13
Respiratory Tract
Fig. 13.111 Adenoid cystic carcinoma. Characteristic three-dimensional
clusters of small cells surrounding cores of hyaline material. Fine-needle
aspirate (Papanicolaou x OI).
other Primary Neoplasms of the Lung
In addition to the lung cancers discussed, less frequently other
primary neoplasms of the lung may exfoliate diagnostic cells into
cellular specimens from the respiratory tract or may be diagnosed
by FNA. These neoplasms include acinic cells carcinoma,418,419
mucoepidermoid
tumor,417,420,421
leiomyosarcoma,422-426
pul-
monary blastoma,427-430 Hodgkin's431-437 and non-Hodgkin's
lymphoma,438-444
endobronchial
granular
cell
tumor,445-449
oncocytoma,450 solitary papilloma of the bronchus,451,452 angio-
sarcoma,453
hemangioendothelioma,454,455
carcinosarcoma,456
endodermal tumor,457 chondrosarcoma,458 malignant fibrous
histiocytoma,459-461 bronchial
gland
carcinoma,462
meningi-
oma,463 clear cell tumor,464 mesothelioma,465,466 benign metasta-
sizing leiomyoma,467 paraganglioma,468 and synovial sarcoma.469
Occasionally, two or more synchronous neoplasms of the lung
or of an adjacent site, such as the larynx, may be diagnosed in
one or more specimens of sputum and bronchial material.470
Mucoepidermoid carcinomas of the large bronchi, like ade-
noid cystic carcinomas, tend to occur with symptoms related to
bronchial irritation or obstruction. The cytologic features have
been described by Tao and Robertson420 and are similar to those
of mucoepidermoid tumors of the salivary glands.
On rare occasions, pulmonary blastomas may be sampled in
specimens of respiratory cytology. In one such case observed in
our laboratory, sputum contained cells interpreted as adenocar-
cinoma. A thoracotomy was performed, and a pulmonary blas-
toma removed. Review of the cytologic specimen revealed tiny
fragments of small malignant cells adherent to the differenti-
ated glandular component. These undoubtedly represented the
mesenchymal component of the tumor.428
Non-Hodgkin's lymphomas may be encountered in all
types of respiratory cytologic specimens. Characteristic findings
include the presence of small single malignant cells, some hav-
ing sharp indentations or bulbous protrusions of the nuclear
membranes and prominent nucleoli (Fig. 13.112). Diagnosis of
Hodgkin's disease (Fig. 13.113) is absolutely dependent on the
finding of Reed-Sternberg cells: malignant tumor cells with two
mirror-image nuclei, each possessing a macronucleolus. Just as
in surgical pathology, Reed-Sternberg cells must be considered
necessary but not sufficient for a diagnosis of Hodgkin's dis-
ease.471 In our experience, most cells in respiratory specimens
Fig. 13.112 Large-cell lymphoma. Sputum (Papanicolaou x OI).
Fig. 13.113 Reed-Sternberg cells in sputum from a patient with
pulmonary involvement with Hodgkin's disease. Note the mirror-image
nuclei with prominent nucleoli. Sputum (Papanicolaou x OI).
that exhibit the features described for Reed-Sternberg cells are
derived from carcinomas or malignant melanomas.
Neoplasms Metastatic to the Lung
Although cancer metastatic to the lung is more common than pri-
mary lung cancer, cytologic evidence of its presence in specimens
of sputum and bronchial material is not reported as frequently
as that of the primary tumors.472,473 There are several reasons for
this. First, exfoliative cytologic techniques are not called on as
frequently for suspected metastatic cancer to the lung as they
are for suspected primary cancer. Second, unless the tumor has
metastasized to the alveolar space, it must ulcerate through the
bronchial mucosa to produce exfoliation of cells. The studies by
Koss17 and by Kern and Schweizer473 have shown that cells from
metastatic tumors to the lung may be seen in respiratory mate-
rial in 50-70% of cases. Patterns of malignant cells that deviate
from those recognized for the primary lung tumors are strongly
suggestive of the presence of cancer metastatic to the lung. Meta-
static tumors to the lung occurring as diffuse nodules or as sin-
gle tumors involving a major bronchus have different cytologic
patterns. In cases of diffuse metastases, tumor cells may occur
in clusters simulating a pattern of BAC but with far fewer cells.
349
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