Benign and Malignant Lesions in Respiratory Cytology MISS SURUTTAYA CHINNAWONG.
Exfoliative respiratory cytology (part 2 of 2)
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Respiratory cytology (continued…) October 2007
description
An introduction to respiratory cytology. Includes info on benign and malignant cytology findings. Discussion on different specimen types including sputum, bronchoalveolar lavage, and brushings.
Transcript of Exfoliative respiratory cytology (part 2 of 2)
Respiratory cytology (continued…)
October 2007
Summary Slide
Benign proliferationsTherapeutic agents InflammationMalignant diseaseMetastases
Reserve cell hyperplasia
Resemble lymphocytes or histiocytes
Tightly cohesive groups Small uniform cells Dark round nuclei Basophilic cytoplasm High N/C Ciliated Columnar along surface Ddx: small cell carcinoma
Malignant disease
Older than 40, peak incidence at 60 More aggressive in younger patients Male > female (3-6:1) Signs and symptoms appear late Weight loss and cough (presenting sx)
Dyspnea, weakness, chest pain, hemoptysis. Acute respiratory distress or cardiac failure
Metastases to mediastinum Effects on vital structures
Bad stuff that happens
Pancoast syndromePain or tingling in shoulder, arm or ulnar
nerve distribution Horner’s sign: ptosis, myosis, anhidrosisDensity on CXR at extreme apex of lung
(superior sulcus tumor)Usually SCC
Squamous cell carcinoma Small cell carcinoma Adenocarcinoma Large cell carcinoma Adenosquamous carcinoma Carcinoid tumor Carcinomas of salivary gland type Unclassified carcinoma
1999 WHO classification of invasive malignant epithelial lung tumors
Adenocarcinoma
Bronchogenic AdenocarcinomaCrowded sheets, cell balls, papillae,
microaciniNuclei
PolarLobulated borderVesicular chromatinProminent nucleoli
CytoplasmFoamy granular or secretory+/- mucin
Bronchioalveolar Carcinoma
Cellular 3D groups Differentiation Resemble:
GobletMesothelialAlveolar macrophages
Squamous cell carcinoma
Keratinizing / well differentiatedFrequent clustersPoor cohesionOdd shapes, central nuclei, prominent nucleoliCytoplasm sharply demarcatedKeratin formation
Foreign body reactionLeukocytes are frequently present
Non keratinizing DDX: Metastases
Large cell undifferentiated carcinoma
Lacks features of glandular, squamous, or neuroendocrune
Cellular, large cells singly and clustersNuclear abnormalities Intense mitotic activityNecrosis commonDDX: Poorly differentiated
adenocarcinoma, metastases.
Small cell carcinoma
Oat cell/Intermediate typeHigh cellularityCytoplasm scantyNuclei are stripped of cytoplasmWell preserved nuclei are 2x lymphocytesMitoses rareCrush nuclear material
Ddx: atypical carcinoid, malignant lymphoma (nuclear molding)
Carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements
Carcinomas with spindle and/or giant cells Pleomorphic carcinoma Spindle cell carcinoma Giant cell carcinoma Carcinosarcoma Blastoma (Pulmonary blastoma)
Carcinoids
Kulchitsky cells Sheets of cuboidal or polygonal cells Basophilici cytoplasm Regular, round, and centrally or peripherally
located nuclei Regularly distributed chromatin granules. Small nucleoli No necrosis Single population (unlike small cell)
Salivary gland analogs
Adenoid-cystic carcinomaMucoepidermoid carcinomaOncocytoma
Metastases
Three times more common than primary adenocarcinoma
Common origins are GI, breast, lymphoma/leukemia.
Multiple nodules favor metastatic Review the primary if you can. Cohesive clusters in a clean background
(20% invade locally diathesis)
References:
Demay. The art and science of cytopathology www.cytologystuff.com Cytotechnology online course
http://www.upstate.edu/courseware/cytotech/atlas/
Pulmonary pathology. Leslie, Wick. www.Uptodate.com
