Bronchoalveolar lavage, histological and immunohistochemical features in cryptogenic organizing pneumonia.

This study describes bronchoalveolar lavage (BAL), histological and immunohistochemical features in a series of 10 patients with cryptogenic organizing pneumonia (COP). The histological diagnosis was performed by transbronchial biopsy in seven cases and by open lung biopsy in three cases. All patients showed a marked increase in lymphocytes and a mild increase in neutrophils and eosinophils in BAL fluid. The number of T-lymphocytes expressing human leucocyte antigen-DR (HLA-DR) surface antigen was increased (p < 0.002). The majority of lymphocytes expressed the CD8 phenotype, so that the CD4/CD8 ratio was markedly decreased. Masson bodies were present in the lung specimens of all patients. Most of the epithelial cells surrounding the Masson bodies were immunoreactive with an anti-granulocyte/macrophage colony-stimulating factor (GM-CSF) monoclonal antibody. The great majority of mononuclear cells in the lung specimens showed immunoreactivity with anti-CD3, anti-CD8 and anti-CD45R0 monoclonal antibodies. In the Masson bodies, spindle cells were immunoreactive with anti-alpha smooth muscle (alpha-sm) actin monoclonal antibody. Glucocorticoid treatment (the therapy of choice in COP) downregulated GM-CSF messenger ribonucleic acid (mRNA) expression in lung epithelial cell lines. These findings indicate that the combination of bronchoalveolar lavage cell profile with histological evidence is a valuable means of corroborating a clinical diagnosis of cryptogenic organizing pneumonia, and that granulocyte/macrophage colony-stimulating factor may be one of the cytokines involved in the pathogenesis.

Bronchoalveolar lavage in the diagnosis of disseminated lung tumors.

We report our experience with bronchoalveolar lavage (BAL) and its value in the diagnosis of malignant lung infiltrates. A total of 162 patients with biopsy- or autopsy-proven cancer had an analysis of BAL fluid performed. Cytologic examination showed malignant cells in 123 (76%) patients. The diagnostic accuracy varied depending on the neoplastic nature and growth pattern of the disease. BAL disclosed cancer cells in 93% of 44 bronchioloalveolar carcinomas. Carcinomatous lymphangitis due to metastatic cancer was diagnosed in 83% of 69 cases. Hematogenous metastases (with sharply circumscribed nodules on chest radiography) were diagnosed in 45% of 22 such cases. We recognized 67% of 15 non-Hodgkin's lymphomas and 3 of 9 cases of Hodgkin's disease with pulmonary involvement. Immunocytochemistry using monoclonal and/or polyclonal antibodies was of value in the identification and classification of cells in non-Hodgkin's lymphoma.

Bronchoalveolar lavage in the diagnosis of low-grade, MALT type, B-cell lymphoma in the lung.

Low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type represents one of the most frequent primary lymphomas in the lung. This study demonstrates the value of bronchoalveolar lavage (BAL) in the diagnosis of this entity. Three patients with biopsy proven MALT lymphoma in the lung were submitted to bronchoscopy. BAL fluid analysis showed an increased cellularity and a striking lymphocytosis. Cytological features consistent with a low-grade malignant lymphoma were present in two cases (medium sized lymphoid cells with an evident lymphoplasmocytoid differentiation, and irregular nuclear borders). In all cases, flow cytometry analysis showed a high percentage of cells expressing a B phenotype (52, 40 and 28%, respectively). In two cases, there was a striking monotypic expression of surface light-chain immunoglobulin (Kappa/Lambda ratio = 38 and 0.04, respectively). Bronchoalveolar lavage appears to be a valuable procedure in the diagnosis of low-grade B-cell lymphoma of MALT type in the lung.