PART TWO
Diagnostic Cytology
Table 13.17
Malignant Neoplasms Metastatic to Lung or Arising in Adjacent
Sites with Malignant Cells in Sputum or Bronchial Material
Squamous cell carcinoma
40%
Adenocarcinoma
34%
Breast
15%
Kidney
6%
Colon
5%
Lymphoma/leukemia
8%
Other
18%
Reproduced with permission from Johnston WW. Cytologic correlations. In: Dail
DH, Hammar SP (eds)
Pulm onary Pathology.
New York: Springer-Verlag, 1987.
Table 13.18
Neoplasms Metastatic to the Lung Diagnosed by
Fine-Needle Aspiration
Type of neoplasm
Number
Percentage
or tissue of origin
of patients
of patients
Malignant melanoma
70
26.8
Urinary and male
genital tract
45
17.2
Breast
39
14.9
Female genital tract
33
12.6
Gastrointestinal tract
26
10.0
Bone and soft tissues
22
8.4
Lymphoma
10
3.8
Mediastinum
3
1.2
Unclassified
9
3.5
Adrenal
1
0.4
Salivary glands
1
0.4
Thyroid
1
0.4
Neuroblastoma
1
0.4
Total
261
100.0
Reproduced with permission from Johnston WW. Cytologic correlations. In: Dail
DH, Hammar SP (eds)
Pulmonary Pathology.
New York: Springer-Verlag, 1987.
A cell cluster occasionally may actually represent the cast of an
alveolar space. The background of the smear is unusually clean,
with virtually no macrophages. It is at times possible to recog-
nize the primary site of the neoplasm by noting cell characteris-
tics and spatial arrangement. When large, single metastases have
produced exfoliation through an ulcerated bronchus, a primary
lung carcinoma may be mimicked. All available surgical tissue
should be compared with the cytologic specimen, because it may
be possible to determine whether the tumor cells are consistent
with the previous primary cancer. Differences noted between the
cytologic specimen and the original tissue specimen may signal
the presence of a second cancer that is either metastatic to the
lung or a new primary cancer of the lung.
Tables 13.17 and 13.18 depict the pattern and frequency of
cancers of nonpulmonary origin manifested in specimens of spu-
tum, bronchial washings, bronchial brushings, and FNAs seen
Fig. 13.114 Metastatic carcinoma of the breast
showing the so-called
owl's-eye pattern of cell wrapping. Bronchial brushing (Papanicolaou x OI).
Fig. 13.115 Metastatic renal cell carcinoma.
The tumor cells exhibit
abundant granular cytoplasm and macronucleoli. Fine-needle aspirate
(Papanicolaou x OI).
in our laboratory during a 10-year period. Although squamous
cell carcinomas appear to be the most common, the appearance
of their cells in respiratory material is most frequently second-
ary to the presence of the primary neoplasm in an anatomic site
adjacent to the respiratory tract, such as the larynx, pharynx, oral
mucosa, tonsil, tongue, and esophagus.
Adenocarcinomas are by far the most common true metastatic
neoplasms detected in sputum and bronchial material. Among
these, adenocarcinomas from the breast, kidney, and colon are
the most often seen. Each one of these may, on occasion, have a
cytologic appearance that is so characteristic that it permits a cyto-
logic diagnosis strongly suggestive of that particular neoplasm.
Ductal carcinoma of the breast that has metastasized to the lung
may show scattered tumor cells occurring singly and as small
clusters. The cells are large and polygonal with macronucleoli
(Fig. 13.114). One tumor cell may mold the nucleus of an adja-
cent cell into an owl-eyed configuration.474 Tumor cells from
renal cell carcinoma occur singly and in flat tissue fragments.
Depending on the differentiation of the tumor, nucleoli may
be small or extremely large. The cytoplasm is characteristically
granular or cleared. Stains for mucin are negative (Fig. 13.115).
350
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