Non-cellular elements and specimen contaminants
Non-cellular findings in respiratory material include those produced by the host, inhaled, formed as response to foreign material and introduced as laboratory contaminants. Curschmann`s spirals are coiled strand of mucus. On Papanicolaou stains, they appear as purple helices. They are a non-specific finding associated with chronic respiratory disorders. Ferruginous bodies are mineral fibers (such […]
Echinococcosis (hydatid disease)
It is contracted by ingestion of Echinococcus granulosus or Echinococcus multilocularis cestode eggs, which hatch into embryos in the small intestine, enter the circulatory system and form hydatid cysts in many organs (such as the lung). In cytologic specimens, the laminated hydatid cystic wall (staining positive with PAS and methenamine silver) can be seen containing […]
Benign cellular changes
Squamous cell changes Bronchial cell changes Bronchial reserve cell hyperplasia Repair Tipe II pneumocytes hyperplasia Squamous cells Squamous cells from the upper respiratory tract often contaminate specimens from the lower tract. Inflammatory conditions of the mouth may exfoliate atypical squamous cells which should not be misdiagnosed as squamous cell carcinoma. Cancer involving head and neck […]
Lymphoma
Hodgkin and non-Hodgkin lymphomas occur as primary tumors of the lung, but spread from an extrapulmonary primary is more common. The most common primary lymphoma of the lung is low-grade extranodal marginal zone lymphoma (MALT lymphoma), followed by diffuse large B-cell lymphoma. Low grade lymphomas are typically incidental, solitary lung masses with an indolent clinical […]
Cell sampling and preparation methods
Respiratory cytomorphology is heavily dependent on specimen type and preparation. Cell sampling and preparation methods are crucial for a correct cytologic interpretation. In the diagnosis of pulmonary nodules, bronchoscopic methods are usually the first approach for central lesions; if negative, fine needle aspiration (FNA) cytology can be performed. FNA cytology is particularly useful for peripheral […]
Sputum
Sputum consists of a mixture of cellular and non-cellular elements cleared by mucociliar apparatus. It is easy to obtain and cause little or no patient discomfort, but its use is declining because of the advent of bronchoscopy and fine needle aspiration. The sensitivity of sputum cytology for the diagnosis of malignancy increases with the number […]
Bronchial material
Bronchial material A great improvement in sampling cells from the lower respiratory tract occurred with the development of the flexible bronchoscope in the late 1960s. The complications of bronchoscopy, including laryngospasm, bronchospasm, disturbances of cardiac conduction and sepsis, are very rare. Bronchoscopic methods are particularly good for diagnosing central lesions, on which a biopsy and […]
Transbronchial fine needle aspiration (FNA)
Transbronchial FNA is especially useful for the diagnosis of primary lung lesions lying beneath the bronchial surface and for staging lung cancer patients with mediastinal lymphadenopaty. The lesion is aspirated by a retractable needle (Wang needle) that is passed through a flexible catheter sent down the bronchoscope. Complications of transbronchial FNA are rare, including endobronchial […]
Transthoracic fine needle aspiration (FNA)
The indication for transthoracic FNA is the presence of a pulmonary mass. This method allows to spare many patients a more invasive surgical procedure. Indications to FNA also include subclassification of obvious malignant neoplasms and persistent lung infections. The most common complication is pneumothorax, requiring a drainage tube in 10% of the patients. FNA is […]
Liquid-based cytology (LBC)
Liquid-based cytology (LBC) has emerged as an alternative to conventional cytopreparatory methods. In particular, LBC has been extensively implemented in the cervical screening program, but it has found broader acceptance also in non-gynecologic cytologic preparations. LBC uses a specially devised instrument which allows a monolayer of cells to be obtained from a liquid sample. Most studies […]