inhalation. Based on this we just ensure good ventilation in the lab and make sure we wear gloves. Our H + S company has never raised any issues with that but I stand to be corrected if anyone knows any better?

Technique wise I usually make two slides for in house cytology. 1 for diff quick and 1 for T.blue. YOu just place a few drops of T.blue to cover the air dried FNA slide and leave it for approx 1 min. Then you rinse the back with distilled water and examine under oil immersion. A positive mast cell is usually really easy to spot once you know what you are looking for and they come up surprisingly often and on lumps that you may otherwise have had no suspicion about!

The two caveats being 1. it wouldn't detect an agranular mast cell tumour and 2. You cant really make any predictions as to the grade.

RE: Cytology: reactive lymph node or...?

Beats — Sat, 14 Nov 2015 11:00:13 GMT

[quote user="Adrian Caunter"]I'd thoroughly recommend everyone gets themselves a bottle of toluidine blue. Super cheap and then super easy to identify mast cell tumors in house.[/quote]

Hi Adrian, I've sometimes wondered about this.

Do you just add a drop of toluidine blue under a coverslip for those diff-quik-style cytology slides that you want to make sure aren't mast cells with granules failing to stain or do you stain up a separate slide?

I got a protocol for doing toluidine blue staining for cytology for mast cells a few years ago but was put off byt the safety recommendations that stated:

"Toluidine Blue: Hazardous with inhalation and coming in contact with skin and eyes. Use gloves and work in a fume cupboard with adequate ventilation."

A bit like doxorubicin or formalin or something, I'm not sure how dangerous the chemical actually is and whether a fume cupboard is overkill or a sensible precaution, but decided not to stock an additional COSHH thingy and jsut to send out those slides (only about 3 a year) where couldn't be sure that weren't mast cells just with the granules failing to stain with modified romansky stain in-house.

I'd be interested to know how you use the toluidine blue in-house and your COSHH assessment as I might rethink this if actually no more hazardous than our immersion oil or similar.

Cheers,

Dave

RE: Cytology: reactive lymph node or...?

Adrian Caunter — Thu, 12 Nov 2015 21:10:50 GMT

Not a cyto guru either!

but.. I'm guessing this is just diff quick which makes the mast cell involvement a little harder to judge. I'd thoroughly recommend everyone gets themselves a bottle of toluidine blue. Super cheap and then super easy to identify mast cell tumors in house. That said - in most mast cell tumors you see mainly mast cells with concurrent eosinophils and thats not the picture I'm getting from your photos. My money is on a granulomatous type reaction with mainly neutrophils and the big old cells are macrophages. If this isn't resolving on meds i'd be wondering if there is something still in there with the caveat of course that there are lots of super fun structures in that area!

RE: Cytology: reactive lymph node or...?

Emily Rainbow — Thu, 12 Nov 2015 08:47:59 GMT

I would agree with Martin. I'd want someone cleverer than me to confirm that they weren't!

RE: Cytology: reactive lymph node or...?

Martin Atkinson — Wed, 11 Nov 2015 18:32:11 GMT

They look horribly like mast cells to me so I'd be sending a slide off for a pathologist to take a look.

RE: Cytology: reactive lymph node or...?

Beats — Mon, 09 Nov 2015 16:47:20 GMT

Hi Fable, I agree looks like suppurative inflammation and most of those cells are degenerative neutrophils. The big ones look like a phagocyte, so maybe monocytes? I'd have FB and inflammed salivary gland on my list as well and check inside mouth for penetrating stick injuries etc. I'm not a cytologist, just my thoughts as fellow GP.

Dave