Respiratory cytology

1. Benign and MalignantBenign and Malignant
Lesions in RespiratoryLesions in Respiratory
CytologyCytology
MISS SURUTTAYA CHINNAWONGMISS SURUTTAYA CHINNAWONG

2. 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

3. Sampling techniquesSampling techniques
• Exfoliative methods
– Sputum cytology
– Bronchial cytology (BW and BB)
– Bronchoalveolar lavage (BAL)
• Fine needle aspiration (FNA)

4. 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

6. Sputum CytologySputum Cytology
• Symptomatic patients
• Techniques:
– ”pick and smear”
– Saccomanno
– Cytospin or monolayer
• Advantages:
• Disadvantages

7. 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

8. Disadvantages of sputumDisadvantages of sputum
• Alveolar macrophages: lower respiratory
tract elements
• Localized lung lesion, peripheral lesion
• Adenocarcinoma, metastatic lesion,
lymphoma
• Benign tumor

9. 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

10. Bronchial cytology:Bronchial cytology:
disadvantagesdisadvantages
• Limited area of the lung examined by
bronchoscopy
• Invasive procedure: unpleasant for the
patients
• Benign tumors, extremely peripheral
lesions

11. Bronchoalveolar lavageBronchoalveolar lavage
• The most distal airspaces
• Diffuse disease process
• Pulmonary infection: opportunistic
infections
• Interstitial lung disease
• Lymphoproliferative disorders
• Malignancy

12. BAL cytologyBAL cytology
• Adequacy: abundant alveolar
macrophages
• Inadequacy: bronchial epithelial cells
or squamous cells >75%

14. 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

15. 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

16. Normal ElementsNormal 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

22. Benign cellularBenign cellular
proliferationsproliferations
• Creola body
– Bronchial cell hyperplasia
• Goblet cell hyperplasia
– Mucin vacuoles with small nuclei
• Reserved cell
– Basal cells with molded nuclei

28. Noncellular componentsNoncellular components
• Corpora amylacea: noncalcified
concretions
• Psammoma bodies
• Ferruginous bodies
• Charcot-Layden crystals
• Curschmann spirals
• Contaminants: pollen, food

33. Nonneoplastic lungNonneoplastic 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

34. Noneoplastic lung diseaseNoneoplastic lung disease
• 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

35. erin pigments in alveolar macropha

37. Pulmonary InfectionPulmonary Infection
• Viral infection
– BAL diagnosis
– Cilicytophthoria: detachment of cilia
• Adenovirus infection
– Reactive epithelial atypia
– Specific viral inclusions