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Rotation - Cytopathology > Ch. 2 - Respiratory Tract & Mediastinum > Flashcards

Ch. 2 - Respiratory Tract & Mediastinum Flashcards

1
Q

What are the normal cells found in the trachea & bronchi?

A

Pseudostratified ciliated respiratory epithelium, goblet cells, reserve cells, and neuroendocrine (Kulchitsky) cells. Can also find smooth muscle, salivary gland…

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2
Q

What are the normal cells found in the terminal bronchioles

A

Nonciliated Clara cells (bland), Type I pneumocytes (paper thin), Type II pneumocytes (plump and cuboidal, vacuolated)

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3
Q

What are the strengths and weaknesses of sputum sampling?

A

Easy to obtain, but frequent contaminants from oral contents. Ideally should be collected multiple times (especially first in AM).

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4
Q

What role do bronchoalveolar lavages fulfill?

A

Useful for diagnosis of infections, especially opportunistic ones such as pneumocystis & mycobacteria.

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5
Q

What is the best indication for transbronchial aspiration (Wang needle method)?

A

Good for distinguishing small cell from NSCLC, staging of NSCLC.

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6
Q

How does EBUS compare to unguided transbronchial (Wang needle) aspiration?

A

Addition of ultrasound improves both sensitivity and specificity, and allows sampling of further/smaller lymph nodes.

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7
Q

What indications exist for percutaneous FNA of the mediastinum/lung? What are its major drawbacks?

A

For peripheral pulmonary masses. There are many contraindications and pneumothorax is extremely common (30%!).

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8
Q

What are some examples of targetable mutations in NSCLC?

A

EGFR, VEGF(?), BRAF, ALK, HER2(?).

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9
Q

What is the significance of reactive squamous cells in a BAL?

A

Probably represents oral contaminants.

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10
Q

Describe the morphology of reactive bronchial changes.

A

Enlarged nuclei with large nucleoli, occasional multinucleation. Occasional “Creola bodies” (large clusters).

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11
Q

What disease does bronchial reserve cell hyperplasia represent? How can it be distinguished?

A

SCLC (cohesive small cells with smudged chromatin and nuclear molding). Distinguished by absence of mitoses/apoptoses.

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12
Q

How can pneumocytes repair/hyperplasia be distinguished from carcinomas?

A

Can be difficult; clinical history is the best guide.

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13
Q

What are ferruginous bodies?

A

Dumbbell-shaped mineral fibers encrusted with ferroproteins, sometimes associated with asbestos exposure.

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14
Q

What are Curschmann spirals?

A

Coiled strands of mucin that stain dark purple. They are nonspecific, not even specific for asthma.

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15
Q

What are Charcot-Leyden crystals?

A

Rhomboid, orangeophilic structures derived from eosinophils in asthmatic patients.

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16
Q

In what conditions can psammoma bodies be seen?

A
  • Papillary tumors (pulmonary adenocarcinoma, mesothelioma, metastatic thyroid & ovarian cancer)
  • Pulmonary TB
  • Alveolar microlithiasis
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17
Q

What are corpora amylacea?

A

Proteinaceous spherical structures of unknown composition; identical to those of prostate.

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18
Q

What does the presence of amorphous protein raise concern for?

A

Amyloidosis, PAP

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19
Q

What are the morphologic features of Measles/RSV?

A

Look for giant cell pneumonia with enormous multinucleated cells.

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20
Q

What are the morphologic features of adenovirus infection?

A
  • Smudge cells (Basophilic inclusions filling entire nucleus)
  • Cowdry-A like inclusions.
  • Also look for ciliocytophthoria.
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21
Q

What role does FNA play in bacterial pneumonia?

A

Not useful for distinguishing infectious agents; only for ruling out underlying malignancy.

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22
Q

What are the FNA features of tuberculosis?

A

Granulomatous inflammation with epithelioid histiocytes and Langhans giant cells, often necrotic. Organisms visible with AFB stain.

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23
Q

What are the morphologic features of Cryptococcus?

A

Highly refractile yeast with thick mucinous capsule.

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24
Q

What are the morphologic features of Histoplasma?

A

Small yeast within macrophages with narrow-based budding, best visualized with silver stain.

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25
Q

What are the morphologic features of Blastomyces?

A

Broad-based budding large yeast with thick cell wall.

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26
Q

What are the morphologic features of Coccidioides?

A

Huge spherules with endospores.

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27
Q

What are the morphologic features of Paracoccidoides?

A

Large “mariner wheel” organism with overlying squamous metaplasia.

28
Q

What are the morphologic features of Sporotrichosis?

A

Small intracellular yeast; quite hard to distinguish from Histoplasma.

29
Q

What are the morphologic features of Aspergillosis?

A

45’-branching organisms with eosinophil and charcot-leyden crystals. May invade vessels. In cavitary lesions, fruiting bodies may be seen.

30
Q

What are the morphologic features of Zygomycosis?

A

90’-branching organisms with aggressive vessel invasion and necrosis.

31
Q

What are the morphologic features of Pneumocystis?

A

Masses of organisms enmeshed in proteinaceous foamy green material. Cysts appear as negative images, but intracystic bodies and trophozoites are distinct.

32
Q

Describe the cytology of Sarcoidosis.

A

Noncaseating granulomas: Multinucleated giant cells, lymphocytes, and epithelioid histiocytes (reniform/boomerang nuclei)

33
Q

Describe the cytology of Wegener granulomatosis

A

Neutrophils, giant cells, “pathergic” (necrotic) collagen, and epithelioid histiocytes.

34
Q

Describe the cytology of Pulmonary amyloidosis.

A

Irregular waxy amorphous material with scalloped and cracked blue-green appearance. May also have giant cell reaction.

35
Q

Describe the cytology of Pulmonary alveolar proteinosis.

A

Opaque, milky gross material with acellular eosinophilic blobs of PAS+ material, some within macrophages.

36
Q

Describe the cytology of pulmonary hamartoma.

A

Mixture of mesenchymal (fibromyxoid, cartilaginous) and benign epithelial elements.

37
Q

Describe the cytology of Inflammatory myofibroblastic tumor.

A

Spindle cells arranged in fascicles or storiform pattern, plus some polymorphous inflammatory cells.

38
Q

What is the principal abnormality in IMT?

A

ALK rearrangements, usually t(2;5) ALK-NPM

39
Q

Describe the cytology of granular cell tumor.

A

Small clusters of macrophage-like cells (Schwann cells) with abundant granular eosinophilic cytoplasm.

40
Q

In lung cancer, what genetic abnormalities are induced by tobacco smoking?

A

3p deletion
p53 mutation
K-RAS mutation
P16 mutation

41
Q

Describe the cytology of squamous cell carcinoma.

A

Well-differentiated: Cohesive with orangeophilia.

Poorly-differentiated: Cohesive clusters of cells with “school of fish” streaming, “potato surface” chromatin.

42
Q

How is adenocarcinoma distinguished from squamous cell carcinoma?

A

Staining for TTF-1 (favors adeno), p40 (favors SQC, but does not trump TTF-1)

43
Q

What are the 5 main histologic subtypes of lung adenocarcinoma?

A 
Lepidic
Acinar
Solid
Papillary
Micropapillary
44
Q

Describe the cytology of lung adenocarcinoma.

A

Sheets, balls, papillae, or scattered cells with well-defined borders and mucin vacuoles. Psammoma bodies can be seen in micropapillary.

45
Q

How is lung adenocarcinoma distinguished from mesothelioma?

A

Immunostaining (complex, later chapter)

Mesothelial cells are distinguished by slitlike “windows” separating cells.

46
Q

Describe the cytology of Large cell carcinoma.

A

Large, syncytial clusters with irregular nuclei, chromatin clearing and often prominent nucleoli.

47
Q

What are some variants of LCNEC?

A

Basaloid, lymphoepithelioma-like, clear cell, with rhabdoid phenotype, and large cell neuroendocrine.

48
Q

What are some subtypes of sarcomatoid carcinoma?

A 
Pleomorphic carcinoma
Spindle cell carcinoma
Giant cell carcinoma
Pulmonary blastoma
Carcinosarcoma
49
Q

Describe the cytology of pulmonary blastoma.

A

A spindle cell component (myxoid, chondroid, osteoid, or rhabdomyoblastic) and an epithelial component (“piano key”-like endometrioid morphology).

50
Q

How are carcinoid, atypical carcinoid, large cell and small cell carcinomas distinguished?

A

Morphology, mitotic rate, MIB-1.

51
Q

Describe the cytology of carcinoid tumor.

A

Loosely cohesive groups of uniform cells in rosette-like structures. Salt & pepper chromatin and no nucleoli.

52
Q

Describe the cytology of atypical carcinoid.

A

Loosely cohesive rosettes with occasional mitoses, some prominent nucleoli, even some necrosis.

53
Q

Describe the cytology of small cell carcinoma.

A

Small cells with scant cytoplasm, crush artifact, many mitoses and necrosis. Also look for paranuclear blue bodies.

54
Q

Describe the cytology of adenoid cystic carcinoma. What is the genetic abnormality?

A

Cylinders or spheres of innocuous epithelial cells surrounding basal lamina material. t(6;9) MYB-NFIB

55
Q

Describe the cytology of mucoepidermoid carcinoma. What is the genetic abnormality?

A

Squamous, intermediate, and mucinous cells. t(11;19) MECT1-MAML2

56
Q

Describe the cytology of clear cell “sugar” tumor. How does it stain?

A

Bland polygonal and spindle cells with glycogen-rich cytoplasm. Stains for melanocyte markers but not keratins (PEComa).

57
Q

Describe the cytology of sarcomas.

A

Sheet-like cellular aggregates of highly atypical cells. Beyond that depends on the sarcoma.

58
Q

What lymphomas are often seen in lung?

A

EMZL, DLBCL, lymphomatoid granulomatosis, PTCL. Primary CHL is uncommon.

59
Q

What metastases should be considered in lung?

A

Colon, melanoma, breast, renal, thyroid.

60
Q

What is the staining pattern of thymoma?

A

Epithelial cells stain for CK5 and p63.

Lymphocytes stain for CD99, CD3, TdT.

61
Q

Distinguish between type A and type B thymoma.

A

Type A thymoma are spindled or ovoid with Hassall corpuscles. Type B are predominantly round or polygonal with varying degrees of lymphocyte infiltration.

62
Q

Describe thymic carcinoma.

A

Obviously malignant cells that stain for CD5 and CD117. TTF-1 negative.

63
Q

What lymphomas are found in the mediastinum?

A

CHL
PMBL
T-LBL

64
Q

What germ cell tumors can be seen in the mediastinum?

A

Teratoma
Seminoma
Nonseminomatous germ cell tumors

65
Q

Describe the cytology of seminoma.

A

Hypercellular loose clusters of round cells with coarse chromatin with abundant vacuolated cytoplasm in a background of small mature lymphocytes. “Tigroid” background due to spilled cytoplasmic glycogen.

66
Q

What is NUT midline carcinoma?

A

A rare, aggressive subtype of SQC characterized by poor differentiation with focal squamous differentiation. Defined by NUT-BRD4 t(15;19) fusion and NUT IHC overexpression.

Rotation - Cytopathology (33 decks)

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