Bronchioloalveolar lavage in the diagnosis of CMV pneumonitis in lung transplant recipients: an immunocytochemical study.

Cytomegalovirus (CMV) pneumonitis is a common opportunistic infection in lung transplant recipients. Its diagnosis usually rests on the identification of viral inclusions in lung parenchyma obtained by transbronchial biopsy, or by examination of the cytologic material obtained by bronchioloalveolar lavage (BAL). To determine whether the use of immunocytochemistry (ICC) increases the sensitivity of cytology in the diagnosis of CMV pneumonitis, we retrospectively selected 17 cases in which transbronchial biopsy and BAL were performed simultaneously, and had positive histology with negative cytology. Five negative controls were selected. The 22 slides were decolorized and restained with ICC for CMV. Of the 17 slides, nine (53%) showed cells with positive nuclear staining. All controls were negative. These results were then correlated with the number of infected cells present in the biopsy tissue, and the location of the cells (interstitial vs. intraalveolar). A good correlation was found between positive cytology and intraalveolar location of infected cells, and no correlation was seen between number of infected cells in the biopsy and the positive cytology. In summary, although histologic evaluation of lung parenchyma obtained by transbronchial biopsy is more sensitive for diagnosis of CMV pneumonitis, the sensitivity of the cytologic evaluation of BAL material can be increased by the use of ICC. The likelihood of positive ICC seems to be related to the presence of infected cells in the alveolar space rather than to the number of infected cells.

Fine needle aspiration biopsy of calcinosis cutis. A case report.

BACKGROUND: Metastatic calcifications are currently an uncommon complication in patients with end-stage renal disease due to improvements in management of these patients. When present, however, calcifications may mimic neoplastic growth and can undergo fine needle aspiration biopsy (FNAB). CASE: A case of calcinosis cutis was diagnosed by FNAB in a 50-year-old male with a history of end-stage renal disease who presented with a subcutaneous nodule in the right side of his neck. CONCLUSION: The presence of histiocytes, foreign body-type giant cells and refractile material (calcium crystals) in FNAB material is diagnostic of calcinosis cutis in the proper clinical setting.

Early diagnosis of cytomegalovirus pneumonitis in lung transplant patients.

Cytomegalovirus (CMV) pneumonitis is an important cause of morbidity and mortality in lung transplant patients and requires timely and accurate diagnosis. This study compares the diagnostic utility of the evaluation of transbronchial biopsy by histology, immunohistochemistry, and simultaneous culture of bronchoalveolar lavage in a population of 13 lung transplant patients who underwent 78 biopsies during a period of 27 months. Our study concludes that, in patients clinically symptomatic for CMV pneumonitis, histology alone is diagnostic for the presence of the virus, whereas culture of bronchoalveolar lavage fluid is not as helpful. In asymptomatic patients, however, immunohistochemistry utilizing monoclonal antibodies to immediate-early and early CMV nuclear antigens may indicate development of CMV pneumonitis before cytopathic changes are evident.

Fine needle aspiration biopsy of intraoral and pharyngeal lesions.

Fine needle aspiration biopsy (FNAB) of superficial and deep-seated lesions has been used extensively with high sensitivity and specificity. However, reports of intraoral FNABs are sparse. We present a series of 44 intraoral FNABs performed between September 1988 and January 1992 at Loyola University Medical Center (36 cases) and Hines Veterans Administration Hospital (8 cases). The age of the patients ranged from 29 to 90 years (mean, 61), with 25 males and 19 females. Biopsy sites included buccal mucosal lesions (13 cases), pharynx/nasopharynx (11), tongue (10), tonsils (6), soft palate and epiglottis (2 each). Of the 44 cases, 32 (72.7%) had follow-up surgical biopsy, and 11 (25%) (all with benign diagnosis) were followed clinically. One aspiration was unsatisfactory. Cytologic diagnosis correlated with tissue biopsy in 25 cases (80.6% sensitivity). In six cases the cytologic material did not reveal a neoplasm found in the tissue sections (19.4% false negative). In one case the cytologic diagnosis of malignancy did not correlate with the surgical biopsy (3.1% false positive; specificity, 96.9%). The results of our study suggest that FNAB of intraoral lesions is less sensitive and specific than that of superficial masses. This may be explained by the small size and superficial location of the lesions as well as by the limited space for maneuvering the needle, with difficulty in fixing the lesion for adequate aspiration.