Cytology of bronchoalveolar lavage in some rare pulmonary disorders: pulmonary alveolar proteinosis and amiodarone pulmonary toxicity.

Cytological patterns of bronchoalveolar lavage (BAL) in pulmonary alveolar proteinosis (PAP) and amiodarone pulmonary toxicity (APT) are presented together with light and electron microscopy (EM). The differential cell count of BAL in both diseases is similar in that alveolar macrophages predominate. However, the cytology of PAP is characterized by scanty macrophages and alveolar epithelial cells in abundant periodic acid-Schiff (PAS)-positive extracellular material. The gross appearance of the BAL fluid is therefore opaque. In contrast, the cytology of APT is characterized by foamy alveolar macrophages with numerous lamellar bodies in their cytoplasm, and the BAL fluid is clear.

Bronchoalveolar lavage in the diagnosis of peripheral primary and secondary malignant lung tumors.

The success rate of cytological examination of the bronchoalveolar lavage fluid (BALF) in patients with primary or metastatic lung tumors varies considerably according to different authors. In a prospective study, we have tried to establish the sensitivity of BAL in comparison with both transbronchial lung biopsy (TBB) and brushing. BAL was performed in 61 patients with lung malignancies and in 56 patients with nonmalignant lung disease: 39 patients had primary lung cancer, 22 had metastatic spread into the lungs. First the part of the lung involved was washed out with 100 ml physiological saline solution during bronchoscopy. Following BAL, 5 TBB and brushing were performed. The smears were stained by the May-Grünwald-Giemsa method. Malignant cells were found in BALF from 17 patients, in TBB specimens from 43 and in brushing smears from 26. TBB was significantly the most successful method applied. Malignant cells were never found in BALF only, nor were they ever found in patients with non-malignant lung disease. The sensitivity of the three methods was equal for primary as compared to metastatic tumors and for interstitial infiltrates as compared to coin lesions. Malignant cells were most frequently found in centrifuged specimens. BAL may be used in suspected malignant interstitial or rounded pulmonary infiltrates when it cannot be reached by forceps or brush, or when TBB and brushing are contra-indicated.

Cytology of endobronchial granular cell tumor.

Cytologic features of four cases of endobronchial granular cell tumor are presented. The diagnostic cells were found in bronchoscopically obtained material. They were arranged in smaller clusters and had finely granular cytoplasm with uniform oval or round nuclei. Frequently the cells are overlooked on regular cytologic examination owing to their benign nature. Nevertheless, there are enough cytomorphologic features that help to distinguish these cells from macrophages and bronchial epithelial cells. It is essential that the possibility of granular cell tumor is considered on cytologic examination. Final diagnosis, however, requires histologic verification.

Human leukocyte interferon alpha (HLI-alpha) for treatment of pleural effusion caused by non small cell lung cancer. A pilot study.

Fourteen patients with ipsilateral pleural effusion from non small cell cancer of the lung, 10 of them with generalized metastasis, were treated with local application of HLI-alpha in addition to other symptomatic treatment. Cytology of pleural fluid at the beginning of treatment yielded cancer cells in all but one. HLI-alpha, 2 x 10(6) International Units (I.U.) diluted in 20 ml of distilled water was injected intrapleurally each time. The mean survival of the HLI-alpha treated patients, measured from the first treatment of the pleural effusion, was 10.8 months. The performance status improved in 9 patients following HLI-alpha treatment. The pleural effusion eventually ceased accumulating in all patients. To judge from cytology of tapped pleural fluid, the cancer cells disappeared during treatment with HLI-alpha in 11 patients.

[The role of pleural effusion cytology in the diagnosis of malignancies]. / Uloga citologije pleuralnih izliva u dijagnostici malignoma.

During 6 yrs' period the malignant or suspicious cells were found in 219 patients. The male to female ratio was 1.2:1. The youngest patient was 21 yrs old, the oldest 92. Most patients were from the age group 55-64 yrs. The most frequent primary localisation of cancer with cytologically positive or suspicious pleural effusion was lung, on the second place was breast cancer in females and pleura in males. In 11.4% of patients the cytologic finding was suspicious. Most frequently the cells of mesothelioma could not be classified with certainty. In 94 patients the malignant cells were found in pleural effusion and also in any other kinds of material. In 125 patients the other materials were not examined or they were negative. In 76 patients apart from cytological examination of pleural effusion the histological examination of the material obtained by blind needle biopsy or by thoracoscopy was examined. Cytology was positive in 67.1% of cases and histology in 89.5%.