Benign and Malignant Lesions in Respiratory Cytology

1. Benign and Malignant Lesions in Respiratory Cytology MISS SURUTTAYA CHINNAWONG

2. Respiratory 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 techniques Exfoliative methods Sputum cytology Bronchial cytology (BW and BB) Bronchoalveolar lavage (BAL) Fine needle aspiration(FNA)

4. Exfoliative 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 Cytology Symptomatic patients Techniques: ”pick and smear” Saccomanno Cytospin or monolayer Advantages: Disadvantages

7. Advantages 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 sputum Alveolar macrophages: lower respiratory tract elements Localized lung lesion, peripheral lesion Adenocarcinoma, metastatic lesion, lymphoma Benign tumor

9. Bronchial 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: disadvantages Limited area of the lung examined by bronchoscopy Invasive procedure: unpleasant for the patients Benign tumors, extremely peripheral lesions

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

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

14. FNA 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 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 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 cellular proliferations Creola body Bronchial cell hyperplasia Goblet cell hyperplasia Mucin vacuoles with small nuclei Reserved cell Basal cells with molded nuclei

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

33. Nonneoplastic lung disease 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 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. Hemosiderin pigments in alveolar macrophages (PAP)

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