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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== | ||
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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> | 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. | *> 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=== | ===Other specimens=== | ||
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Image: Bronchial epithelium with inflammation - alt -- very high mag.jpg | BBE - very high mag. | Image: Bronchial epithelium with inflammation - alt -- very high mag.jpg | BBE - very high mag. | ||
</gallery> | </gallery> | ||
www | <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> | *[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> | ||
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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== | ||
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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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**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> | *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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====Image==== | ====Image==== | ||
=====Case 1===== | |||
<gallery> | <gallery> | ||
Image:Small_cell_lung_cancer_-_cytology.jpg | | 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> | </gallery> | ||
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====Image==== | ====Image==== | ||
=====Case 1===== | |||
<gallery> | <gallery> | ||
Image:Squamous_carcinoma_lung_1_cytology.jpg |SCC. (WC) | |||
Image:Squamous_carcinoma_lung_2_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> | </gallery> | ||
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===General=== | ===General=== | ||
Etiology: | Etiology: | ||
*Aspiration or inhalation of a fatty substance, e.g. mineral oils, petroleum jelly.<ref name=pmid19901490/> | *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. | *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=== | ===Cytology=== |
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