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
 Painor 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
 Nonkeratinizing
 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