13
Respiratory Tract
Table 13.11 Acinar Adenocarcinoma
Cytologic feature
Sputum
Bronchial wash
Bronchial brush
BAL
FNA
Mixture of cell clusters, tissue
fragments, and single cells
+
+
+
+
+
Vesicular, lobulated, and
eccentrically placed nuclei
+
+
+
+
+
Chromatin extremely finely
dispersed and powdery
+
+
+
+
+
Macronucleoli centrally placed
+
+
+
+
+
Cytoplasm foamy and
cyanophilic, finely vacuolated
or showing hyperdistended
secretory vacuoles
+
+
+
+
+
Tissue fragments may show
only clusters of tumor cells
arranged in syncytial groupings
or true acini, tubules, and papil-
lary structures
+
+
+
+
+
Large irregular sheets
-
-
+
-
-
Small irregular sheets
+
+
+
+
+
BAL = bronchoalveolar lavage; FNA=^
fine-needle aspiration.
Table 13.12 Bronchioloalveolar Carcinoma
Cytologic feature
Sputum
Bronchial wash
Bronchial brush
BAL
FNA
Ball-like cluster cells
+
-
-
-
-
Papillary fronds
+
+
+
+
+
Nuclei round to oval with bland, finely
granular chromatin
+
+
+
+
+
Nucleoli but inconspicuous
+
+
+
+
+
Single cells may bear a strong
resemblance to alveolar macrophages,
which may also be present in large
numbers
+
+
+
Cytoplasmic villi may mimic cilia
+
+
+
+
+
Cells may or may not exhibit secretory
vacuoles
+
+
+
+
+
BAL = bronchoalveolar lavage; FNA=fine-needle aspiration.
identified in specimens of respiratory material, attempts to fur-
ther classify the adenocarcinoma into acinar, papillary, or bron-
chioloalveolar cell types are less successful. Readers may consult
further the work of Roger and associates,373 Smith and Frable,374
and Gupta,375 who have studied the differences in cytologic
presentation among the various adenocarcinomas. Cytologic
features of these neoplasms are summarized in Tables 13.11 and
Table 13.12. Papillary adenocarcinomas have not been sepa-
rately tabulated, because their cytomorphology, similar to their
histomorphology, shows considerable overlap with BAC.
Adenocarcinomas appear in cytologic material with both
single cells and cell clusters (Figs 13.82 to 13.88). The chro-
matin in well-differentiated tumors is typically finely granular
to powdery in appearance. The nuclei are enlarged and round
to oval with varying degrees of nuclear membrane abnormali-
ties. They may, however, be so bland in appearance that one
must rely on other features, such as variation of cell size and
shape, cell crowding, disorganization within groups, and lack
of cohesion, to establish a diagnosis of malignancy. In many
adenocarcinomas of the acinar type, the presence of centrally
placed macronucleoli is a prominent feature. The cytoplasm may
vary in appearance from homogeneous to extremely vacuolated.
The vacuoles may be multiple and small, imparting a delicate
foamy appearance to the cytoplasm, or may be large, causing
indentation and margination of the nucleus. Large amounts
of extracellular mucin may suggest the rare variant mucinous
339
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