<\/a><\/p>\n PULMONARY Introduction<\/strong><\/p>\n Lower respiratory cytology is important in the evaluation of pulmonary disease. Diagnosis is achieved by evaluation of exfoliative cytology (sputum, bronchial brushing, bronchial wash, and bronchoalveolar lavage) and fine needle aspiration (FNA) cytology (percutaneous, transthoracic, transbronchial and endoscopic-ultrasound guided).<\/p>\n For optimal pulmonary cytology proper specimen collection, fixation and processing are imperative. Collection in Cytolyt\u00ae<\/sup> for preparing a ThinPrep\u00ae<\/sup> slide has shown to be an excellent technique for respiratory tract specimens and has overcome many limitations of conventional smears by reducing the number of slides to examine, eliminating air-drying artifact and limiting obscuring elements such as mucus, blood and inflammation. Residual material from the specimen vial can be used for ancillary studies, such as special stains for organisms.<\/p>\n The main diagnostic issues in pulmonary cytology include identification of organisms, distinguishing reactive type 2 pneumocytes from well differentiated bronchioloalveolar carcinoma, reactive bronchial epithelium from malignancy, adenocarcinoma from squamous cell carcinoma, non-small cell carcinoma from small cell anaplastic carcinoma and cytologic differential diagnosis of neuroendocrine tumors. On ThinPrep slides microorganisms are easier to find and the morphology is similar to conventional smears. Due to well-preserved nuclear features the differential diagnosis between reactive type 2 pneumocytes and bronchioloalveolar carcinoma is relatively straightforward.<\/p>\n The general features of pulmonary cytology prepared by ThinPrep technique, compared to conventional preparation methods include:<\/p>\n Background<\/em><\/strong><\/p>\n Architectural Pattern: Cellular Features: Nuclear molding in small cell anaplastic carcinoma is subtle. It appears more like gentle nuclear overlap. Crush artifact can be seen either as spindled nuclei or as long blue fibrous structures.<\/p>\n Advantages: <\/em><\/strong><\/p>\n Bibliography <\/strong><\/p>\n Pulmonary FNA, Herpes Simplex Virus Infection of Lung. Pulmonary FNA, Large Cell Carcinoma of Lung. A sheet of poorly differentiated carcinoma cells with distinct cell borders. The cells are disorganized and show focal nuclear overlap. Background is clean and tumor diathesis is not seen. The tumor cells have no specific features of squamous or glandular differentiation. 40x<\/p><\/div>\n<\/div>\n Pulmonary FNA, Adenocarcinoma of Lung. A cluster of malignant glandular cells with scalloped cell borders. Background is clean and tumor diathesis is not seen. The malignant cells are well-preserved. Cytoplasm shows fine to large discrete vacuoles, some with engulfed neutrophils. 60x<\/p><\/div>\n<\/div>\n Pulmonary FNA, Adenocarcinoma of Lung. Nuclei are round to oval, eccentric and have vesicular chromatin. Nuclear membrane shows some irregularity and thickness. Nucleoli are single, prominent and cherry-red in color. Nuclear to cytoplasmic ratio is high. Pulmonary FNA, Bronchioloalveolar Carcinoma of Lung. Pulmonary FNA, Bronchioloalveolar Carcinoma of Lung. Pulmonary FNA, Bronchioloalveolar Carcinoma of Lung. Pulmonary FNA, Poorly Differentiated Squamous Carcinoma of Lung. Pulmonary FNA, Poorly Differentiated Squamous Carcinoma of Lung. The cytoplasm is cyanophilic and densely vacuolated. Nuclei are enlarged, relatively round (compare the size with the nucleus of the benign macrophage in the lower mid field) with prominent nucleoli. Nuclear to cytoplasmic ratio is high. 40x<\/p><\/div>\n<\/div>\n Pulmonary FNA, Poorly Differentiated Squamous Carcinoma of Lung. On higher magnification the cells show occasional intracellular bridges. Nuclei are centrally placed with coarse and unevenly distributed chromatin with prominent parachromatin clearing. Nucleoli are prominent and cherry-red in color. 60x<\/p><\/div>\n<\/div>\n Pulmonary FNA, Poorly Differentiated Carcinoma of Lung. Scattered single cells and cohesive group of malignant cells with a high nuclear to cytoplasmic ratio. The cells around the periphery are better visualized. Cytoplasm is delicate and appears as a syncytium with sharp outer cell borders. 40x<\/p><\/div>\n<\/div>\n Pulmonary FNA, Poorly Differentiated Carcinoma of Lung. Pulmonary FNA, Non-Keratinizing Squamous Carcinoma of Lung. Pulmonary FNA, Non-Keratinizing Squamous Carcinoma of Lung. Pulmonary FNA, Non-Keratinizing Squamous Carcinoma of Lung. The malignant cells show dense cyanophilic cytoplasm with sharp cellular outlines. Few cells show intracytoplasmic vacuoles which may raise a diagnosis of adenocarcinoma. Nuclei have vesicular chromatin, minimal membrane irregularity and single or multiple prominent nucleoli. 60x<\/p><\/div>\n<\/div>\n Pulmonary FNA, Non-Keratinizing Squamous Carcinoma of Lung.<\/strong> Pulmonary FNA, Keratinizing Squamous Carcinoma of Lung. Pulmonary FNA, Keratinizing Squamous Carcinoma of Lung. Pulmonary FNA, Keratinizing Squamous Carcinoma of Lung. Pulmonary FNA, Keratinizing Squamous Carcinoma of Lung. Pulmonary FNA, Keratinizing Squamous Carcinoma of Lung. Pulmonary FNA, Keratinizing Squamous Carcinoma of Lung. Pulmonary FNA, Small Cell Carcinoma of Lung.
\nRana S. Hoda MD, FIAC <\/em><\/p>\n\n
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\nCharacteristic viral cytopathic effects of multinucleation, nuclear molding, and ground-glass chromatin with eosinophilic intranuclear inclusions are seen. 60x<\/p><\/div>\n<\/div>\n
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\nPulmonary FNA, Herpes Simplex Virus Infection of Lung.<\/strong>
\nCharacteristic viral cytopathic effects of multinucleation, nuclear molding, and ground-glass chromatin with eosinophilic intranuclear inclusions are seen.
\n60x<\/div>\n
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\nPulmonary FNA, Large Cell Carcinoma of Lung.<\/strong>
\nA sheet of poorly differentiated carcinoma cells with distinct cell borders. The cells are disorganized and show focal nuclear overlap. Background is clean and tumor diathesis is not seen. The tumor cells have no specific features of squamous or glandular differentiation.
\n40x<\/div>\n
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\nPulmonary FNA, Large Cell Carcinoma of Lung.<\/strong>
\nThe tumor cells are large when compared to the few apoptotic cells within the sheet. Cytoplasm is well-preserved, moderate in amount and dense to finely vacuolated. Cellular changes suggestive of intracellular bridges, a feature of squamous differentiation, are focally visible. Nuclei are round to oval with coarse clumped chromatin and thickened smooth membrane. Nucleoli are prominent, irregular, single and multiple. Nuclear to cytoplasmic ratio is high.
\n60x<\/div>\n
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\nPulmonary FNA, Adenocarcinoma of Lung.<\/strong>
\nA cluster of malignant glandular cells with scalloped cell borders. Background is clean and tumor diathesis is not seen. The malignant cells are well-preserved. Cytoplasm shows fine to large discrete vacuoles, some with engulfed neutrophils.
\n60x<\/div>\n
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\nNuclei are round to oval, eccentric and have vesicular chromatin. Nuclear membrane shows some irregularity and thickness. Nucleoli are single, prominent and cherry-red in color. Nuclear to cytoplasmic ratio is high. 60x<\/p><\/div>\n<\/div>\n
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\nPulmonary FNA, Adenocarcinoma of Lung.<\/strong><\/p>\n
\n60x<\/p><\/div>\n
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\nThree dimensional group of well differentiated adenocarcinoma cells with few ill-defined microacini. Background shows mucoid material. 60x<\/p><\/div>\n<\/div>\n
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\nPulmonary FNA, Bronchioloalveolar Carcinoma of Lung.<\/strong>
\nThree dimensional group of well differentiated adenocarcinoma cells with few ill-defined microacini. Background shows mucoid material.
\n60x<\/div>\n
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\nCytoplasm is moderate in amount, of variable density with occasional vacuoles. Nuclei show loss of polarity, are small and hyperchromatic with minimal pleomorphism. These cells are difficult to distinguish from reactive bronchial cells. 60x<\/p><\/div>\n<\/div>\n
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\nPulmonary FNA, Bronchioloalveolar Carcinoma of Lung.<\/strong>
\nCytoplasm is moderate in amount, of variable density with occasional vacuoles. Nuclei show loss of polarity, are small and hyperchromatic with minimal pleomorphism. These cells are difficult to distinguish from reactive bronchial cells.
\n60x<\/div>\n
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\nThe three dimensional group shows considerable depth of focus, dense cytoplasm with hyperchromatic nuclei and prominent nucleoli. Background shows mucoid material. 60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nPulmonary FNA, Bronchioloalveolar Carcinoma of Lung.<\/strong>
\nThe three dimensional group shows considerable depth of focus, dense cytoplasm with hyperchromatic nuclei and prominent nucleoli. Background shows mucoid material.
\n60x<\/div>\n
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\nA loosely cohesive fragment of malignant squamous cells is seen. Tumor diathesis appears as small clumps of necrotic material in the background. 20x<\/p><\/div>\n<\/div>\n
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\nPulmonary FNA, Poorly Differentiated Squamous Carcinoma of Lung.<\/strong>
\nA loosely cohesive fragment of malignant squamous cells is seen. Tumor diathesis appears as small clumps of necrotic material in the background.
\n20x<\/div>\n
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\n<\/strong>
\nPulmonary FNA, Poorly Differentiated Squamous Carcinoma of Lung.<\/strong>
\nThe cytoplasm is cyanophilic and densely vacuolated. Nuclei are enlarged, relatively round (compare the size with the nucleus of the benign macrophage in the lower mid field) with prominent nucleoli. Nuclear to cytoplasmic ratio is high.
\n40x<\/div>\n
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\n<\/strong>
\nPulmonary FNA, Poorly Differentiated Squamous Carcinoma of Lung.<\/strong>
\nOn higher magnification the cells show occasional intracellular bridges. Nuclei are centrally placed with coarse and unevenly distributed chromatin with prominent parachromatin clearing. Nucleoli are prominent and cherry-red in color.
\n60x<\/div>\n
\n<\/a><\/p>\n
\n<\/strong>
\nPulmonary FNA, Poorly Differentiated Carcinoma of Lung.<\/strong>
\nScattered single cells and cohesive group of malignant cells with a high nuclear to cytoplasmic ratio. The cells around the periphery are better visualized. Cytoplasm is delicate and appears as a syncytium with sharp outer cell borders.
\n40x<\/div>\n
\n<\/a><\/p>\n
\nNuclei are round to oval, eccentric, hyperchromatic and show prominent nucleoli. The tumor cells lack definite cytological features of glandular or squamous origin 60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nPulmonary FNA, Poorly Differentiated Carcinoma of Lung.<\/strong>
\nNuclei are round to oval, eccentric, hyperchromatic and show prominent nucleoli. The tumor cells lack definite cytological features of glandular or squamous origin
\n60x<\/div>\n
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\nLoosely cohesive sheet and single malignant squamous cells are seen in a background of clumps of necrosis. 20x<\/p><\/div>\n<\/div>\n
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\nPulmonary FNA, Non-Keratinizing Squamous Carcinoma of Lung.<\/strong>
\nLoosely cohesive sheet and single malignant squamous cells are seen in a background of clumps of necrosis.
\n20x<\/div>\n
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\nHigher magnification shows a syncytium of cells with abundant dense cytoplasm with angulated and streaming borders. The nuclei are enlarged, hyperchromatic and show minimal overlap. 40x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nPulmonary FNA, Non-Keratinizing Squamous Carcinoma of Lung.<\/strong>
\nHigher magnification shows a syncytium of cells with abundant dense cytoplasm with angulated and streaming borders. The nuclei are enlarged, hyperchromatic and show minimal overlap.
\n40x<\/div>\n
\n<\/a><\/p>\n
\n<\/strong>
\nPulmonary FNA, Non-Keratinizing Squamous Carcinoma of Lung.<\/strong>
\nThe malignant cells show dense cyanophilic cytoplasm with sharp cellular outlines. Few cells show intracytoplasmic vacuoles which may raise a diagnosis of adenocarcinoma. Nuclei have vesicular chromatin, minimal membrane irregularity and single or multiple prominent nucleoli.
\n60x<\/div>\n
\n<\/a><\/p>\n
\nClassic cell in cell arrangement of non-keratinizing squamous cell carcinoma is seen here. 60x<\/div>\n<\/div>\n
\n<\/strong>
\nPulmonary FNA, Non-Keratinizing Squamous Carcinoma of Lung.<\/strong>
\nClassic cell in cell arrangement of non-keratinizing squamous cell carcinoma is seen here.
\n60x<\/div>\n
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\nDyshesive groups of keratinized squamous cells with orangeophilic, pleomorphic cytoplasm with elongated “fibre” and “tadpole” forms. 20x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nPulmonary FNA, Keratinizing Squamous Carcinoma of Lung.<\/strong>
\nDyshesive groups of keratinized squamous cells with orangeophilic, pleomorphic cytoplasm with elongated “fibre” and “tadpole” forms.
\n20x<\/div>\n
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\nThe backround shows a necrotic tumor diathesis. 20x<\/p><\/div>\n<\/div>\n
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\nPulmonary FNA, Keratinizing Squamous Carcinoma of Lung.<\/strong>
\nThe backround shows a necrotic tumor diathesis.
\n20x<\/div>\n
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\nA single malignant cell with sharp straight cytoplasmic borders. 40x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nPulmonary FNA, Keratinizing Squamous Carcinoma of Lung.<\/strong>
\nA single malignant cell with sharp straight cytoplasmic borders.
\n40x<\/div>\n
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\nThe nucleus is elongated, centrally placed with open chromatin, parachromatin clearing and a prominent nucleolus 60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nPulmonary FNA, Keratinizing Squamous Carcinoma of Lung.<\/strong>
\nThe nucleus is elongated, centrally placed with open chromatin, parachromatin clearing and a prominent nucleolus
\n60x<\/div>\n
\n<\/a><\/p>\n
\nSingle and small groups of keratinized squamous cells with background tumor diathesis. 40x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nPulmonary FNA, Keratinizing Squamous Carcinoma of Lung.<\/strong>
\nSingle and small groups of keratinized squamous cells with background tumor diathesis.
\n40x<\/div>\n
\n<\/a><\/p>\n
\nHigher maginification shows rigid pleomorphic cytoplasm and a single hyperchromatic nucleus with inconspicuous nucleoli. 60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nPulmonary FNA, Keratinizing Squamous Carcinoma of Lung.<\/strong>
\nHigher maginification shows rigid pleomorphic cytoplasm and a single hyperchromatic nucleus with inconspicuous nucleoli.
\n60x<\/div>\n
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\nSmall clusters, many single hyperchromatic cells and few nuclei devoid of cytoplasm are seen. 20x<\/p><\/div>\n<\/div>\n
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\nPulmonary FNA, Small Cell Carcinoma of Lung.<\/strong>
\nSmall clusters, many single hyperchromatic cells and few nuclei devoid of cytoplasm are seen.
\n20x<\/div>\n
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\nPulmonary FNA, Small Cell Carcinoma of Lung.<\/strong>
\nHigher magnification shows a cluster of hyperchromatic cells with dual population. The viable cells show a high nuclear to cytoplasmic ratio with scant cytoplasm. Nuclei are hyperchromatic and irregular with “salt and pepper” chromatin. Nucleoli are not seen. Nuclear molding, although present, is subtle. The non-viable cells or individual tumor cell necrosis is seen as intermixed apoptotic bodies.
\n60x<\/div>\n