The rare disease pemphigus may result in exfoliation of extremely
abnormal-appearing immature squamous cells with enlarged
nuclei and centrally placed macronucleoli. These cells are easily
mistaken for cancer cells.
So-called irritation forms of bronchial epithelium may occur in
response to a wide variety of insults varying from microorganisms
to environmental toxins. These altered cells are characterized by
marked nuclear enlargement, coarsening of the chromatin pat-
tern, and one or more enlarged nucleoli.73-79 Nuclear enlarge-
ment may be at a magnitude of 10 to 20 times the diameter of
a normal bronchial cell nucleus (Figs. 13.8 to 13.11). Saito and
associates have described in some detail the atypical reparative
changes in bronchial cells after brushing.80
Another extremely common response to irritation is the pres-
ence of multinucleation; however, the nuclei are small and mir-
ror images of one another (Fig. 13.12). These cells have been
studied extensively by Chalon and associates.81,82 Although such
cells may be seen after a wide variety of insults, they are most
commonly seen after instrumentation.
Hyperplasia o f Bronchial Epithelium
Koss and Richardson were among the first investigators to note
the diagnostic pitfall posed by hyperplasia of bronchial epithelial
cells.83 These changes may occur in association with a number
of chronic diseases of the lung, including tuberculosis,84,85 bron-
chiectasis, chronic bronchitis, and asthma.79,86,87 Naylor and
Railey described a patient who had chronic asthmatic bronchi-
tis and in whom papillary tissue fragments exfoliating from the
hyperplastic bronchial epithelium were noted and incorrectly
diagnosed as adenocarcinoma.87 These tissue fragments have
come to bear the name
after the patient in whom
they were seen. The fragments may be seen in the sputum and
bronchial brushings from 42% of cases of asthmatic bronchitis.
The cytologic presentation is that of papillary clusters of cells
partially covered on the surface by well-differentiated ciliated
respiratory epithelium. Some nuclear molding is seen between
Fig. 13.8 Reactive bronchial epithelium. Bronchial brushing
(Papanicolaou x MP).
Fig. 13.10 Reparative epithelium. These cells form a cohesive sheet and
exhibit abundant cytoplasm, prominent nucleoli, and nuclear enlargement.
Bronchial brushing (Papanicolaou x MP).
Fig. 13.9 Reactive bronchial epithelium. Bronchial brushing
(Papanicolaou x MP).
Fig. 13.11 Highly reactive bronchial epithelium. Although the cells
show some variation in nuclear size and prominent nucleoli, the cytoplasm
maintains a distinctive cuboidal to columnar shape. An extensive search
revealed a few ciliated cells with identical nuclear features. Bronchial
brushing (Papanicolaou x MP).