sft Lung Cytology Flashcards
Saccomanno Method
for sputum cytology; 50% ethanol, 2% carbowax, spun at slow rate to homogenize specimen, then smeared
BAL adequacy criterion
at least 1 pulmonary macrophage
What is this; what is it associated with?
Creola body (benign cells with cilia on edge); Asthma
Differential, more specific finding, etiology?
Pulmonary alveolar proteinosis (must rule out necrosis and Pneumocystis); in Pap stain, dense globules are more specific than granular debris; usually autoimmune.
Diagnosis? Buzz words? Risk factors?
PJP, alveolar casts of fluffy debris, crushed ping pong balls on GMS
Fungus type? Clues?
Uniform thickness, septations, acute angle branching
Fungus type? Clues?
Cryptococcus, plemorphic yeast forms, thick capsule highlighted by mucicarmine
Fungus type? Clues?
Zygomyces/Mucor; variable hyphal thickness, no septations, right angle branching
Organism?
Coccidioides; large spherule with endospores
Strongyloides stercoralis
Paragonimus westermani, thick shell with shouldered operculum
Name of CMV inclusion?
Cowdry type A body
Necrotizing granuloma (left) with giant cells (right), as in Mycobacterium tuberculosis infection.
Necrotic debris with filamentous Nocardia organisms
How do non-tuberculoid mycobacterial infections present?
MAC, usually present as aggregates of histiocytes filled with organisms
Differential? Name of the thing with the arrow.
Non-necrotizing granuloma, like in sarcoid. Arrow points to an asteroid body with a giant cell (common in sarcoid but not specific)
Asbestos/ferruginous bodies (stain + for iron)
Plant matter on left (refractile cell wall); skeletal muscle on right (aspirated meat)
Specific name of finding? Association?
Curschmann spiral; inpissated mucus seen in asthma patients
Finding?
Collagen balls, commonly seen in pleural effusions; Thin rim of streaming nuclei around periphery
Finding? Cause?
Cornflaking, caused by air trapping during coverslipping
Pollen, round, refractile borders, no internal structure
Alternaria . Air-borne contaminant fungi that have short yellow-brown conidiospores with transversely and longitudinally septate macroconidia (snow shoe-like/hand-grenade)
Starch granules
Diagnostic finding?
Lung adenocarcinoma, intracytoplasmic mucin
In lung, diagnosis?
Micropapillary carcinoma
In lung, dx?
SCC (keratinization in pap stain and diff quick, left and right, respectively)
Lung, dx? Features?
Small cell carcinoma, nuclei 2-3x background lymphs, salt and pepper chromatin, frequent mitoses, necrotic diathesis, molding/crush artifact, indistinct nucleoli
Lung, dx? How to differentiate from similar appearing cells?
Carcinoid tumor; plasmacytoid cells in rosettes with neuroendocrine nuclei; lack mitosis and necrotic background
When to consider mesothelioma on cytology?
Marked mesothelial nuclear atypia or clusters >15 cells.
Pleural effusion fluid, dx?
Benign papillary mesothelial proliferation with psammoma bodies.
What are the 3 patterns of mesothelioma?
epithelial, sarcomatoid, mixed/biphasic
IHC for mesothelial vs carcinoma
Ours is WT1, calretinin, MOC31, BEREP4; mesothelial also + for D240 and CK5/6, HMBE-1; carcinoma also + for mCEA, TTF1 if lung or thyroid
Pleural effusion, dx?
Mesothelioma (incredibly large clusters are almost always malignant)
Most common causes of malignant effusions?
Primary effusion lymphoma. IHC and associations?
HHV8 (often EBV coinfected); associated with Kaposi sarcoma and multicentric Castleman disease (+/- plasmablastic lymphoma)
