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