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Chapter 15 - Lung Pathology (Robbins and Cotran Pathologic Basis of...
Chapter 15 - Lung Pathology (Robbins and Cotran Pathologic Basis of Disease )
CELLULAR PATHOLOGY#2. BENIGN CONDITIONS OF THE RESPIRATORY TRACT
Recognition of benign conditions essential to to avoid false negative and false suspiciousreports.(1) Proliferative abnormalities, (2) Inflammatory processes (Bacterial and fungal: Squamousepithelial changes and Pulmonary changes; Viral diseases), (3) Cytological changes due totherapy.
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Proliferative Abnormalities
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Hyperplasia:Abnormal multiplication of the basal or germinative cells. The epithelium thickens toseveral layers, usually with a surface layer of ciliated columnar epithelium. The cells areuniform.Cytology: Cells from such an area may be present after (prolonged) bronchial intubation.Cells may show the following features:Clusters of small dark nuclei tightly packed with scanty basophilic cytoplasm. (Not sosuperimposed as adenocarcinoma)Size of about a leucocyte.Usually find an occasional columnar cell in the area.
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Bronchial Epithelial Hyperplasia:A columnar, triangular, or cubic shape;A palisade arrangement of the cells (cells are palisading);Eccentrically located nuclei,A distinct terminal plate or suggestion of such a plate (i.e. a dome-shaped end of the cell);
NB:
More or less well preserved cilia. Only remnants of cilia may be of great aid inidentifying the cell as benign – regardless of nuclear abnormality.The above findings may occur particularly in chronic bronchitis and bronchiectasis.Differential diagnosis:Oat cell carcinoma in which cells lie loosely.Broncheolo-alveolar carcinoma.Small histiocytes: Occasionally have scanty cytoplasm which may not be finely vacuolated.Usually one or more nuclei may show kidney shape.
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Squamous Metaplasia:Similar process to that of the endocervix.(Seehttp://www.scribd.com/doc/14693767/Basic-Concepts-in-Cytopathology)Columnar epithelium is replaced by squamous epithelium. Reflects chronic irritation of therespiratory mucosa and an attempt at defence.Epithelium may be replaced in small areas or extensive areas by metaplastic tissue whichmay be partially or wholly squamous. If often coexists with basal hyperplasia which may bea stepping stone between squamous metaplasia and carcinoma.Metaplasia is found in many chronic diseases of the lungs, e.g. bronchitis, abcess, chronicinterstitial pneumonia, tuberculosis, radiation and chemotherapy and bronchogenic
carcinoma.Cytology:Metaplastic cells are usually smaller than (normal) squamous epithelial cells; Larger than basal cells with more cytoplasm, which is usually eosinophilic and not as dense as cancer cells.There may be some columnar appearance. Size and shape are regular.Edges of a group may be flat with regular arrangement of nuclei. Nuclei may be large. Degenerative changes are frequent. Nucleoli may be present.Atypical metaplasia changes are very similar to such changes in the endocervix and similar diagnostic rules apply.1.Variation in size and shape is important.2.Cytoplasmic staining from being delicate in the non-atypical metaplasia becomesdenser and more eosinophilic with atypical metaplasia.3.Alteration in N/C ratio occurs but the amount of cytoplasm may be increased withincreasing degrees of atypia, which is opposite of pathology in the uterine cervix.4.Nuclei size and shape varies. Hyperchromasia; chromatin irregularity becomes moredisturbed as the atypia becomes more marked. Note: Both hyperplasia and metaplasia may result from a variety of irritant: fumes, smoke,trauma.
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Cytology of Inflammatory Processes
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Bacterial and Fungal: Note: There are normally polymorphs in sputum.Heavily purulent exudate will be found in all disorders associated with tissue breakdown,e.g. bronchitis, abscesses, TB, pneumonia from any cause, and cancer. There may be a proteinaceous debris on the smear in any of these conditions. There is usually a heavymixed bacterial flora.Upper respiratory tract infections may be associated with so-called PAP. cells: smallsquamous cells with abundant cytoplasm, regular nuclear margin, dark round or oval nuclei.Hyperchromasia may be quite alarming.Abnormal pulmonary macrophages may be present in many inflammatory conditions,including Lipoid pneumonia (inhalation of oily substances into lungs). (Cytoplasm containsdiscrete round vacuoles; stain strongly with Sudan's stain.)Heart failure cells: In conditions of pulmonary congestion due to heart failure, themacrophages may contain hemosiderin – a breakdown product of hemoglobin fromdegenerate red blood cells. It is dark brown and the macrophages have a granular appearance. Prussian blue stain for iron is diagnostic.In most cases specific diagnosis cannot be made on cytological specimens.Diagnosis of specific inflammatory reactions is possible though in a few conditions, e.g.:1.Tuberculosis : Lymphocytes may be very numerous. Occasionally sausage shapedepitheloid cells may be found, e.g. inside Langhans cells, in granuloma with caseousnecrosis.2.Asbestosis : Later discussed.3.Fungi :Candida albicans most frequent fungal infection.Blastomyces dermatiidis: may be mistaken for human cells. Single or budding spherical
cells, 8 – 15
µ
m in diameter. Thick refractile walls gives a double contoured appearance. No hyphae. Budding: single bud is characteristic. Bud remains in close position tomother cell, with flattening where the two cells contact. Cytoplasm varies and may seescattered brownish red granules. May be basophilic. Cells found associated with markedinflammatory reactivity. Multinucleated giant cells engulf the organism.Cryptococcus neoformans: Usually a secondary invader in the dehibilitated. Single budding is also a characteristic, but the daughter cell pinches off leaving attenuatedisthmus of attachment to the mother cell assuming a tear drop shape. NB: The cell is thick walled, 5 – 20
µ
m in diameter (very small). Buds may remainattached producing a short chain. Note: The organism must be seen inside histiocytes to be diagnostic. Inflammatoryreaction may be extremely slight.Pneumocystis carinii: A frequently fatal complication of some severe underlying disease;in patients undergoing corticosteroid or immunosuppressive therapy. Cyst forms aresmall round, disc shaped or crescentic. Silver stains reveal no internal structure. Thiscan be seen with Giemsa. PAP stain frothy and structureless.Alternaria species: Non-pathogenic. Golden-brown irregularly septated forms whichlook rather like seeds.Aspergillus spp.: Thick septate hyphae with 45
0
angle brush-like branching. The septatehyphae are strong morphological evidence of infection. Occasional spore heads resemblea brush.Aspergillomes of the lung may produce marked cellular atypia which may be mistakenfor cancer.Actinomyces: Caused by the anaerobic organism
Actinomyces israeli
is of world wideoccurrence. It is not classified as a fungi but as bacteria which display branching.Pulmonary actinomycosis may develop from a sub-diaphragmatic hepatic abscess, or byaspiration. Chronic abscesses develop and the organism in the lesion occur as colonieswhich are termed “grains”. These can be seen with the naked eye in the pus as grey or yellow “sulphur granules”. Microscopically these are delicate branching, interstisionedgram +ve filaments which may terminate in eosin-staining enlargement or clubs.
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Viral diseases:May affect any part of the body including respiratory tract and affected cells may be presentin washings from the sinuses.1. Viral pneumonia:Possible appearances of altered bronchial cells include:
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Loss of cytoplasmic borders – clusters.Loss of cilia and rounding of cells: Ciliocytophora (C.C.P.) is a term from Papanicolaou.Experimental work done by Cynthia Pierce (Proc. Soc. Experimental Biol. Med. 98, 489,1958). Indicates a mass destruction of ciliated cells. They break in half and one seesanucleated ciliated tufts and the nuclei with fragmented cytoplasm. The nucleus may showkaryorrhexis-like degeneration. Acidophilic (eosinophilic) cytoplasmic inclusion may be present. Occurrence: Inflammatory viral pneumoniaBronchogenic carcinoma – relative frequent association.
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Nuclear enlargement.
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Hyperchromasia.
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Nucleoli may be present.Differential diagnosis: Adenocarcinoma. NB: if ciliated cells are present with similar atypias
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Cell Pathology -- Lecture 2 - Benign Conditions of the Respiratory Tract
Academic Notes: Cytopathology Lecture 2 -- Benign Conditions of the Respiratory Tract.
Cape Peninsula University of Technology, ND, B.Tech.: Biomedical Technology
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this doc need a good revision
Some of the information presented in this document is not correct. The author was not keen to the correct medical terminology following some of the topics.