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Benign and Malignant Benign and Malignant Lesions in Respiratory Lesions in Respiratory
CytologyCytology
MISS SURUTTAYA CHINNAWONGMISS SURUTTAYA CHINNAWONG
Respiratory CytologyRespiratory Cytology
• Major role:– Diagnosis of malignant neoplasms
involving lung both primary and metastatic
• Minor role:– Opportunistic infection– Specific inflammatory process– Benign neoplasms, some
Sampling techniquesSampling techniques
• Exfoliative methods– Sputum cytology– Bronchial cytology (BW and BB)– Bronchoalveolar lavage (BAL)
• Fine needle aspiration (FNA)
Exfoliative methodsExfoliative methods
• Factors influences diagnostic yields– Tumor mass
• Location, size, histologic type
– Infiltrative lesion: inflammation• Diffuse process or localized process
• Sensitivity and specificity• False negative diagnoses
Sputum CytologySputum Cytology
• Symptomatic patients• Techniques:
– ”pick and smear”– Saccomanno– Cytospin or monolayer
• Advantages:• Disadvantages
Advantages of sputumAdvantages of sputum• Noninvasive• Reflect constituents from many regions of
lung• Useful for centrally located malignancies
(Squamous cell/Small cell CA)• High diagnostic yields: induced sputum, 3-5
samples continuously examined• Chronic inflammations: Asthma, COPD• Respiratory infections
Disadvantages of Disadvantages of sputumsputum
• Alveolar macrophages: lower respiratory tract elements
• Localized lung lesion, peripheral lesion
• Adenocarcinoma, metastatic lesion, lymphoma
• Benign tumor
Bronchial cytologyBronchial cytology
• Fiberoptic bronchoscopy• Bronchoscope positions at the area of
abnormality• Adequacy: large number of bronchial
epithelial cells and alveolar macrophages• Inadequate specimen: heavy oral
contamination, obscuring blood, inflammatory process, dried artefact
Bronchial cytology: Bronchial cytology: disadvantagesdisadvantages
• Limited area of the lung examined by bronchoscopy
• Invasive procedure: unpleasant for the patients
• Benign tumors, extremely peripheral lesions
Bronchoalveolar lavageBronchoalveolar lavage
• The most distal airspaces• Diffuse disease process• Pulmonary infection: opportunistic
infections• Interstitial lung disease• Lymphoproliferative disorders• Malignancy
BAL cytologyBAL cytology
• Adequacy: abundant alveolar macrophages
• Inadequacy: bronchial epithelial cells or squamous cells >75%
FNA cytologyFNA cytology
• Percutaneous transthoracic FNA– Direct lung tap– CT-guided FNAB
• Transbronchial (Wang’s needle) FNA– Bronchoscopy– Staging of lung tumors
• Hilar nodes• Mediastinal nodes• Subcarinal nodes
FNA lung lesionFNA lung lesion
• Sensitivity: 75-95%• Specificity: 95-100%• Classification of tumor: 70-85%• Complications: lesion depth/size, needle
– Pneumothorax: 5-10% need treatment– Hemoptysis– Air embolism
Normal Elements Normal Elements
• Upper respiratory tract– Nonkeratinizing stratified squamous cells
• Lower respiratory tract– Ciliated columnar bronchial epithelial cells– Goblet cells– Alveolar pneumocytes
• Reactive changes– Flat cohesive sheets – Multinucleated ciliated cells
Benign cellular Benign cellular proliferationsproliferations
• Creola body– Bronchial cell hyperplasia
• Goblet cell hyperplasia– Mucin vacuoles with small nuclei
• Reserved cell– Basal cells with molded nuclei
Noncellular Noncellular componentscomponents
• Corpora amylacea: noncalcified concretions
• Psammoma bodies• Ferruginous bodies• Charcot-Layden crystals• Curschmann spirals• Contaminants: pollen, food
Nonneoplastic lung Nonneoplastic lung diseasedisease
• Sarcoidosis– Granulomatous inflammation of lung
parenchyma with hilar/mediastinal node involement
– FNA diagnosis– Diagnosis includes typical features of
nonnecrotizing granuloma and exclusion of specific infectious etiology
– Culture and special stains needed
Noneoplastic lung Noneoplastic lung diseasedisease
• Pulmonary alveolar proteinosis– BAL diagnosis
• Gross: cloudy/milky white with graular debris
– Paucicellular sample of mononuclear inflammatory cells
– Amorphous basophilic granular debris– D/Dx: Pneumocystosis, Nocardia,
amyloidosis
Hemosiderin pigments in alveolar macrophages (PAP)
Pulmonary InfectionPulmonary Infection
• Viral infection– BAL diagnosis– Cilicytophthoria: detachment of cilia
• Adenovirus infection
– Reactive epithelial atypia– Specific viral inclusions