Exfoliative Respiratory Cytology (part 2 Of 2)

Respiratory cytology (continued…) October 2007

Summary Slide  Benign

proliferations  Therapeutic agents  Inflammation  Malignant disease  Metastases

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 syndrome  Pain

or tingling in shoulder, arm or ulnar nerve distribution  Horner’s sign: ptosis, myosis, anhidrosis  Density on CXR at extreme apex of lung (superior sulcus tumor)  Usually SCC

1999 WHO classification of invasive malignant epithelial lung tumors  Squamous

cell carcinoma  Small cell carcinoma  Adenocarcinoma  Large cell carcinoma  Adenosquamous carcinoma  Carcinoid tumor  Carcinomas of salivary gland type  Unclassified carcinoma

Adenocarcinoma Bronchogenic Adenocarcinoma Crowded sheets, cell balls, papillae, microacini Nuclei Polar Lobulated border Vesicular chromatin Prominent nucleoli

Cytoplasm Foamy granular or secretory +/- mucin

Bronchioalveolar Carcinoma  Cellular  3D

groups  Differentiation  Resemble:  Goblet  Mesothelial  Alveolar macrophages

Squamous cell carcinoma  Keratinizing

/ well differentiated

 Frequent

clusters  Poor cohesion  Odd shapes, central nuclei, prominent nucleoli  Cytoplasm sharply demarcated  Keratin formation Foreign body reaction  Leukocytes are frequently present  Non

keratinizing  DDX: Metastases

Large cell undifferentiated carcinoma  Lacks

features of glandular, squamous, or neuroendocrune  Cellular, large cells singly and clusters  Nuclear abnormalities  Intense mitotic activity  Necrosis common  DDX: Poorly differentiated adenocarcinoma, metastases.

Small cell carcinoma  Oat

cell/Intermediate type

 High

cellularity  Cytoplasm scanty  Nuclei are stripped of cytoplasm  Well preserved nuclei are 2x lymphocytes  Mitoses rare  Crush 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

carcinoma  Mucoepidermoid carcinoma  Oncocytoma

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