PART TWO
Diagnostic Cytology
Fig. 13.40 Pulmonary alveolar proteinosis. Specimens typically contain
numerous rounded fragments of amorphous material, such as the one
shown. Bronchoalveolar lavage (Papanicolaou x MP).
Koss has discussed the cytology and histochemistry of acellu-
lar masses derived from patients with alveolar proteinosis.17 In a
study performed in his laboratory, no histochemical differences
could be found between the eosinophilic masses of this pro-
tein and those in the sputum of patients without the disorder.
Electron microscopy has now confirmed that the lamellar bod-
ies visible by light microscopy in the proteinaceous material are
surfactant (Fig. 13.40).
Sosolik and his associates have emphasized the usefulness of
bronchoalveolar lavage in the detection of the offending phos-
pholipoproteinaceous debris in this disease, but they have also
emphasized that the light microscopic findings are preliminary
and should be confirmed by electron microscopy.144
The pathogenesis of this disease is still under debate but may
be related to underlying defects in macrophage function.145
Ferruginous bodies have been noted in tissues and cellular
specimens from the lungs for many years. They were all formerly
called asbestos bodies, reflecting the belief that all were formed as
a reaction to inhaled fibers of asbestos. Now it is recognized that
a number of different inhaled mineral fibers may result in quite
similar structures.146-148 These bodies are composed of various
substances, including iron, which are encrusted on a thin nee-
dle-like fiber (Fig. 13.41). Increasing attention is being focused
on their relationship to bronchogenic carcinoma.149-151 Leiman
and Markowitz have recommended further evaluation of a pul-
monary mass when the FNA shows only asbestos bodies.152,153
Roggli and associates have emphasized that the finding of even
one ferruginous body in respiratory material or an FNA is indica-
tive of large numbers of these in the lung.150 Roggli and associates
have also evaluated the asbestos body content of broncholavage
fluid from 20 patients with a history of occupational asbestos
exposure. Large numbers of asbestos bodies in the broncholav-
age fluid were indicative of considerable occupational exposure,
whereas occasional bodies were a nonspecific finding.151
In a 1988 report, Wheeler and associates found bronchial
washing specimens stained with Prussian blue to be more sensi-
tive than sputum for the identification of asbestos bodies.154
Psammoma bodies
(calcospherites) and corpora amyla-
cea are the names given to several varieties of dark-staining,
rounded bodies with concentric rings and radial striations,
which may appear in respiratory material. Corpora amylacea
are composed of glycoproteins and do not calcify. Psammoma
Fig. 13.41 Ferruginous body partially engulfed by a macrophage, from a
patient with asbestosis. Sputum (Papanicolaou x OI).
Fig. 13.42 Plant cells. Sputum (Papanicolaou x HP).
bodies are calcified and contain phosphates, iron, magnesium,
and sudanophilic material. Corpora amylacea are seen in cir-
cumstances of heart failure, pulmonary infarction, and chronic
bronchitis. Psammoma bodies have been associated with the
rare disease pulmonary microlithiasis and with malignant neo-
plasms, including bronchioloalveolar carcinoma and small-cell
undifferentiated carcinoma.155-157
Any structure that can be breathed into the respiratory pas-
sages or any particle of masticated food is capable of appearing
in the respiratory specimen and of producing great confusion
in the examiner if its identity is not recognized. Plant cells may
be confused with cancer cells,158 and structures such as pollen
and starch granules may be confused with infectious organisms
(Figs 13.42 and 13.43). Plant cells and other food particles have
also been reported in FNAs from aspiration pneumonia.159
Shahar and associates have reported rhomboid crystals in
association with aspiration of barium sulfate.160
Cytology of Respiratory Infections
This section describes observations and experiences in the cyto-
logic detection of the most important and common pulmo-
nary infections. It is not intended to be an exhaustive review
318
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