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

2. Respiratory Cytology Major role: Minor 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 Fine needle aspiration (FNA)
Sputum cytology
Bronchial cytology (BW and BB)
Bronchoalveolar lavage (BAL)
Fine needle aspiration (FNA)
Exfoliative methods/Fine needle aspiration (FNA) ทำยังไงคะหรือเอาไว้อธิบายปากเปล่า (มีรูปโชว์ไหม)

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: Advantages:
”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: %
Complications: lesion depth/size, needle
Pneumothorax: 5-10% need treatment
Hemoptysis
Air embolism

16. Normal Elements Upper respiratory tract Lower 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