13
Respiratory Tract
Fig. 13.37 Follicular bronchitis. Small lymphocytes presumably arising in
a ruptured lymphoid follicle. Sputum (Papanicolaou x OI).
Fig. 13.39 Curschmann spiral with dense central core of inspissated
mucus. Sputum (Papanicolaou x MP).
Fig. 13.38 Charcot-Leyden crystals from a patient with asthma. Bronchial
washing (Papanicolaou x MP).
Other cells originating from circulating blood, which may be
seen in respiratory cellular samples, include lymphoctyes, eosi-
nophils, neutrophils, plasma cells, and megakaryocytes.136,137
Lymphocytes may be associated with a chronic inflammatory
process or with rupture of a lymphoid follicle in the wall of a
bronchus (Fig. 13.37). These cells may stream out in the mucus
strands, mimicking the exfoliation pattern of small-cell undiffer-
entiated carcinoma. Absence of necrosis, molding, and nuclear
abnormalities help to rule out carcinoma. Eosinophils may be
seen most frequently in association with asthmatic bronchitis
but also with any disease with a component of allergy. Charcot-
Leyden crystals may accompany the eosinophils (Fig. 13.38).
Plasma cells are commonly encountered in chronic inflam-
matory exudates. Usuda and colleagues have reported a case
of pseudotumor of the lung diagnosed by bronchial brushing
cytology.138
Cellular specimens obtained by FNA may contain various
cells unique to them because of the anatomic route followed by
the needle as it is inserted percutaneously into the lung. Thus,
such a specimen may contain squamous epithelial cells, cells
from various skin appendages, fibrofatty connective tissue, stri-
ated muscle, capillaries, and mesothelium. The last occurs in
monolayered sheets and may be a diagnostic pitfall if it is reac-
tive and hyperplastic. Rarely fragments of liver tissue may be
present if the physician performing the aspiration tried to enter
the lung too far inferiorly on the chest wall.
Cocker and associates have reported a case of pulmonary
endometriosis in which specimens of bronchial brushings, a
FNA, and core biopsy revealed a population of small, monot-
onous cells with finely granular cytoplasm interpreted as neo-
plasm. A lobectomy revealed endometriosis.139
Noncellular inanimate Components
In addition to cells from the host and living microorgan-
isms, many different nonliving structures and substances may
be present in specimens from the lower respiratory tract. The
presence of some may indicate specific problems. Others may
serve only to confuse and to produce incorrect diagnoses. Some
may be derived from the patient, may have been inhaled, or
may have contaminated the specimen after it was taken from
the patient.140 Structures and substances produced by the host
include Curschmann spirals, inspissated mucus spheres, amy-
loid, alveolar proteinosis, ferruginous bodies, psammoma bod-
ies, Schaumann bodies,141 and asteroid bodies from sarcoidosis,
and corpora amylacea. Inhaled or contaminating structures
include food, pollen granules, and any materials floating
around in the laboratory s environment during the cytoprepara-
tion procedure.
Curschmann spirals are casts of small bronchioles formed
from inspissated mucus (Fig. 13.39). They are seen in any con-
dition characterized by chronic and excessive production of
mucus. Asthmatic bronchitis is a classic example. Small inspis-
sated masses of mucus occasionally round up and adhere to one
another in a way that suggest nuclei. In extreme situations, the
nuclear hyperchromasia and molding of small-cell undifferenti-
ated carcinoma may be suggested.
The cytology of bronchial amyloidosis has been reported
by Chen.142 Hsiu and associates have reported the diagnosis of
primary amyloidosis by FNA of a hilar mass.143 Both reports
described the amyloid as presenting as amorphous eosinophilic
masses, some having scalloped edges. These masses showed
green birefringence under polarized light with Congo red
staining.
317
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