Question

role of the cell block in fine needle aspiration. acta cytol 1984;28: 630- 631.

Answer 1

Cell blocks prepared from residual tissue fluids and

fine-needle aspirations can be useful adjuncts to smears

for establishing a more definitive cytopathologic

diagnosis. They can be particularly useful for

categorization of tumors that otherwise may not be

possible from smears themselves. A modified cell block

technique using an improvised ethanol formalin fixative

(Nathan alcohol formalin substitute) followed by a

simple paraffin processing schedule is described. This

improved preparation offers excellent cytomorphologic

features corresponding closely to cells in

Papanicolaou-stained smears and ensures optimal

preservation of histochemical and immunocytochemical

properties. The technique is simple and reproducible

and uses routine safe laboratory chemicals. The efficacy

of cell blocks also is discussed.

The use of cell blocks in routine nongynecologic

cytopathology varies in each institution. Despite the

increased use of fine-needle aspiration cytology (FNAC)

and immunocytochemistry in the diagnosis of solid tumors,

only limited information is available to assess the contribution

of cell blocks, although the value of cell blocks has

been acknowledged.1,2 Several techniques also have been

reported that vary in scope and the type of fixatives and

embedding techniques used, making valid comparison

difficult.1-8

Most methods previously described are inconvenient or

time consuming in a routine active pathology laboratory and

include using chemicals that have hazardous potential. In

addition, except for mercuric chloride–based fixatives, most

do not offer the optimal morphologic characterization of

cells compared with corresponding smears.

This article reports a 2-year study of a cell block preparation

arising from the need to replace the excellent but

highly hazardous B-5 mercury fixative,9 which had been

very successful in our hands. The development for a suitable

alternative, aimed at achieving the following basic

cytologic expectations, was undertaken: (1) the cells closely

resemble corresponding cells in alcohol-fixed Papanicolaou-stained

smears; (2) there is adequate clarity and delineation

of nuclear and cytoplasmic details; (3) loose cells,

cell aggregates, and microscopic tissue fragments are easily

recoverable; (4) the cell block sections are suited to a wide

variety of histochemical stains and immunocytochemistry;

(5) the method is simple, reproducible, and readily adaptable

in a routine hospital laboratory; and (6) the final cell

morphology in paraffin sections is no less than in B-5–fixed

sections. The contribution of cell blocks in the final diagnosis

using this method of preparation also was evaluated.

Answer 2

→Plasma Thromboplastin cell block method provides high cellularity, better architectural patterns and good preservation of cellular and nuclear details, thereby, increasing diagnostic yield in the cytological evaluation of serous effusions when compared to conventional smears alone. Moreover, it is easier to apply immunomarkers and perform molecular studies on the cell blocks that can be stored indefinitely for future testing. Thus, cell blocks can act as a useful adjunct to the conventional cytosmears for evaluation of serous effusions.

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