PART TWO
Diagnostic Cytology
Fig. 13.33 Multinucleated macrophages from a patient with sarcoidosis.
An asteroid body is present in the cytoplasm in the lower portion of the cell.
Fine-needle aspirate (Papanicolaou x OI).
Fig. 13.34 Epithelioid macrophages from a patient with sarcoidosis.
Note the abundant cytoplasm and bland nuclear appearance. Fine-needle
aspirate (Papanicolaou x MP).
alveolar macrophage originates in the bone marrow.17 The
presence of this characteristic cell most frequently laden with
particles of carbon helps to establish that a specimen of sputum
is satisfactory. Risse and associates, in 1987 reports, noted that
in patients with primary lung cancer, sputum samples with true-
positive cytologic diagnoses contained significantly more cells
from the lower respiratory tract, such as alveolar macrophages
and bronchial columnar cells, than did sputum samples with
false-negative cytologic diagnoses.37 The macrophages are recog-
nized by the eccentric position of the nucleus, abundant foamy
cytoplasm, and the phagocytosed material, usually carbon. On
occasion, the nuclei may assume a bean shape and show one
or more nucleoli and cytoplasmic processes. A study by Mylius
and Gullvag has shown an increase in the alveolar macrophage
count with a higher level of particulate pollution in the work-
place.120 Collins and associates have reported the use of tracheal
aspirates stained with oil red O to identify and quantitate lipid-
laden alveolar macrophages as a marker for aspiration pneumo-
nia in young children.121
Binucleated and multinucleated giant cell macrophages
are not infrequently encountered. These cells may be seen in
Fig. 13.35 Multinucleated macrophage with numerous cytoplasmic
vacuoles from a patient with lipoid pneumonia. Sputum
(Papanicolaou x MP).
Fig. 13.36 Alveolar macrophages laden with refractile granules of
hemosiderin. Sputum (Papanicolaou x MP).
association with chronic lung disease of many varieties, includ-
ing sarcoidosis (Fig. 13.33),122,123 tuberculosis,124-127 infections
with nontuberculous
mycobacteria,128 giant cell
interstitial
pneumonia,129 and other inflammatory diseases,130 but they are
not diagnostic and may be seen in respiratory material in the
absence of clinical disease. With granulomatous disease, char-
acteristic epithelioid cells may be shed (Fig. 13.34).131 Large
vacuoles containing lipid have been reported in pulmonary mac-
rophages in the presence of lipoid pneumonia (Fig. 13.35).132,133
Multinucleated cells laden with lipid may be numerous, and
they may mimic adenocarcinoma or liposarcoma. Tabatowski
and associates have reported finding nonpigmented alveolar
macrophages and phagocytic multinucleated giant cells in the
bronchial washings from a hard-metal worker with giant cell
interstitial pneumonia.134 In the presence of intra-alveolar hem-
orrhage, macrophages laden with hemosiderin may appear in
the cellular specimen (Fig. 13.36). Greenebaum and associates
have reported blackened broncholavage fluid from crack smok-
ers. Microscopically, the black was represented by heavy accu-
mulations of carbonaceous material both within macrophages
and within the intercellular compartment.135
316
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