Tzanck test: Difference between revisions
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==Historical Perspective== | ==Historical Perspective== | ||
*Diagnostic cytology is the study of individual cells and their characteristics and functions. | *Diagnostic [[cytology]] is the study of individual [[cells]] and their characteristics and functions. | ||
*George Papanicolaou is considered the father of exfoliative cytology. | *George Papanicolaou is considered the father of exfoliative [[cytology]]. | ||
*Cytology technique was first used by Tzanck for the diagnosis dermatological disorders such as herpes and other | *[[Cytology]] technique was first used by Tzanck for the diagnosis dermatological disorders such as [[herpes]] and other vesico-bullous lesions. | ||
*The test is named after Arnault Tzanck (1886-1954), a Russian dermatologist. | *The test is named after Arnault Tzanck (1886-1954), a Russian dermatologist. | ||
*The different techniques of cytological studies include aspiration cytology, imprint smear, exudate smear, skin scraping smear, and Tzanck smear. | *The different techniques of cytological studies include aspiration cytology, imprint smear, exudate smear, skin scraping smear, and Tzanck smear. | ||
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===Sample Collection=== | ===Sample Collection=== | ||
*In patients with suspected viral lesions the sample must be collected from fresh vesicular lesions rather than the healing crusted lesions, to have a sample with adequate number of virus infected cells. | *In patients with suspected viral lesions the sample must be collected from fresh vesicular lesions rather than the healing crusted lesions, to have a sample with adequate number of virus infected cells. | ||
*The vesicle should be | *The [[vesicle]] should be un-roofed and the base of the [[ulcer]] must be scraped with a scalpel or with a scapula. | ||
*The obtained material should be then transferred on to a clean glass slide. | *The obtained material should be then transferred on to a clean glass slide. | ||
*Care should should be taken that the glass slide is clean and has no finger prints as the specimen will not | *Care should should be taken that the glass slide is clean and has no finger prints as the specimen will not stay on the glass slide with finger prints. | ||
===Fixation of the Smear=== | ===Fixation of the Smear=== | ||
*A fixative fluid contains reactive chemicals and is useful for the preservation of the specimens. The fixative fluid prevents the denaturation of the proteins and autolysis and helps in maintaining the cellular morphology and its contents. | *A fixative fluid contains reactive chemicals and is useful for the preservation of the specimens. The fixative fluid prevents the denaturation of the proteins and [[autolysis]] and helps in maintaining the cellular morphology and its contents. | ||
*Fixatives usually contain chemicals like formalin, glutaraldehyde, methanol, ethanol, acetone, acetic acid, chromates, and picric acid. | *Fixatives usually contain chemicals like [[formalin]], [[glutaraldehyde]], [[methanol]], [[ethanol]], [[acetone]], [[acetic acid]], chromates, and [[picric acid]]. | ||
*Once the sample is transferred on to the glass slide it should be fixed immediately using a fixative fluid to prevent | *Once the sample is transferred on to the glass slide it should be fixed immediately using a fixative fluid to prevent drying of the tissue. | ||
===Staining of the Smear=== | ===Staining of the Smear=== | ||
*Many stains can be used for the fixation of the Tzanck smear must the most commonly used stain is the Giemsa stain. | *Many stains can be used for the fixation of the Tzanck smear must the most commonly used stain is the [[Giemsa stain]]. | ||
*Other stains that can be used include the following: | *Other stains that can be used include the following: | ||
**Hematoxylin and eosin | **[[Hematoxylin and eosin stain|Hematoxylin and eosin]] | ||
**Wright | **[[Wright's stain]] | ||
**Methylene blue | **[[Methylene blue]] | ||
**Papanicolaou | **[[Papanicolaou stain|Papanicolaou]] | ||
**Toluidine blue | **[[Toluidine blue]] | ||
===Interpretation of the Smear Findings=== | ===Interpretation of the Smear Findings=== | ||
A typical Tzanck cell is a large round keratinocyte with a hypertrophic nucleus, hazy or absent nucleoli, and abundant basophilic cytoplasm. The basophilic staining is deeper peripherally on the cell membrane due to the cytoplasm's tendency to get condensed at the periphery, leading to a perinuclear halo.<br> | A typical Tzanck cell is a large round [[keratinocyte]] with a hypertrophic [[nucleus]], hazy or absent [[nucleoli]], and abundant [[basophilic]] [[cytoplasm]]. The basophilic staining is deeper peripherally on the [[cell membrane]] due to the cytoplasm's tendency to get condensed at the periphery, leading to a perinuclear halo.<br> | ||
The following are the list of cutaneous diseases which can be differentiated based on the findings on the Tzanck smear: | The following are the list of cutaneous diseases which can be differentiated based on the findings on the Tzanck smear: | ||
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|- | |- | ||
| rowspan="4" |Immunobullous Lesions | | rowspan="4" |Immunobullous Lesions | ||
|Pemphigus | |[[Pemphigus vulgaris]] | ||
|Multiple acantholytic cells (Tzanck cells) | |Multiple acantholytic cells (Tzanck cells) | ||
|- | |- | ||
|Toxic epidermal necrolysis | |[[Toxic epidermal necrolysis]] | ||
|Necrotizing basal cells with scattered inflammatory cells and | |Necrotizing basal cells with scattered [[inflammatory cells]] and [[fibroblasts]] | ||
|- | |- | ||
|Staphylococcal | |[[Staphylococcal scalded skin syndrome]] | ||
|Dyskeratotic acantholytic cells with few inflammatory cells | |Dyskeratotic acantholytic cells with few [[inflammatory cells]] | ||
|- | |- | ||
|Bullous | |Bullous pemphigiod | ||
Steven-Johnson's Syndrome | [[Stevens-Johnson syndrome|Steven-Johnson's Syndrome]] | ||
Erosive Lichen Planus | Erosive [[Lichen planus|Lichen Planus]] | ||
|Findings are non-specific with no acantholytic cells | |Findings are non-specific with no acantholytic cells | ||
|- | |- | ||
| rowspan="4" |Cutaneous Infections | | rowspan="4" |Cutaneous Infections | ||
|Herpes Simplex | |[[Herpes simplex|Herpes Simplex]] | ||
Varicella | [[Varicella]] | ||
Herpes Zoster | [[Herpes zoster|Herpes Zoster]] | ||
|Multinucleated syncytial giant cells and acantholytic cells | |[[Giant multinucleated cell|Multinucleated]] syncytial giant cells and acantholytic cells | ||
Intranuclear inclusion bodies surrounded by subtle clear halo is a characteristic of herpetic infection | Intranuclear [[inclusion bodies]] surrounded by subtle clear halo is a characteristic of herpetic infection | ||
|- | |- | ||
|Molluscum contagiosum | |[[Molluscum contagiosum]] | ||
|Intracytoplasmic molluscum bodies (Henderson-Patterson bodies) | |Intracytoplasmic molluscum bodies (Henderson-Patterson bodies) | ||
|- | |- | ||
|Vaccinia, Milker's nodules and variola | |[[Vaccinia]], Milker's nodules and [[variola]] | ||
|Variable number of acantholytic cells and detached keratinocytes | |Variable number of acantholytic cells and detached [[keratinocytes]] | ||
Eosinophilic cytoplasmic | Eosinophilic cytoplasmic [[Inclusion bodies|inclusion]] called "Guarnieri body" may be present | ||
|- | |- | ||
|Leishmaniasis | |[[Leishmaniasis]] | ||
|Leishman-Donovan (LD) bodies | |Leishman-Donovan (LD) bodies | ||
Wright Cells | Wright Cells | ||
|- | |- | ||
| rowspan="2" |Genodermatosis | | rowspan="2" |Genodermatosis | ||
|Hailey-Hailey disease | |[[Hailey-Hailey disease]] | ||
|Multiple acantholytic cells. | |Multiple acantholytic cells. | ||
|- | |- | ||
|Darier disease | |Darier disease | ||
|"Corps ronds" and "grains" appearance | |"Corps ronds" and "grains" appearance | ||
"Corps ronds" are isolated keratinocytes with a round shape and an acidophilic cytoplasm, the grains are seen as small, hyaline, acidophilic ovoid bodies resembling pomegranate seeds. | "Corps ronds" are isolated [[keratinocytes]] with a round shape and an [[acidophilic]] [[cytoplasm]], the grains are seen as small, hyaline, [[acidophilic]] ovoid bodies resembling pomegranate seeds. | ||
|- | |- | ||
| rowspan="6" |Cutaneous Tumors | | rowspan="6" |Cutaneous Tumors | ||
|Basal cell epithelioma | |[[Basal cell epithelioma]] | ||
|Clusters of basaloid cells with peripheral palisading | |Clusters of basaloid cells with peripheral palisading | ||
|- | |- | ||
|Squamous cell carcinoma | |[[Squamous cell carcinoma]] | ||
|Isolated cells with pleomorphism | |Isolated cells with [[pleomorphism]] | ||
Presence of nuclear and cytoplasmic changes | Presence of nuclear and cytoplasmic changes | ||
|- | |- | ||
|Paget's disease | |[[Paget's disease]] | ||
|Round to oval cells with amphophilic, vacuolated cytoplasm and a hypertrophic nucleolated nucleus | |Round to oval cells with amphophilic, vacuolated [[cytoplasm]] and a hypertrophic nucleolated [[nucleus]] | ||
|- | |- | ||
|Erythroplasia of Queyrat | |[[Erythroplasia of Queyrat]] | ||
|Polyhedral, spindle-shaped and round cells with "poikilokaryosis" | |Polyhedral, spindle-shaped and round cells with "poikilokaryosis" | ||
|- | |- | ||
|Mastocytoma | |[[Mastocytoma]] | ||
|Numerous mast cells | |Numerous [[mast cells]] | ||
|- | |- | ||
|Histiocytosis X | |[[Histiocytosis X]] | ||
|Multinucleate atypical Langerhans | |Multinucleate atypical [[Langerhans cells]] | ||
|} | |} | ||
Revision as of 17:53, 24 April 2017
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Historical Perspective
- Diagnostic cytology is the study of individual cells and their characteristics and functions.
- George Papanicolaou is considered the father of exfoliative cytology.
- Cytology technique was first used by Tzanck for the diagnosis dermatological disorders such as herpes and other vesico-bullous lesions.
- The test is named after Arnault Tzanck (1886-1954), a Russian dermatologist.
- The different techniques of cytological studies include aspiration cytology, imprint smear, exudate smear, skin scraping smear, and Tzanck smear.
Tzanck Smear
Sample Collection
- In patients with suspected viral lesions the sample must be collected from fresh vesicular lesions rather than the healing crusted lesions, to have a sample with adequate number of virus infected cells.
- The vesicle should be un-roofed and the base of the ulcer must be scraped with a scalpel or with a scapula.
- The obtained material should be then transferred on to a clean glass slide.
- Care should should be taken that the glass slide is clean and has no finger prints as the specimen will not stay on the glass slide with finger prints.
Fixation of the Smear
- A fixative fluid contains reactive chemicals and is useful for the preservation of the specimens. The fixative fluid prevents the denaturation of the proteins and autolysis and helps in maintaining the cellular morphology and its contents.
- Fixatives usually contain chemicals like formalin, glutaraldehyde, methanol, ethanol, acetone, acetic acid, chromates, and picric acid.
- Once the sample is transferred on to the glass slide it should be fixed immediately using a fixative fluid to prevent drying of the tissue.
Staining of the Smear
- Many stains can be used for the fixation of the Tzanck smear must the most commonly used stain is the Giemsa stain.
- Other stains that can be used include the following:
Interpretation of the Smear Findings
A typical Tzanck cell is a large round keratinocyte with a hypertrophic nucleus, hazy or absent nucleoli, and abundant basophilic cytoplasm. The basophilic staining is deeper peripherally on the cell membrane due to the cytoplasm's tendency to get condensed at the periphery, leading to a perinuclear halo.
The following are the list of cutaneous diseases which can be differentiated based on the findings on the Tzanck smear:
| Class | Disease | Cytological Findings |
|---|---|---|
| Immunobullous Lesions | Pemphigus vulgaris | Multiple acantholytic cells (Tzanck cells) |
| Toxic epidermal necrolysis | Necrotizing basal cells with scattered inflammatory cells and fibroblasts | |
| Staphylococcal scalded skin syndrome | Dyskeratotic acantholytic cells with few inflammatory cells | |
| Bullous pemphigiod
Erosive Lichen Planus |
Findings are non-specific with no acantholytic cells | |
| Cutaneous Infections | Herpes Simplex | Multinucleated syncytial giant cells and acantholytic cells
Intranuclear inclusion bodies surrounded by subtle clear halo is a characteristic of herpetic infection |
| Molluscum contagiosum | Intracytoplasmic molluscum bodies (Henderson-Patterson bodies) | |
| Vaccinia, Milker's nodules and variola | Variable number of acantholytic cells and detached keratinocytes
Eosinophilic cytoplasmic inclusion called "Guarnieri body" may be present | |
| Leishmaniasis | Leishman-Donovan (LD) bodies
Wright Cells | |
| Genodermatosis | Hailey-Hailey disease | Multiple acantholytic cells. |
| Darier disease | "Corps ronds" and "grains" appearance
"Corps ronds" are isolated keratinocytes with a round shape and an acidophilic cytoplasm, the grains are seen as small, hyaline, acidophilic ovoid bodies resembling pomegranate seeds. | |
| Cutaneous Tumors | Basal cell epithelioma | Clusters of basaloid cells with peripheral palisading |
| Squamous cell carcinoma | Isolated cells with pleomorphism
Presence of nuclear and cytoplasmic changes | |
| Paget's disease | Round to oval cells with amphophilic, vacuolated cytoplasm and a hypertrophic nucleolated nucleus | |
| Erythroplasia of Queyrat | Polyhedral, spindle-shaped and round cells with "poikilokaryosis" | |
| Mastocytoma | Numerous mast cells | |
| Histiocytosis X | Multinucleate atypical Langerhans cells |
In dermatopathology, the Tzanck test, also Tzanck smear, is scraping of an ulcer base to look for Tzanck cells. It is sometimes also called the Chickenpox skin test and the herpes skin test.
Tzanck cells are found in:
It is named after Arnault Tzanck (1886-1954), a Russian dermatologist.
External links
- Tzanck test - medlineplus.org.
- Definition of Tzanck test - medterms.com.