mgh:cyto-1-7

1-7 Respiratory Cytology: W.S. Black-Schaffer MD, Mary Rego CT

• Lecture: Respiratory cytology, part 1 by Dr. WS Black-Schaffer
• Lecture: Respiratory cytology, part 2. by Dr. W.S. Black-Schaffer

• Indications for cytology examination
• Procuring the specimen
• Test platforms/specimen processing and triage
• Report

Basic cytomorphology

Cytology Respiratory Specimens –MN05-J8970

• Sputum
• Bronchial washing and brushings
• Bronchoalveolar lavage (BAL)
• Fine needle aspirations (FNA)

Normal Respiratory Cytology –MN05-X13303

• Squamous cells (oral contamination)
• Glandular cells
• ciliated columnar
• mucous goblet cells
• Pneumocytes
• Alveolar macrophages

Alveolar macrophages –MN06-M2366

• Oval to bean shaped nuclei
• Mononucleated or multinucleated
• Foamy cytoplasm
• Phagocytic cells
• carbon histiocytes
• siderophages
• lipophages(associated with aspiration pneumonia)

Granulomatous Inflammation –MN05-F5872

• Seen in pt’s with TB, Sarcoid and Rheumatoid Arthritis.
• Can see giant cells
• Nodular collections of epithelioid histiocytes
• Cells with elongated nuclei with pale chromatin and tiny nucleoli

Chondroid Hamartoma–C03-C14116

• Cartilage
• mature - homogenous, waxy
• immature - fibrillar texture
• Epithelium
• small bland bronchial cells
• Respiratory Infection –MN08-F9275 and N12-9869

Candida and Actinomyces from oral contamination

• Aspergillus
• 45º angle branching of true septate
• Pneumocystis
• foamy alveolar casts
• GMS- stain cell wall of cyst black
• cysts are 4 to 8 um
• Zygomycetes-(Mucor)
• broad, irregular ribbon-like hyphae
• folding of hyphae

Squamous Cell Carcinoma –C92-8306 and MN06-324

• Keratinizing (Well-Diff)/ Nonkeratinizing(Mod to poorly Diff)
• Bizarre cell shapes
• Cytoplasm is dense or hard with defined cell borders
• Heavy keratinization(seen in Keratinizing SCC)
• Coarsely granular and/or opaque nucleus
• Nucleoli possible

Bronchogenic adenocarcinoma –C00-A43961

• 3-D balls, single cells, syncytia
• Lacy, fine, vacuolated cytoplasm
• Cuboidal cells, eccentric nuclei
• Finely granular irregular chromatin
• Nucleoli

Bronchioloalveolar Carcinoma –C01-W33204

• 3-D balls, papillary growth
• Finely granular to clear cytoplasm
• Eccentric nuclei
• Pale to moderately hyperchromatic chromatin
• Intranuclear cytoplasmic invaginations
• Psammoma bodies may be seen

Small Cell Carcinoma –C03-T32870 and MN04-G5451

• Single and syncytial
• Nuclear molding
• Scant cytoplasm
• Oval to angulated nuclei
• Nucleoli not prominent
• Dense chromasia (salt and pepper chromatin)
• Crush artifact ( nuclear DNA streaming)
• One to four times the size of a lymphocyte

Carcinoid –C02-M34743

• Uniform cuboidal cells
• Scant to moderate cytoplasm
• Small round to oval nuclei
• Stippled granular chromatin
• Small nucleoli possible
• Small blood vessels in background

Metastatic malignancy –MN07-T9423, MN07-T9423 and C97-B18744

• Compare the metastatic with the primary lesion
• Usually no tumor diathesis
• Presence of multiple nodules and a history of morphologically compatible cancer strongly favor metastasis

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