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'''Pulmonary cytopathology''' is a subset of [[cytopathology]]. | [[Image:Macrophages in bronchial wash specimen -- very high mag.jpg|thumb|right|Pulmonary macrophages. Bronchial wash. [[Diff-Quik]]. (WC)]] | ||
[[Image:Bronchial cells - bronchial wash - 2 -- very high mag.jpg|thumb|right|Benign bronchial cells. Bronchial wash. [[Pap stain]]. (WC)]] | |||
'''Pulmonary cytopathology''', also '''lung cytology''', is a subset of [[cytopathology]]. | |||
This article deals only with pulmonary cytopathology (FNAs, sputum samples). An introduction to cytopathology is in the ''[[cytopathology]]'' article. An introduction to lung pathology is in the ''[[lung]]'' article. | This article deals only with pulmonary cytopathology (FNAs, sputum samples). Pleural cavity specimens are dealt with in the ''[[mesothelial cytopathology]]'' article. | ||
An introduction to cytopathology is in the ''[[cytopathology]]'' article. An introduction to lung pathology is in the ''[[lung]]'' article. | |||
=Introduction= | =Introduction= | ||
==Specimen types== | ==Specimen types== | ||
#Bronchial brushings. | #Bronchial brushings. | ||
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#Bronchoalveolar lavage (BAL). | #Bronchoalveolar lavage (BAL). | ||
#Endobronchial ultrasongraphic transbronchial needle aspiration (EBUS-TNA). | #Endobronchial ultrasongraphic transbronchial needle aspiration (EBUS-TNA). | ||
#[[Endoscopic ultrasound-guided fine needle aspiration]]. | |||
==Adequacy criteria== | ==Adequacy criteria== | ||
* | ===EBUS=== | ||
There is a proposed standard for EBUS specimens:<ref name=pmid22246929>{{Cite journal | last1 = Nayak | first1 = A. | last2 = Sugrue | first2 = C. | last3 = Koenig | first3 = S. | last4 = Wasserman | first4 = PG. | last5 = Hoda | first5 = S. | last6 = Morgenstern | first6 = NJ. | title = Endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA): a proposal for on-site adequacy criteria. | journal = Diagn Cytopathol | volume = 40 | issue = 2 | pages = 128-37 | month = Feb | year = 2012 | doi = 10.1002/dc.21517 | PMID = 22246929 }}</ref> | |||
*> 5 low power fields (×10 objective) with >= 100 lymphocytes and < 2 groups of bronchial cells. | |||
Note: | |||
*A simplified version: 5 fields of view x 100 cells/1 field of view = 500 cells. | |||
===Other specimens=== | |||
Brushings, washes and lavages: | |||
*One should see pulmonary macrophages (large cells with bubbly green/brown cytoplasm, eccentric reniform nucleus). | |||
Notes: | |||
*Ciliated cells may be from the nasopharynx - not proof of lung parenchymal tissue. | |||
*There is no generally accepted standard for bronchial brushings, washes and lavages. A house standard at a larger teaching centre is:<ref>UHN PCY50001.08 P.11.</ref> | |||
**Sputum: >= 10 pulmonary macrophages. | |||
==Normal cytology== | |||
*Cells with cilia = good. | |||
*Cells with "[[terminal bar]]" (band at luminal aspect of cell - associated with cilia) = good. | |||
===Images=== | |||
====Cartilage==== | |||
<gallery> | |||
Image: Bronchial cartilage - ebus -- intermed mag.jpg | Cartilage - intermed. mag. (WC) | |||
Image: Bronchial cartilage - ebus -- high mag.jpg | Cartilage - high mag. (WC) | |||
</gallery> | |||
====Epithelium==== | |||
<gallery> | |||
Image: Bronchial epithelium - ebus -- intermed mag.jpg | Bronchial epi. - intermed. mag. (WC) | |||
Image: Bronchial epithelium - ebus -- high mag.jpg | Bronchial epi. - high mag. (WC) | |||
Image: Bronchial epithelium - ebus -- very high mag.jpg | Bronchial epi. - very high mag. (WC) | |||
</gallery> | |||
<gallery> | |||
Image: Bronchial cells - bronchial wash -- high mag.jpg | EBCs - high mag. | |||
Image: Bronchial cells - bronchial wash -- very high mag.jpg | EBCs - high mag. | |||
Image: Bronchial cells - bronchial wash - 2 -- high mag.jpg | EBCs - high mag. | |||
Image: Bronchial cells - bronchial wash - 2 -- very high mag.jpg | EBCs - high mag. | |||
</gallery> | |||
==Reactive bronchial cells== | |||
===Cytology=== | |||
Features: | |||
*Clusters of small round cells. | |||
*+/-Grooves. | |||
====Images==== | |||
* | <gallery> | ||
Image: Bronchial epithelium with inflammation -- high mag.jpg | BBE - high mag. | |||
Image: Bronchial epithelium with inflammation -- very high mag.jpg | BBE - very high mag. | |||
Image: Bronchial epithelium with inflammation - alt -- very high mag.jpg | BBE - very high mag. | |||
</gallery> | |||
<gallery> | |||
Image: Reactive bronchial cells -- very high mag.jpg | RBCs - very high mag. | |||
Image: Reactive bronchial cells -- extremely high mag.jpg | RBCs - extremely high mag. | |||
</gallery> | |||
=====www===== | |||
*[http://www.cytologystuff.com/gallery/images_large/slide0612.jpg Reactive bronchial cells (cytologystuff.com)].<ref>URL: [http://www.cytologystuff.com/study/section12ng.htm http://www.cytologystuff.com/study/section12ng.htm]. Accessed on: 19 August 2015.</ref> | |||
==Actinomycetes== | |||
{{Main|Actinomycetes}} | |||
Image: | |||
*[http://www.cytologystuff.com/gallery/images_large/slide0540.jpg Actinomycetes (cytologystuff.com)].<ref>URL: [http://www.cytologystuff.com/study/section11ng.htm http://www.cytologystuff.com/study/section11ng.htm]. Accessed on: 26 October 2015.</ref> | |||
=Infection= | =Infection= | ||
If you see lotsa lymphocytes think tumour.<ref>Attributed to SM. 6 January 2010.</ref> | If you see lotsa lymphocytes think tumour.<ref>Attributed to SM. 6 January 2010.</ref> | ||
== | ==Pneumocystis pneumonia== | ||
{{Main|Pneumocystis pneumonia}} | |||
*Abbreviated ''PCP''. | |||
Features: | Features: | ||
*Casts of frothy material/large proteinaceous debris - approximately the size of an alveolus. | *Casts of frothy material/large proteinaceous debris - approximately the size of an alveolus. | ||
DDx: | |||
*[[Pulmonary alveolar proteinosis]]. | |||
==Aspergillosis== | ==Aspergillosis== | ||
{{Main|Aspergillosis}} | |||
Features: | Features: | ||
*Hyphae... branching at 45 degrees. | *Hyphae... branching at 45 degrees. | ||
Image: | Image: | ||
<gallery> | |||
Image:Pulmonary_aspergillosis.jpg | Aspergillosis. (WC) | |||
</gallery> | |||
==Zygomycosis== | ==Zygomycosis== | ||
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Image: | Image: | ||
<gallery> | |||
Image:Zygomycosis.jpg | Zygomycosis. (WC) | |||
</gallery> | |||
==Crytococcus== | ==Crytococcus== | ||
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**Seen well on Pap stain... harder to see on rapid Romanowsky stain. | **Seen well on Pap stain... harder to see on rapid Romanowsky stain. | ||
*Spherical - 5-15 micrometres. | *Spherical - 5-15 micrometres. | ||
DDx: | DDx: | ||
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**Has broad based budding. | **Has broad based budding. | ||
*Coccidioidomycosis - larger (20-60 micrometers). | *Coccidioidomycosis - larger (20-60 micrometers). | ||
Image: | |||
<gallery> | |||
Image:Cryptococcus.jpg | Cryptococcus. (WC) | |||
</gallery> | |||
=Cancer= | =Cancer= | ||
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|- | |- | ||
! | ! | ||
! Small cell carcinoma | ! [[Small cell carcinoma]] | ||
! Adenocarcinoma | ! Adenocarcinoma | ||
! Squamous cell carcinoma | ! [[Squamous cell carcinoma]] | ||
! Value | ! Value | ||
|- | |- | ||
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| Absent | | Absent | ||
| Absent | | Absent | ||
| R/i & r/o: small cell carcinoma and carcinoid | | R/i & r/o: small cell carcinoma and [[carcinoid]] | ||
|- | |- | ||
| Small nucleoli (difficult to see on Field stain) | | Small nucleoli (difficult to see on Field stain) | ||
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| Weak discriminative valuable | | Weak discriminative valuable | ||
|- | |- | ||
| Large nucleoli | | Large [[nucleoli]] | ||
| '''Never''' | | '''Never''' | ||
| '''Present''' | | '''Present''' | ||
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| '''Present''' | | '''Present''' | ||
| Present r/i squamous (strong) | | Present r/i squamous (strong) | ||
|- | |||
| Image | |||
| [[Image:Lung small cell carcinoma -- extremely high mag.jpg|thumb|center|120px|SmCC - Pap stain. (WC)]] | |||
| [[Image:Lung adenocarcinoma - Pap stain -- very high mag.jpg|thumb|center|120px|LA - Pap stain. (WC)]] | |||
| [[Image:Squamous carcinoma - lung FNA -- very high mag.jpg|thumb|center|120px|SCC - Pap stain. (WC)]] | |||
| <!-- Value --> | |||
|} | |} | ||
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#*Good ones are visible with 10X objective (excludes SCLC). | #*Good ones are visible with 10X objective (excludes SCLC). | ||
#*Look for subtle large ones - at higher power. | #*Look for subtle large ones - at higher power. | ||
#*Neuroendocrine tumours occasionally may appear to have nucleoli - one should see good nucleoli in 3-4 cells in one field. | #*Neuroendocrine tumours occasionally may appear to have [[nucleoli]] - one should see good nucleoli in 3-4 cells in one field. | ||
#'''Abundant cytoplasm''' - virtually excludes small cell carcinoma. | #'''Abundant cytoplasm''' - virtually excludes small cell carcinoma. | ||
#Vacuoles with mucin (pink discolouration) - virtually diagnostic, though only seen occasionally. | #Vacuoles with mucin (pink discolouration) - virtually diagnostic, though only seen occasionally. | ||
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==Adenocarcinoma== | ==Adenocarcinoma== | ||
{{Main|Adenocarcinoma of the lung}} | |||
===General=== | |||
*Most common type of lung cancer. | *Most common type of lung cancer. | ||
===Cytology=== | ===Cytology=== | ||
Features: | Features: | ||
*Eccentric nucleus: | |||
**+/-Nuclear grooves. | |||
**+/-Nuclear pseudoinclusions. | |||
*Nucleolus. | *Nucleolus. | ||
**Good ones are visible with 10X objective (virtually excludes SCLC). | **Good ones are visible with 10X objective (virtually excludes SCLC). | ||
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*Abundant cytoplasm - virtually excludes small cell carcinoma. | *Abundant cytoplasm - virtually excludes small cell carcinoma. | ||
*Vacuoles with mucin (pink discolouration) - virtually diagnostic. | *Vacuoles with mucin (pink discolouration) - virtually diagnostic. | ||
Notes: | Notes: | ||
*May be subtle, i.e. have minimal cytologic changes. | *May be subtle, i.e. have minimal cytologic changes. | ||
*No nuclear moulding -esp. important if no nucleolus visible. | |||
DDx: | DDx: | ||
*[[Creola body]] - have cilia, may be subtle. | |||
*Benign mesothelium (also sheets of cells). | *Benign mesothelium (also sheets of cells). | ||
*Atypical adenomatous hyperplasia (AAH) - thought to be the precursor to adenocarcinoma.<ref name=pmid11235908>{{Cite journal | last1 = Mori | first1 = M. | last2 = Rao | first2 = SK. | last3 = Popper | first3 = HH. | last4 = Cagle | first4 = PT. | last5 = Fraire | first5 = AE. | title = Atypical adenomatous hyperplasia of the lung: a probable forerunner in the development of adenocarcinoma of the lung. | journal = Mod Pathol | volume = 14 | issue = 2 | pages = 72-84 | month = Feb | year = 2001 | doi = 10.1038/modpathol.3880259 | PMID = 11235908 |url = http://www.nature.com/modpathol/journal/v14/n2/full/3880259a.html }}</ref> | *[[Atypical adenomatous hyperplasia]] (AAH) - thought to be the precursor to adenocarcinoma.<ref name=pmid11235908>{{Cite journal | last1 = Mori | first1 = M. | last2 = Rao | first2 = SK. | last3 = Popper | first3 = HH. | last4 = Cagle | first4 = PT. | last5 = Fraire | first5 = AE. | title = Atypical adenomatous hyperplasia of the lung: a probable forerunner in the development of adenocarcinoma of the lung. | journal = Mod Pathol | volume = 14 | issue = 2 | pages = 72-84 | month = Feb | year = 2001 | doi = 10.1038/modpathol.3880259 | PMID = 11235908 |url = http://www.nature.com/modpathol/journal/v14/n2/full/3880259a.html }}</ref> | ||
**AAH has a size criterion, ergo not really possible to diagnose on cytopathology specimen. | **AAH has a size criterion, ergo not really possible to diagnose on cytopathology specimen. | ||
*Vegetable cell - contaminant.<ref name=pmid8384547>{{Cite journal | last1 = Naryshkin | first1 = S. | last2 = Young | first2 = NA. | title = Respiratory cytology: a review of non-neoplastic mimics of malignancy. | journal = Diagn Cytopathol | volume = 9 | issue = 1 | pages = 89-97 | month = | year = 1993 | doi = | PMID = 8384547 }}</ref> | |||
====Images==== | |||
<gallery> | |||
Image: Lung adenocarcinoma - Pap stain -- high mag.jpg | LA - Pap - high mag. (WC) | |||
Image: Lung adenocarcinoma - Pap stain -- very high mag.jpg | LA - Pap - very high mag. (WC) | |||
Image: Lung adenocarcinoma - Pap stain - alt -- very high mag.jpg | LA - Pap - very high mag. (WC) | |||
Image: Lung adenocarcinoma - Diff-Quik -- high mag.jpg | LA - [[Diff-Quik stain|DQ]] - high mag. (WC) | |||
Image: Lung adenocarcinoma - Diff-Quik -- very high mag.jpg | LA - DQ - very high mag. (WC) | |||
</gallery> | |||
==Neuroendocrine tumours== | ==Neuroendocrine tumours== | ||
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The grouping can be divided into four types:<ref name=cancerorg_car>[http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_lung_carcinoid_tumor_56.asp http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_lung_carcinoid_tumor_56.asp]</ref> | The grouping can be divided into four types:<ref name=cancerorg_car>[http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_lung_carcinoid_tumor_56.asp http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_lung_carcinoid_tumor_56.asp]</ref> | ||
*Small cell carcinoma. | *[[Small cell carcinoma of the lung|Small cell carcinoma]]. | ||
*Large cell neuroendocrine carcinoma. | *Large cell neuroendocrine carcinoma. | ||
*Typical carcinoid. | *[[Typical carcinoid]]. | ||
*Atypical carcinoid. | *[[Atypical carcinoid]]. | ||
Cytologic features useful for differentiation: | Cytologic features useful for differentiation: | ||
*Small cell carcinoma: necrosis, scant cytoplasm, mitoses. | *Small cell carcinoma: necrosis, scant cytoplasm, mitoses. | ||
*Typical carcinoid: often more cytoplasm, no necrosis, low mitotic rate ( | *Typical carcinoid: often more cytoplasm, no necrosis, low mitotic rate (MIB1: scant staining). | ||
*Atypical carcinoid: higher mitotic rate/ | *Atypical carcinoid: higher mitotic rate/MIB1 than ''typical carcinoid'',<ref>WG. February 2010.</ref> no necrosis. | ||
Notes:<ref name=cancerorg_car/> | Notes:<ref name=cancerorg_car/> | ||
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==Small cell lung carcinoma== | ==Small cell lung carcinoma== | ||
===General=== | |||
*Is the most easy lung cancer to miss, as one is usually looking for large cells. | *Is the most easy lung cancer to miss, as one is usually looking for large cells. | ||
===Microscopic=== | |||
Features: | |||
*Morphologic features of malignancy: | *Morphologic features of malignancy: | ||
**Irregular nuclear membrane. | **Irregular nuclear membrane. | ||
**Chromatin clumping. | **Chromatin clumping. | ||
**Marked nuclear size variation. | **Marked nuclear size variation. | ||
* | *Nuclear moulding - most useful for distinguishing from NSCLC<ref name=pmid10941334>{{Cite journal | last1 = Sturgis | first1 = CD. | last2 = Nassar | first2 = DL. | last3 = D'Antonio | first3 = JA. | last4 = Raab | first4 = SS. | title = Cytologic features useful for distinguishing small cell from non-small cell carcinoma in bronchial brush and wash specimens. | journal = Am J Clin Pathol | volume = 114 | issue = 2 | pages = 197-202 | month = Aug | year = 2000 | doi = 10.1309/8MQG-6XEK-3X9L-A9XU | PMID = 10941334 |url=http://ajcp.ascpjournals.org/content/114/2/197.full.pdf }}</ref><ref>URL: [http://onlinelibrary.wiley.com/doi/10.1002/dc.10297/abstract http://onlinelibrary.wiley.com/doi/10.1002/dc.10297/abstract]. Accessed on: 31 May 2011.</ref> - '''key feature'''. | ||
*Stippled chromatin - '''key feature'''. | *Stippled chromatin - '''key feature'''. | ||
*Scant cytoplasm - so scant it often near impossible to see - '''important feature'''. | |||
*Small cells ~ 2x RBC. | *Small cells ~ 2x RBC. | ||
* | *Bare nuclei common - very useful if present. | ||
*Necrosis - ''essential''. | |||
**Cell fragmentation - smeared gray background (Pap stain), fragmented nuclei. | |||
Notes: | Notes: | ||
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*Small cell leukemias may mimic small cell carcinoma; difference: leukemias typically have smaller cells (~size of RBC vs. ~2x of RBC), and lymphoglandular bodies. | *Small cell leukemias may mimic small cell carcinoma; difference: leukemias typically have smaller cells (~size of RBC vs. ~2x of RBC), and lymphoglandular bodies. | ||
Image: | ====Image==== | ||
=====Case 1===== | |||
<gallery> | |||
Image:Small_cell_lung_cancer_-_cytology.jpg | SmCC showing nuclear moulding - [[Field stain]]. (WC) | |||
</gallery> | |||
=====Case 2===== | |||
<gallery> | |||
Image: Lung small cell carcinoma - Diff-Quik -- high mag.jpg | SmCC - [[Diff-Quik]] - high mag. (WC) | |||
Image: Lung small cell carcinoma - Diff-Quik -- very high mag.jpg | SmCC - Diff-Quik - very high mag. (WC) | |||
Image: Lung small cell carcinoma - Diff-Quik -- extremely high mag.jpg | SmCC - Diff-Quik - extremely high mag. (WC) | |||
Image: Lung small cell carcinoma -- very high mag.jpg | SmCC - [[Pap stain]] - very high mag. (WC) | |||
Image: Lung small cell carcinoma -- extremely high mag.jpg | SmCC - Pap stain - extremely high mag. (WC) | |||
</gallery> | |||
=====Case 3===== | |||
<gallery> | |||
Image: Small cell carcinoma - BRB -- high mag.jpg | SmCC - high mag. | |||
Image: Small cell carcinoma - BRB - alt -- high mag.jpg | SmCC - high mag. | |||
Image: Small cell carcinoma - BRB - alt 2 -- high mag.jpg | SmCC - high mag. | |||
Image: Small cell carcinoma - BRB -- very high mag.jpg | SmCC - very high mag. | |||
Image: Small cell carcinoma - BRB - alt -- very high mag.jpg | SmCC - very high mag. | |||
Image: Small cell carcinoma - BRB - alt 2 -- very high mag.jpg | SmCC - very high mag. | |||
Image: Small cell carcinoma - BRB -- very high mag.gif | SmCC - high very mag. | |||
</gallery> | |||
==Squamous cell carcinoma== | ==Squamous cell carcinoma== | ||
=== | {{Main|Squamous cell carcinoma of the lung}} | ||
===Cytology=== | |||
General - features: | |||
*Nuclear features of malignancy (required): | |||
*Nuclear features of malignancy (required | |||
**Irregular nuclear membrane, e.g. notches, sharp discontinuities. | **Irregular nuclear membrane, e.g. notches, sharp discontinuities. | ||
**Nuclear hyperchromasia - "jet-black" nuclei on Pap stain '''key feature'''. | **Nuclear hyperchromasia - "jet-black" nuclei on Pap stain '''key feature'''. | ||
**Increased NC ratio. | **Increased [[NC ratio]]. | ||
**Variation of nuclear size from cell-to-cell. | **Variation of nuclear size from cell-to-cell. | ||
Features - well-differentiated: | |||
* | *Classically single cells. | ||
*Keratinized = orange/red staining on Pap stain. | |||
**"Intense" (blue) staining of cells on rapid Romanowsky + pyknotic (small shriveled) nucleus.<ref>GS. 24 February 2010.</ref> | |||
Features - poorly differentiated: | |||
*Mix of spindle cells/epithelioid cells usu. present in clusters '''without''' a common border. | |||
*Usu. lack keratinization, i.e. not orange/red. | |||
*"Dense" appearing cytoplasm. | |||
**+/-Laminae (layers)/lines in the cytoplasm. | |||
Notes: | Notes: | ||
*One should see abnormal squamous cells to call it SCC. | *One should see abnormal squamous cells to call it SCC. | ||
** | **One should think of ''adenocarcinoma'' as the default - it is more common. | ||
*Poorly differentiated SCC may look like adenocarcinoma. | *Poorly differentiated SCC may look like adenocarcinoma. | ||
====Image==== | |||
=====Case 1===== | |||
<gallery> | |||
Image:Squamous_carcinoma_lung_1_cytology.jpg |SCC. (WC) | |||
Image:Squamous_carcinoma_lung_2_cytology.jpg |SCC. (WC) | |||
</gallery> | |||
=====Case 2===== | |||
<gallery> | |||
Image: Squamous carcinoma - lung FNA -- high mag.jpg | SCC - high mag. | |||
Image: Squamous carcinoma - lung FNA - alt -- high mag.jpg | SCC - high mag. | |||
Image: Squamous carcinoma - lung FNA -- very high mag.jpg | SCC - very high mag. | |||
Image: Squamous carcinoma - lung FNA - alt -- very high mag.jpg | SCC - very high mag. | |||
Image: Squamous carcinoma - lung FNA -- high and very high mag - animation.gif | SCC animation - very high mag. | |||
Image: Squamous carcinoma - lung FNA -- extremely high mag.jpg | SCC - extremely high mag. | |||
Image: Squamous carcinoma - lung FNA - alt 2 -- extremely high mag.jpg | SCC - extremely high mag. | |||
</gallery> | |||
==Malignant melanoma== | ==Malignant melanoma== | ||
{{Main|Malignant melanoma}} | |||
===Cytology=== | |||
Classic features: | Classic features: | ||
#Loosely cohesive cells and single cells. | #Loosely cohesive cells and single cells. | ||
#Mixure of epithelioid cells and spindle cells. | #Mixure of epithelioid cells and spindle cells. | ||
#Malignant cells have: | #Malignant cells have: | ||
#*Prominent red nucleolus. | #*Prominent [[red nucleolus]]. | ||
#*Pigmented cytoplasm - '''key feature''' (often not pigmented). | #*Pigmented cytoplasm - '''key feature''' (often not pigmented). | ||
#*Pigment may only be present in macrophages | #*Pigment may only be present in macrophages | ||
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#The classic appearance of melanoma without pigment is closest to adenocarcinoma (which may have red nucleoli, large cells, abundant cytoplasm, occasional binucleation). | #The classic appearance of melanoma without pigment is closest to adenocarcinoma (which may have red nucleoli, large cells, abundant cytoplasm, occasional binucleation). | ||
#*Differentiating morphologic features: adenocarcinoma - 3-D clusters of cells, no spindle-shaped cells. | #*Differentiating morphologic features: adenocarcinoma - 3-D clusters of cells, no spindle-shaped cells. | ||
#Bug-eyed monster cells - may vaguely resemble a Reed-Sternberg cell (RSC) - diagnostic of Hodgkin's lymphoma (HL). | #Bug-eyed monster cells - may vaguely resemble a Reed-Sternberg cell (RSC) - diagnostic of [[Hodgkin's lymphoma]] (HL). | ||
#*RSCs do not have the granular cytoplasm typical of melanoma. | #*RSCs do not have the granular cytoplasm typical of melanoma. | ||
#*Nuclei usually adjacent, i.e. not at opposite poles of the cell. | #*Nuclei usually adjacent, i.e. not at opposite poles of the cell. | ||
#*Background of melanoma different than HL. | #*Background of melanoma different than HL. | ||
Images | ====Images==== | ||
<gallery> | |||
Image:Melanoma_-_cytology_field_stain.jpg | Bug-eyed monster cell in melanoma. [[Field stain]]. (WC) | |||
</gallery> | |||
=Other= | =Other= | ||
==Asthma== | ==Asthma== | ||
{{Main|Asthma}} | {{Main|Asthma}} | ||
===Cytology=== | |||
Classic findings: | |||
*''Eosinophils''. | |||
*''Curschmann's spirals'' = spiral-shaped mucous plugs.<ref name=pmid9812228>{{cite journal |author=Cenci M, Giovagnoli MR, Alderisio M, Vecchione A |title=Curschmann's spirals in sputum of subjects exposed daily to urban environmental pollution |journal=Diagn. Cytopathol. |volume=19 |issue=5 |pages=349–51 |year=1998 |month=November |pmid=9812228 |doi= |url=}}</ref> | |||
*''Creola bodies'' = clusters of (ciliated) bronchial epithelial cells,<ref name=pmid2818212>{{Cite journal | last1 = Isohima | first1 = K. | last2 = Takahashi | first2 = K. | last3 = Soda | first3 = R. | last4 = Hukasaka | first4 = N. | last5 = Tanabe | first5 = K. | last6 = Ozaki | first6 = K. | last7 = Nakato | first7 = H. | last8 = Araki | first8 = M. | last9 = Tuzi | first9 = M. | title = [The clinical significance of Creola body in the sputum of asthmatic patients]. | journal = Arerugi | volume = 38 | issue = 7 | pages = 542-8 | month = Jul | year = 1989 | doi = | PMID = 2818212 }}</ref> presence associated with more [[eosinophil]]s.<ref name=pmid2383179>{{Cite journal | last1 = Motojima | first1 = S. | last2 = Kushima | first2 = A. | last3 = Ogata | first3 = H. | last4 = Tateishi | first4 = K. | last5 = Fukuda | first5 = T. | last6 = Makino | first6 = S. | title = [Relationship between presence of Creola bodies and airway hyperresponsiveness in patients with bronchial asthma]. | journal = Arerugi | volume = 39 | issue = 4 | pages = 377-83 | month = Apr | year = 1990 | doi = | PMID = 2383179 }}</ref> | |||
Note: | Note: | ||
*''Curschmann's spirals'' are a non-specific finding; they may be seen in a range of conditions in including chronic bronchitis, asymptomatic smokers and | *''Curschmann's spirals'' are a non-specific finding; they may be seen in a range of conditions in including chronic bronchitis, asymptomatic smokers and lung cancer.<ref name=pmid9812228/> | ||
**They can also been in Pap tests. | |||
====Images==== | |||
<gallery> | |||
Image:Curshman%27s_Spiral.jpg | Curschmann spiral. (WC) | |||
</gallery> | |||
www: | |||
*[http://www.medeponyms.com/images/eponyms/creola_body.jpg Creola body (medeponyms.com)].<ref>URL: [http://www.medeponyms.com/entry/27/ http://www.medeponyms.com/entry/27/]. Accessed on: 31 March 2012.</ref> | |||
==Pulmonary hamartoma== | ==Pulmonary hamartoma== | ||
{{Main|Pulmonary hamartoma}} | |||
===General=== | ===General=== | ||
*Non-neoplastic growth - see ''[[hamartoma]]''. | *Non-neoplastic growth - see ''[[hamartoma]]''. | ||
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*No cytologic features of malignancy. | *No cytologic features of malignancy. | ||
*Fat. | *Fat. | ||
==Drug-induced pulmonary toxicity== | |||
===General=== | |||
*Need clinical history. | |||
===Cytology=== | |||
Features: | |||
*Macrophages - classic for amiodarone toxicity. | |||
==Mucinous metaplasia== | |||
===Cytology=== | |||
Features: | |||
*Cluster of cells with abundant clear cytoplasm. | |||
*Bland nuclei. | |||
DDx: | |||
*[[Signet ring cell carcinoma]] - often single cells. | |||
==Lipoid pneumonia== | |||
*[[AKA]] ''cholesterol pneumonia''. | |||
*[[AKA]] ''lipid granulomatosis''. | |||
*[[AKA]] ''lipoid pneumonitis''. | |||
===General=== | |||
Etiology: | |||
*Aspiration or inhalation of a fatty substance, e.g. mineral oils (for [[constipation]]<ref name=pmi17846847>{{Cite journal | last1 = Simmons | first1 = A. | last2 = Rouf | first2 = E. | last3 = Whittle | first3 = J. | title = Not your typical pneumonia: a case of exogenous lipoid pneumonia. | journal = J Gen Intern Med | volume = 22 | issue = 11 | pages = 1613-6 | month = Nov | year = 2007 | doi = 10.1007/s11606-007-0280-7 | PMID = 17846847 }}</ref>), petroleum jelly.<ref name=pmid19901490/> | |||
*Often does not have the classic associations seen in [[aspiration pneumonia]], i.e. intoxication, neurologic disease. | |||
Clinical: | |||
*Chronic cough<ref name=pmid26371101>{{Cite journal | last1 = Bell | first1 = MM. | title = Lipoid pneumonia: An unusual and preventable illness in elderly patients. | journal = Can Fam Physician | volume = 61 | issue = 9 | pages = 775-7 | month = Sep | year = 2015 | doi = | PMID = 26371101 }}</ref> - classic finding. | |||
*+/-Dyspnea.<ref name=pmi17846847/> | |||
*+/-Fever. | |||
*Lower lobe air space disease - opacification (left>right). | |||
*+/-[[Hemoptysis]] (uncommon). | |||
Treatment: | |||
*Stop exposure to lipoid material.<ref name=pmid26371101/> | |||
DDx (clinical): | |||
*Viral pneumonia. | |||
*Others. | |||
===Cytology=== | |||
Features:<ref name=pmid19901490>{{Cite journal | last1 = Khilnani | first1 = GC. | last2 = Hadda | first2 = V. | title = Lipoid pneumonia: an uncommon entity. | journal = Indian J Med Sci | volume = 63 | issue = 10 | pages = 474-80 | month = Oct | year = 2009 | doi = 10.4103/0019-5359.57639 | PMID = 19901490 | URL = http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2009;volume=63;issue=10;spage=474;epage=480;aulast=Khilnani }}</ref> | |||
*Macrophages with multiple fat droplets. | |||
**Often fill the cytoplasm. | |||
*Nucleus often eccentric; '''not''' distorted (as seen in signet ring cells). | |||
DDx: | |||
*[[Signet ring cell carcinoma]]. | |||
*[[Gastroesophageal reflux disease]] - also ''Oil red O'' +ve.<ref>{{Cite journal | last1 = Hopkins | first1 = PM. | last2 = Kermeen | first2 = F. | last3 = Duhig | first3 = E. | last4 = Fletcher | first4 = L. | last5 = Gradwell | first5 = J. | last6 = Whitfield | first6 = L. | last7 = Godinez | first7 = C. | last8 = Musk | first8 = M. | last9 = Chambers | first9 = D. | title = Oil red O stain of alveolar macrophages is an effective screening test for gastroesophageal reflux disease in lung transplant recipients. | journal = J Heart Lung Transplant | volume = 29 | issue = 8 | pages = 859-64 | month = Aug | year = 2010 | doi = 10.1016/j.healun.2010.03.015 | PMID = 20466562 }}</ref> | |||
====Image==== | |||
*[http://www.indianjmedsci.org/viewimage.asp?img=IndianJMedSci_2009_63_10_474_57639_u2.jpg Lipoid pneumonia (indianjmedsci.org)].<ref name=pmid19901490/> | |||
===Stains=== | |||
*[[Oil red O stain]] +ve.<ref name=pmid25374742>{{Cite journal | last1 = Yampara Guarachi | first1 = GI. | last2 = Barbosa Moreira | first2 = V. | last3 = Santos Ferreira | first3 = A. | last4 = Sias | first4 = SM. | last5 = Rodrigues | first5 = CC. | last6 = Teixeira | first6 = GH. | title = Lipoid pneumonia in a gas station attendant. | journal = Case Rep Pulmonol | volume = 2014 | issue = | pages = 358761 | month = | year = 2014 | doi = 10.1155/2014/358761 | PMID = 25374742 }}</ref> | |||
*Iron stain -ve. | |||
==Non-specific inflammation== | ==Non-specific inflammation== | ||
Line 286: | Line 503: | ||
***One in several HPFs (40x obj. with 22 mm eye piece) is enough. | ***One in several HPFs (40x obj. with 22 mm eye piece) is enough. | ||
*Acute - neutrophils. | *Acute - neutrophils. | ||
**~10/HPF ( | **~10/HPF (40x obj. 22mm eye piece). | ||
*Chronic - lymphocytes + occ. plasma cells. | *Chronic - lymphocytes + occ. plasma cells. | ||
**~5 small lymphocytes/HPF ( | **~5 small lymphocytes/HPF (40x obj. 22 mm eye piece). | ||
*Mixed acute & chronic inflammation. | *Mixed acute & chronic inflammation. | ||
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