Inverse correlation of expiratory lung flows and sputum eosinophils in status asthmaticus.

Seventy-six consecutive patients admitted to Los Angeles County General Hospital with acute asthma were studied. Blood and sputum smears for cell counts were obtained on all patients within 12 hours of admission. Fifty-one (67%) patients were able or willing to perform spirometry and flow/volume curves in the first 24 hours of hospitalization. The severity of airway obstruction as assessed by forced expiratory volume in one second (FEV1), maximum mid-expiratory flow rate (MMFR), and forced vital capacity (FVC) was compared with blood and sputum eosinophil counts. Although there was no relation between the blood eosinophilia and airway obstruction, an inverse relationship between the number of eosinophils in the sputum and airway flow rates was observed. Higher percentages of sputum eosinophils were associated with diminished flow rates. We believe that sputum eosinophils may be helpful in the initial assessment of severe bronchial asthma.

Bronchial casts associated with hilar lymphatic and pulmonary lymphoid abnormalities.

A patient who has expectorated bronchial casts for 23 years is reported. The casts contained mucus, fibrin, and lymphocytes, and the resected middle lobe showed dilated lymphatics with thickened walls at the hilum and lymphoid aggregates in the terminal bronchioles.

A quantitative cytologic study of sputum in early squamous cell bronchogenic carcinoma.

The abnormal cells (atypical squamous cells and cancer cells) in the sputum of 12 in situ and 20 early invasive squamous cell carcinomas were studied quantitatively and compared with the cells in 12 borderline cases and 11 frankly invasive squamous cell carcinomas, In in situ and early invasive squamous cell carcinomas, the mean nuclear diameters were larger and multinucleated cells and distinct nucleoli were more frequent than in borderline cases. Furthermore, the mean cellular diameters and the number of abnormal cells per slide were smaller, the distinct nucleoli were less frequent and acidophilic cytoplasms were more frequent than in frankly invasive squamous cell carcinomas. The results indicate that (1) in situ and early invasive squamous cell carcinomas are generally distinguishable cytologically from borderline cases and from frankly invasive squamous cell carcinomas and (2) the cytologic differentiation between in situ and early invasive squamous cell carcinomas is quantitatively insufficient.

[Bronchial cytology in the diagnosis of broncho-pulmonary cancer in Tunisia]. / Apport de la cytologie bronchique dans le diagnostic du cancer broncho-pulmonaire en Tunisie.

The authors present a retrospective study of 287 pulmonary cytologic exams censed in Pasteur Institute - Tunis between 1970 and 1986. These 287 exams consist of 145 bronchic aspiration liquids and 142 spittles. A systematic exam was practiced in patients presenting a pulmonary symptomatology suggesting little or not at all broncho pulmonary cancer. 40 of these exams present cancerous cells (15 cases) or suspected cancerous cells (25 cases). The biopsy confirms a malignant tumor in 25 patients (5%). These results should urge us toward a cytologic exam not only in adults presenting any respiratory symptomatology, but also in subjects at high risk, especially smokers. Localising the tumor is necessary for the biopsy. This biopsy will lead us to determine the histologic type and consequently the adequate therapy.

Sinus tract extension of a liver hydatid cyst and recovery of diagnostic hooklets in sputum.

A 67-year-old man, born in Turkey but living within the United States since 1975, presented with a four-month history of right lower chest pain. Chest x-ray revealed a right lower lobe infiltrate. Liver scan revealed multiple calcified cysts consistent with unilocular hydatid disease. The patient was taken to surgery for liver cysts removal. Although there was no specific evidence of lung cysts, it was recommended that sputum specimens be submitted for evidence of hydatid sand, i.e., hooklets and scolices. Hooklets were found, thus confirming the sinus tract connection between lung and liver. This case emphasizes the point that hooklets can be recovered in sputum and identified, even when there are few present. This approach also represents a noninvasive procedure that, along with serology, could be used as an alternative to biopsy technics under certain conditions.

Malignancy-associated cellular markers (MAC) in oral and bronchial epithelial cells in sputum specimens: possible morphologic marker for high-risk groups (asbestos-exposed workers).

To verify a possible role of malignancy-associated cellular markers (MAC) in high-risk groups, the authors reviewed a total of 291 consecutive sputum specimens from 97 workers exposed to asbestos. The asbestos workers were matched according to smoking habits and cellular changes. Twelve subjects (12.3%) had MAC in epithelial cells; eight were smokers, four nonsmokers. Among MAC+ smokers, three sputum specimens contained cells of squamous metaplasia and one had cells from carcinoma in situ. Two MAC+ nonsmokers had cells of squamous metaplasia, too. In addition, MAC+ cells were also identified in four inflammatory samples, belonging either to smokers or nonsmokers. Two MAC+ subjects had a negative sputum specimen. In keeping with these results, the authors believe that MAC evaluation in sputum specimens might be of help in the oncologic follow-up of asbestos-exposed workers.

Crystals occurring in pulmonary cytology specimens. Association with Aspergillus infection.

Birefringent needlelike crystals in rosette or wheat-sheaf-like arrangements were found in pulmonary cytology specimens from 11 of 65 patients who had either sputum cultures positive for Aspergillus or histologically confirmed pulmonary aspergilloma. No crystals were found in specimens from 60 control patients with and without known fungal disease. The crystals were most often associated with A. niger infection (45.4%), followed by A. flavus (16%). Crystals were also observed in one case of A. fumigatus infection and in one case in which the species was not determined. In two cases, crystals were found more than one year before sputum cultures became positive; in one of these patients, a fungus ball was not identified by X ray until five years after the first appearance of the crystals in the sputum. Sixty-four percent of the patients with crystals also showed moderate to severe cytologic atypia. The crystals are thought to be calcium oxalate. We conclude that the presence of birefringent needlelike crystals with rosette or wheat-sheaf-like arrangements in pulmonary cytology specimens is a reliable marker for the presence of Aspergillus infection, which may be detected before cultures are positive or a fungus ball is evident on X ray.

The value of provoked expectoration in obtaining sputum samples for cytologic investigation. A prospective, consecutive and controlled investigation of 134 patients.

A prospective controlled investigation in 134 consecutive outpatients compared the cytologic adequacy of sputum samples obtained by spontaneous and provoked expectoration. Inhalation of nebulized 10% sodium chloride was used for provoked expectoration. A significantly higher number of adequate samples was produced after provocation, as judged by the presence of alveolar macrophages (X2 = 5.63; p less than 0.02). The improvement in sample adequacy was limited to the nonsmokers and ex-smokers in the study. This result, together with the relatively high cost of cytologic sputum examinations, indicates that provoked expectoration should at least be applied to the collection of sputum samples from nonsmokers and ex-smokers.

Fine needle aspiration cytology of bronchioloalveolar-cell carcinoma of the lung.

The fine needle aspiration cytology features of twelve peripherally located bronchioloalveolar cell carcinomas of the lung diagnosed by fine needle aspiration biopsy are described. A spectrum of cytomorphologic changes was appreciated, including classic groups showing uniform malignant cells having prominent depth of focus with a lack of significant nuclear molding. Other cells showed features of atypical alveolar macrophages and bronchial-lining cells. The smears demonstrated malignant cells arranged along alveolar septae and possessing hobnail-shaped nuclei. Two cases had associated psammoma bodies, and one case demonstrated optically clear nuclei in the malignant cells. This series stresses the fine needle aspiration features that aid in the recognition of this specific lung neoplasm and its differentiation from benign reactive pulmonary lesions, other primary lung cancers and metastatic tumors.

Fine needle aspiration of the lung: a study of 53 consecutive cases.

We reviewed our fine needle aspirations of the lung and chest on 53 consecutive patients from January 1979 through June 1982. Almost all of the patients had been studied by sputum and bronchial cytology and many by bronchial or transbronchial biopsy, but none of the patients had a definitive diagnosis. All of the lung aspirates were done in the department of radiology, using a 22 gauge Chiba disposable needle and the Wright-Giemsa stain. Twenty-four cases (45%) were diagnosed as malignant and ten cases (19%) were considered suggestive. Nineteen cases (36%) were read as negative for malignant cells, but in six of these cases (11% of total) we were able to make the diagnosis of an infectious process based on characteristic cytologic findings.

Early detection of precancerous lesions in dysplasias of the lung by rapid DNA image cytometry.

Hematoxylin-and-eosin-stained cytologic smears of sputum from 28 patients with dysplastic and suspicious cell findings were subjected to DNA image cytometry after Feulgen restaining. The nuclear DNA contents were measured with a TV-based image-analysis system, the Leitz TAS plus, combined with an automatic microscope. Computation of DNA data was performed according to an algorithm for the diagnosis and grading of malignancy. Of the 19 cases that were proven to be malignant in the follow-up, either by histologic examination, sputum cytology, fine needle aspiration biopsy or autopsy, the algorithm identified 17 as malignant in a stage (dysplasia) in which cytology was not yet able to present a definite diagnosis of malignancy. Only two cases of bronchial carcinoma were not detected in the state of dysplasia by this procedure. The periods between the DNA diagnosis of malignancy in dysplasia and the morphologic evidence of cancer varied from three days up to six months. Of the 11 cases that had been classified as benign by the algorithm, 9 were confirmed as benign during the clinical follow-up. Rapid DNA image cytometry appears able to separate squamous dysplasias of the lung into precancerous and nonprecancerous lesions.

Meningioma: a case of transcranial recurrence managed by base-of-skull technique and a review of the tumor.

Meningiomas are the most common benign intracranial neoplasms, and although the otolaryngologist rarely sees these lesions, he or she may encounter them in surgery of the skull base. Surgical removal is the primary treatment modality for these meningiomas. To avoid recurrent disease, the best initial therapy is the most extensive procedure that can reasonably be effected. Chemotherapy and irradiation therapy have, at best, only limited roles in treatment.

Unsuspected strongyloides coexisting with adenocarcinoma of the lung.

The findings in an unsuspected case of Strongyloides stercoralis infestation coexisting with adenocarcinoma of the lung are presented. The diagnosis of adenocarcinoma was confirmed histologically by lung biopsies; the parasitic infection was initially diagnosed by sputum cytology and then by bronchial washings. A stool specimen submitted to the microbiology laboratory confirmed the diagnosis of S. stercoralis infection. This case again suggests the possibility that neoplastic disease may play a role similar to that of immunosuppression in creating an immune deficiency, thus increasing the susceptibility to infectious diseases.

Diagnosis and typing of lung carcinomas by cytopathologic methods. A review of 108 cases.

A correlative review was made of the type of cytology specimens (sputum, bronchial washing and bronchial brushing) together with the corresponding histopathologic specimens of 108 patients. One hundred patients had primary pulmonary carcinomas diagnosed histopathologically (84) or clinically (16); 5 had carcinomas metastatic to the lungs and 3 had apparently false-positive cytologic results for lung cancer. The correlative review was used to determine the diagnostic reliability of pulmonary cytopathologic techniques in the detection and classification of lung carcinomas (i.e., the sensitivity and accuracy). The overall sensitivities of sputum, bronchial washing and bronchial brushing cytology were 60%, 66% and 77%, respectively (p less than 0.05). Bronchial brushing had a higher sensitivity (80%) for peripheral and metastatic lesions than did sputum (37%) or bronchial washing (60%). The overall accuracies of sputum, bronchial washing and bronchial brushing cytology were 79%, 75% and 76%, respectively, which is not statistically different. Regardless of the sampling methods, cytologic typing of squamous-cell and small-cell carcinomas was highly accurate but was less satisfactory for the other types of lung carcinomas. In the 16 cases in which endoscopic biopsies were either not attempted or gave negative results, one or more pulmonary cytologic specimens showed malignant cells. It is concluded that: (1) pulmonary cytopathologic techniques have excellent sensitivity and accuracy in the diagnosis of lung carcinomas; (2) they may establish the diagnosis of pulmonary carcinomas when endoscopic biopsies give negative results; and (3) they are particularly helpful in cases in which endoscopic biopsies suffer from a low yield (peripheral lesions) or create a considerable danger to the patients (iatrogenic hemorrhage).

The application of visual cell profiles in the study of premalignant atypias in sputum.

Because the diagnosis of squamous-cell carcinoma of the lung by routine cytologic screening of sputum is often inconclusive, our laboratory is studying the use of cytomorphologic profiles as a reliable diagnostic aid. This study reports the analysis of the profiles of 75 subjects, both cigarette-smoking volunteers and hospitalized patients suspect for lung cancer. Twenty-five of the subjects had been classified as having squamous metaplasia, 25 as having atypias and 25 as having squamous-cell carcinoma. Four slides were made for each subject, with 100 random fields viewed on each slide. The frequency of free alveolar macrophages, metaplastic squamous cells, epithelial atypical cells and malignant squamous cells were noted for each field. The results indicated that, although there were large differences between individual profiles within each diagnostic category, there were significant differences between the average profiles for each diagnostic category. Furthermore, although there were differences in cell frequencies from slide to slide and within slides, the differences were constant across diagnostic categories. The results are supportive of the progressive-atypia hypothesis for squamous-cell carcinoma of the lung and provide a baseline for comparison with subsequent individual profiles.

[Fiber bronchoscopy in the diagnosis of bronchopulmonary tumors. Evaluation of the diagnostic efficacy of a cyto-histologic protocol in an ambulatory center]. / La fibrobroncoscopia nella diagnosi del tumore broncopolmonare. Valutazione della resa diagnostica di un protocollo cito-istologico presso un centro ambulatoriale.

An examination was made of the series of 439 lung tumours diagnosed ambulatorially at the Turin Social Health Dispensary to assess the diagnostic return from several techniques (cytology of the sputum, bronchial aspirate and brushing; histology on a biopsy specimen) used singly or in combination. It was also sought to determine the increase in sensitivity obtained by adding technique to each one other, and to establish the overall sensitivity of the protocol. It was found that biopsy was the most sensitive technique (91% in tumours visible by fibrobronchoscopy). The single cytological techniques displayed a lower sensitivity than in the literature, and there was no significant difference among them. The most sensitive combination was brushing + sputum (89.2%), while the sensitivity of the protocol as a whole was much the same as that reported in the literature. In the case of fibrobronchoscopically visible lesions, multiple biopsies (preferably 3) may be sufficient, whereas combination of the three cytological techniques is necessary to ensure acceptable sensitivity with regard to invisible lesions.

The significance of "positive" respiratory cytology determinations in a series of 327 patients.

The authors reviewed all "positive" respiratory cytology diagnoses rendered over the past ten years at a medical center. Three hundred twenty-seven patients (with a total of 689 "positive" respiratory cytology determinations) were classified as having nonmalignant respiratory tract disease by using a unique system of explicit, reproducible verification criteria. Five patients with false-positive results (1.5%) and seven false-positive patient determinations (1.0%) were encountered. None of these were typed cytologically as small cell anaplastic carcinoma, and none were bronchial determinations. Overall patient typing accuracy was 72.2%; 75.2% of all sputum and 61.2% of all bronchial determinations were typed accurately. Our lowest typing accuracy (53.3%) was encountered in patients with poorly differentiated carcinoma. The findings from this study confirm the continued need for systematic analysis of respiratory cytology data from large groups of patients. Only then can cytopathologists hope to improve upon the clinical value of this diagnostic modality.