Tzanck Smear

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1. Tzanck Smear By – Dr Nainshi Bhatt

2. Tzanck test Introduced by Arnault Tzanck in 1947. Tzanck smear - scraping of an ulcer base to look for  Tzanck cells . Simple, fast and inexpensive test used for screening of acantholytic diseases. Routine stain : Geimsa Other stains : PAP, Gram stain Immunoflorescence

3. Tzanck smear For viral infections:- the vesicle should be unroofed or the crust removed, and the base scraped with a scalpel or the edge of a spatula. In blistering disorders :- the intact roof of a blister is opened along one side, folded back and the floor gently scraped. In suspected tumors:- any crust should be removed from ulcerated tumors, and non-ulcerated tumors should be incised with a sharp, pointed scalpel. A sample of tumor is then obtained with either a blunt scalpel.

4. Keratinocytes If the cytological sample is taken from normal skin, most of the cells are anucleated keratinocytes .

5. Keratinocytes On histopatology :- Polygonal or circular cells, are eosinophilic due to the keratin content in their cytoplasm. The N:C favors the cytoplasm.

6. Mechanism of acantholysis Distruption of desmosomes Desmosomal cadherins :- Homophilic adhesion Desmoglein and desmocollin are transmembranous Desmoplakin and plakoglobin are cytoplasmic components One end of DSG attaches to other DSG and the other end attaches to PG which in turns attaches to DP which in turns attaches to keratin filaments.

7. Tzanck cells In some erosive- vesiculobullous and tumoral diseases, the keratinocyte cytoplasm shrinks, becomes rounded, and turns into acantholytic cells, also called Tzanck cells. These are round, hyperchromatic nucleated cells The nucleus/cytoplasm ratio of acantholytic cells favors the nucleus.

8. Tzanck cells These cells have a perinuclear halo with pale staining around the nucleus.

9. Tzanck cells The cytoplasm in the periphery is stained more darkly basophilic and creates an image called as “mourning edge.”

10. Tzanck cells The diameter of the acantholytic cells is approximately 2–2.5 times the size of the lymphocyte

11. HSV Acantholytic cells, multinucleated giant cells and intranuclear inclusions

12. Bullous pemphigoid Keratin is not normally found in the cytoplasm of keratinocytes that have not lost their nuclei. Keratinocytes that have not lost their nuclei and have keratin-containing cytoplasm are called dyskeratotic cells. The cytoplasm of dyskeratotic keratinocytes stained with MGG stain has a pinkish appearance due to keratin accumulation.

13. Bullous pemphigoid

14. Darier’s Disease Rare inherited (autosomal dominant) Mutation in sarcoplasmic /endoplasmic reticulum calcium ATPase 2 (SERCA2) Mutation elicits stress in the endoplasmic reticulum and induces dyskeratosis , acantholysis , and apoptosis.

15. Darier’s Disease Corps ronds are pyknotic nucleated keratinocytes with a transparent halo around them. Grains are the smallest apoptotic cells; they are miniaturized and have the shape of pomegranate seeds

16. Acantholytic Squamous Cell Carcinoma Acantholytic cells, irregular nucleated atypical keratinocyte and mitosis

17. Pemphigus - Cell surface of acantholytic cells is either flat or contains sawtooth -like cytoplasmic protrusions . Abundant inflammatory cells - Streptocytes and rosette

18. Hailey–Hailey’s Disease Rare Mutation of ATP2C1 gene –calcium pump regulator

19. Thankyou