[The value of cytologic and bacteriologic analysis of bronchoscopic specimens with direct microscopy in the diagnosis of pulmonary tuberculosis]. / Vrijednost citoloskih i bakterioloskih analiza bronhoskopskih uzoraka direktnom mikroskopijom u dijagnozi plucne tuberkuloze.

The authors review results for detection of acid-fast bacilli by the method of direct fluorescent microscopy in cytologic specimens obtained by fiberbronchoscopy and in which a granulomatous inflammation was found cytomorphologically. Direct fluorescent microscopy revealed acid-fast bacilli in 30.2% of the specimens. In 10.2% of the patients, acid-fast bacilli detected by fluorescent microscopy were the only positive bacteriological findings which confirmed tuberculosis. The authors suggest this method for all those patients in whose bronchoscopic specimens, suspected cases of tuberculosis infection could be established cytomorphologically.

[Chemotherapy of tuberculosis]. / Kemoterapija tuberkuloze.

In the last fifty years, chemotherapy of tuberculosis has achieved a great success in the treatment of the disease as well as well as in the shortening of the treatment period. This is due to the appearance of new and very effective antitubercular agents. The course of therapy, which twenty, thirty years ago or even earlier lasted two years or longer, today is reduced to nine months or less. The recommendations for protocol of tuberculosis therapy as suggested by World Health Organization as well as by English and American societies for control and tuberculosis therapy are reported in this paper.

[Pleural biopsy]. / Biopsija pleure.

From 1975 to December 1990, 391 needle biopsies were performed in 379 patients, aged from 19 to 82 years. The combination of cytological and histological examination of pleural biopsy specimens was done. Histologically useful specimens were obtained in 265 (67.8%) biopsies and cytologically satisfactory in 106 (27.1%). Histology revealed non-specific changes in 136 (51.3%) cases, malignant neoplasm in 61 (23-0%), granulomatous inflammation in 47 (17.8%), chronic inflammation in 20 (7.6%) and rheumatoid pleuritis in 1 (0.3%) case. Cytology showed the presence of malignant neoplastic cells in 60 (56.7%), granulomatous changes in 44 (41.5%) and changes that were cytomorphologically denoted as non-Hodgkin's lymphoma and rheumatoid pleuritis in 2 of the 106 useful biopsy specimens.

[Comparative analysis of bronchoalveolar lavage and transbronchial biopsy in pulmonary sarcoidosis]. / Komparativna analiza bronhoalveolne lavaze i transbronhalne biopsije u plucnoj sarkoidozi.

This study was carried out in 59 patients with histological evidence of pulmonary sarcoidosis. In all patients, bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) were performed simultaneously. In histologic specimens of TBB, 24/59 (41%) patients had luminal alveolitis, 36/59 (61%) mural alveolitis, 41/59 (69%) granulomas 11/59 (15%) diffuse fibrosis and 24/59 (41%) focal fibrosis. Cytological examinations of BAL revealed 22/59 (37%) patients without alveolitis, 20/59 (34%) with low intensity alveolitis and 17/59 (29%) with high intensity alveolitis. Comparative analysis of these patients showed the association of the alveolitis in BAL and the mural alveolitis or granulomas in TBB (p less than 0.01). The conclusion of this study is that cytological findings in BAL represent interstitial cells very well.

[Intrathoracic extramedullary hematopoiesis]. / Intratorakalna ekstramedularna hematopojeza.

The authors report on 29 cases of intrathoracic localization of extramedullary hematopoiesis. Out of them, 26 cases were confirmed by cytomorphologic examination of the aspirate specimens obtained by transtracheal biopsy of carina while in 3 cases the specimens for cytologic analysis were obtained by transthoracic fine needle aspiration of solitary shadows in the lung parenchyma. The cytomorphologic finding of the hematopoietic cells of the specimens obtained by transtracheal biopsy was unexpected in patients with an active pulmonary tuberculosis, primary bronchial carcinoma, broncho and pleuropneumonia, lung abscess, sarcoidosis, chronic bronchitis, rheumatoid arthritis as well as in patients with hemoptysis.

[Hodgkin's lymphoma of the lungs]. / Hodgkinov limfom pluca.

A case of the patient with Hodgkin's lung lymphoma, who ten years ago was treated because of having Hodgkin's lymphoma of the mediastinum and neck, is reported in this paper. This time, the patient has been admitted to the hospital due to the pulmonary infiltration in the left upper lobe. As the etiology of the pulmonary infiltration could not be established by a routine diagnostic procedure (sputum cytology, catheter bronchial aspirate smears, bronchial brushing, excision of the bronchial mucosa, transtracheal and transbronchial aspiration), the transthoracic fine needle aspiration was performed to confirm the diagnosis. Cytologically, beside erythrocytes, the cells of the bronchial epithelium, eosinophilic granulocytes and lymphocytes, the cells of the Reed-Sternberg cell type were found in the transthoracic aspirate smears too.

[Cytology of bronchial inflammatory pseudotumor]. / Citologija upalnog pseudotumora bronha.

A presentation is given of a 23-year-old girl who due to cough, hemoptysis and chest pains was treated in the regional hospital as having pneumonia. A bronchoscopy was performed and it revealed the tumor which obturated the right main bronchus. Due to this, surgery was performed. The cytologic analysis of the sample, taken intraoperatively, showed that numerous fibroblasts, single or combined in groups, lymphocytes, plasma cells, mastocytes and some neutrophilic granulocytes were present as well as macrophages.

[Bronchoscopy in the post-therapeutic monitoring of patients with bronchial carcinoma]. / Bronhoskopija u postterapijskom pracenju bolesnika sa karcinomom bronha.

A study of 970 patients treated for bronchogenic carcinoma (operation, cytostatic therapy, irradiation) reveal that only 122 (12.5%) were evaluated by the bronchoscopy. Among 47 (38.5%) out of 122 patients recidivation was confirmed (cytology or histology). The efficacy of radiology and sputum cytology is poor. Only 22/47 (47%) had radiologic evidence of recidivation and 18/47 (38%) had positive sputum cytology. Radiology and sputum cytology reveal recidivation in 27/47 (57%) patients. It means that bronchoscopy is the method of choice in the posttherapeutic monitoring of patients with bronchogenic carcinoma.

[Tuberculosis of the peripheral lymph nodes]. / Tuberkuloza perifernih limfnih cvorova.

An analysis of 2.414 fine needle aspiration specimens, obtained from peripheral lymph nodes, was done in 2.287 patients during the period from 1979 till the end of 1989. This investigation was performed at the Cytologic Laboratory of the Clinic for Lung Diseases "Jordanovac" in Zagreb. Totally, there were 150 (6.2%) aspirates which, cytomorphologically, appeared to have a granulomatous reaction with necrosis. Of 150 aspirates, Mycobacterium tuberculosis was found microscopically and/or by culture in 73 (3.02%) of them. The patients were less than 40 years of age in 63% of the cases. As to the localization, the highest rate of tuberculous lymph nodes (91.8%) was found in the neck and supraclavicular areas.

[Lymphocytes in sputum]. / Limfociti u sputumu.

The authors analysed 116 hospitalized patients who, in their routine cytologic examination of the sputum, had also a cytomorphologic finding of lymphocytes. The greatest majority of these patients, 63 of them or 54.3% suffered from malignant neoplasm. Out of these 63 patients, 53 of them or 45.7% suffered from primary bronchial carcinoma, whereas 10 patients or 8.6% had non-Hodgkin's lymphoma, metastatic lung cancer of extrathoracic primary localization, Hodgkin's lymphoma, while two patients were supposed to have lung neoplasm. Our study also revealed that 14 patients (out of 116 hospitalized patients) or 12.0% suffered from broncho-pleuropneumonia, 13 or 11.2% from an active pulmonary tuberculosis, 7 or 6.0% from a chronic obstructive bronchitis, 5.1% from sarcoidosis, 3.4% from post tuberculosis pulmonary changes while 2.5% of the patients were found to have a pleural empyema. One case of bronchial asthma, tuberculous pleurisy, bronchiectasis, hamartoma, hemoptysis and a pulmonary infarction were found as well. Due to their own experience the authors conclude that the lymphocytes in the sputum were found to be the most frequent in patients suffering from primary bronchial carcinoma, broncho-pleuropneumonia and pulmonary tuberculosis but that they could also be found in many others pathologic changes of pulmonary parenchyma.

[Hypernephroma cells in pleural effusions]. / Stanice hipernefroma u pleuralnom izljevu.

A rare case of finding of hypernephroma cells in pleural effusion as well as their cytomorphological picture are presented in this paper. Cytomorphologically, the hypernephroma cells in pleural effusion occurred in clusters from three, four to about twenty of cells and rarely appeared singly. The cytoplasm of the cells appeared to be abundant, not sharply bordered and varied in colour from a light-grey to a slight pink-grey while within the cytoplasm, the small pale vacuoles were visible. The nuclei of the cells were regularly round-to-oval shape with a slight anisonucleosis and contained one, rarely two, a good visible blue nucleoli. Of other cells, erythrocytes were also present together with the cells of mesothelial serosa and lymphocytes. Cytomorphologically, the hypernephroma cells in pleural effusion have the same characteristics as have the hypernephroma cells in metastases of lymph nodes in mediastinum or in metastatic nodes of the lung.

[Cytomorphologic changes in bronchial epithelial cells in a patient exposed to an aerosol of the organophosphorus insecticide, Ekalux 25 (quinalphos), 0,0-diethyl-0-quinoxaline-2-phosphorothioate]. / Citomorfoloske promjene na stanicama bronhalnog epitela u bolesnika izlozenog aerosolu organofosfornog insekticida "Ekalux 25" (kvinalfos) 0,0-dietil-0-kvinoksalin-2-il fosforotioat.

In this paper, the authors present cytomorphological changes of the bronchial epithelial cells in the patient who inhaled aerosol organophosphate insecticide "Ekalux 25" 0,0-diethyl-0-quinoxaline-2-il-phosphorothioate, while spraying crops, i.e. Colorado beetle. Our cytomorphologic examination of the sputum (obtained on the 13th and 15th day after the patient's exposure to the insecticide) revealed neutrophil granulocytes, degenerate changed macrophages, degenerate changed bronchial epithelial cells, squamous metaplasia with a poor number of lymphocytes and erythrocytes. Beside this, we also found atypical hypertropic cells of the bronchial epithelium (occurring in single forms or in groups) most of which appeared to be without cilia. Cytoplasm of those cells occurred to be not sharply bordered but poor and had a grey blue colour. Chromatin pattern of the nuclei was more coarse or "wiped", while nucleoli, as rule, appeared to be not discernible. There also occurred some nuclei in mitosis. The number of nuclei in those cells varies from one to several. Sputum specimens obtained later for cytologic analysis as well as bronchoscopic specimens, obtained on the 17th day after the patient's admission to the hospital, did not show any similar cytomorphologic changes. The authors of this paper think that it would be interesting to examine and follow-up the cytomorphologic specimens (bronchial secret, catheter bronchial aspirate smears, brushing and histopathologically) as early as the first days (if it is possible) of a patient's exposure to the organophosphate compounds.