Alveolar lavage fluid (ALF) of normal volunteer subjects: cytologic, immunocytochemical, and biochemical reference values.

OBJECTIVE: Pooled bronchoalveolar lavage fluid (BALF), the return of lavage, contains both bronchial and alveolar material which differ from each other. Artifacts may be created by filtering, centrifuging and washing cells before cytopreparation. This study presents reference values of healthy volunteers for the alveolar sample, ALF, cytopreparation being performed without filtration or centrifugation. METHODS: Eighteen healthy, non-smoking volunteers underwent a standard bronchoalveolar lavage using 10 aliquots of 20 ml of saline. Excluding the return of the first and second aliquots, the rest were pooled and examined cytologically, immunocytochemically and biochemically. The mean, standard deviation, and 95% confidence limits were calculated for the following variables: amount of return, estimated content of epithelial lining fluid (ELF), total and differential cell counts on filter and cytocentrifuge (CCF) preparations, computed cell counts per unit volume of ALF, distribution of lymphocyte subgroups CD3+CD2, CD4, CD8, CD19, CD25 and CD57, and the ratio of CD4 to CD8, the amounts of lymphocytes in the same subgroups per volume of ALF, and the concentrations of total protein, albumin, immunoglobulins A, G and M, hyaluronic acid, eosinophilic cationic protein (ECP), procollagen III aminoterminal propeptide (PCP) and beta 2-microglobulin in ALF and in ELF, as well as the ratios of the concentrations of the solutes in ALF to the same in serum. RESULTS: The 95% confidence limits of means for the most important variables were as follows: estimated ELF content 0.42-0.74%; total cells in ALF 76.6-143.0 x 10(6) l-1; distribution of inflammatory cells on filter and CCF slides: macrophages 74.9-83.6 and 81.4-90.1%, lymphocytes 13.1-22.5 and 8.1-16.4%, and neutrophils 1.0-4.1 and 0.7-2.7%, respectively; distribution of lymphocyte subsets: CD3+CD2 85.6-90.6%, CD4 44.3-53.1%, CD8 26.9-35.8%; concentration of solutes in ALF: total protein 44.8-61.3 mg l-1, albumin 15.4-22.2 mg l-1, IgA 1.8-3.4 mg l-1, IgG 3.1-6.1 mg l-1, IgM 0.05-0.26 mg l-1, hyaluronic acid 8.8-11.1 micrograms l-1, ECP 0.19-0.77 micrograms l-1, PCP 0.005-0.58 micrograms l-1, beta 2-microglobulin 62.2-81.5 micrograms l-1. CONCLUSIONS: Our results show that excluding the bronchial sample from ALF of volunteer subjects and omitting filtering and washing before cytopreparation produces cytologic, immunocytochemical and biochemical reference values with reasonable 95% confidence limits to be used in clinical settings.

Histological subtypes or grading of pulmonary adenocarcinoma. A histochemical and electron microscopic study.

To reveal whether the different histological subtypes of pulmonary adenocarcinoma are composed of different types of cells, we analyzed basic mucus histochemistry and ultrastructural features in a series of 61 adenocarcinomas correlating the findings with four ways of histological classification and grading. 82% of the tumours were composed of a single and 18% of two or more cell types. The original WHO classification had no association with the histochemical or ultrastructural features studied. A modified WHO classification, however, based on the prevailing subtype, had significant associations with five, a classification based on prevailing growth pattern with four, and histological grading with eight histochemical and electron microscopic features. The results suggest that it is more important to classify pulmonary adenocarcinomas by histological grades than by subtypes.

Ultrastructural morphology of mucoid effusion in secretory otitis media.

The ultrastructural morphology of 19 mucoid middle ear effusions in 14 children with secretory otitis media was studied. Phagocytosing neutrophil granulocytes were the most common inflammatory cells, and ingested bacteria were present in some of them. The next in frequency were macrophages and lymphocytes. Monocytes and polyblasts were also present in most specimens. No plasma cells, eosinophil granulocytes or mast cells were seen. Epithelial cells were common, and great numbers of free and phagocytosed mucus granules were found. Considerable numbers of all the celltypes were in various stages of disintegration. Thus, it seems that the effusion in secretory otitis media is primarily of inflammatory origin, and the dissolution of the cells with liberated cellular contents, together with the secretion of the mucosa, contributes to the formation of the effusion.