LUNG CYTOLOGY

LUNG CYTOLOGY
Wei Sun, M.D.
Wei Sun, M.D.
New York University
New York University
School of Medicine
School of Medicine
NYU
Medical
Center
Cytologic
Cytologic
Sampling Methods
Sampling Methods
Sputum:
Sputum:
from a spontaneous deep cough,
from a spontaneous deep cough,
obtained on arising in the morning when a
obtained on arising in the morning when a
change in position
change in position
Bronchial Brushings:
Bronchial Brushings:
using bronchoscope
using bronchoscope
Bronchial Washings:
Bronchial Washings:
using bronchoscope
using bronchoscope
Bronchoalveolar
Bronchoalveolar
Lavage
Lavage
(BAL):
(BAL):


Therapeutic: clear the alveolar space
Therapeutic: clear the alveolar space


Diagnostic:
Diagnostic:
Pneumocystis
Pneumocystis
carinii
carinii
,
,
bacteria, fungal, parasitic,
bacteria, fungal, parasitic,
bronchoalveolar
bronchoalveolar
carcinoma
carcinoma
FNA (CT guided and EBUS guided)
FNA (CT guided and EBUS guided)
Endobronchial
Endobronchial
Ultrasound
Ultrasound
(EBUS) guided FNA
(EBUS) guided FNA
I. Non
I. Non
-
-
Tumor Lung
Tumor Lung
Cytology
Cytology
Pulmonary alveoli (AE1/AE3), pneumocyte I & II
Pulmonary alveolar macrophages
Normal Bronchial cells
Normal Bronchial cells
May be
May be
hypercellular
hypercellular
Often elongated
Often elongated
Round nuclei
Round nuclei
Fine chromatin
Fine chromatin
Cilia
Cilia
•CK+
•TTF-1+
Benign bronchial cells
Nonspecific bronchial cell atypia: Reactive
Nonspecific bronchial cell atypia: Syncytia
Ciliocytophthoria
Pulmonary macrophages (dust cells)
“Heart failure”
cells
Charcot-Leyden crystals
Curschmann spiral
Ferruginous Bodies (Asbestos Bodies)
Vegetable (plant) cells
Creola bodies: Fragments of hyperplastic
reactive bronchial epithelium
Basal cell
hyperplasia
of bronchial
epithelium
Squamous metaplasia of bronchial epithelium
Hyperplasia of
type II pneumocytes
Atypical type II pneumocytes
Lipid pneumonia
Lipid pneumonia
Granulomatous Inflammation (Tuberculosis)
Actinomyces
Herpes simplex
CMV
Cryptococcus
Blastomycosis
Coccidiomycosis
Paracoccidiomycosis
Histoplasmosis
Candida
Aspergillus
Mucormycosis
Pneumocystis carinii
Q
Strongyloides stercoralis
Acute irradiation
effect on bronchial
Cells
Acute irradiation
effect on squamous
cells
II. Tumor Lung Cytology
II. Tumor Lung Cytology
Squamous
Squamous
Cell Carcinoma
Cell Carcinoma
Hypercellular
Hypercellular
Dyshesive
Dyshesive
Keratin Formation
Keratin Formation
Angulated nuclei
Angulated nuclei
Dark smudgy
Dark smudgy
chromatin
chromatin
• Mass on
CXR
• p63+
• TTF-1+/-
Squamous cell
carcinoma
Squamous cell carcinoma
Squamous cell
carcinoma
Squamous cell
carcinoma
Undifferentiated large cell
Undifferentiated large cell
Carcinoma
Carcinoma
Hypercellular
Hypercellular
Large groups
Large groups
Large cells
Large cells
Single cells
Single cells
• TTF-1+
• CK7+
• CEA+
• B72.3+
• BerEp4+
• MOC31+
Undifferentiated
large cell carcinoma
Small Cell Carcinoma
Small Cell Carcinoma
Salt and pepper
Salt and pepper
chromatin
chromatin
No or small nucleoli
No or small nucleoli
Molding
Molding
Mitoses
Mitoses
Necrosis
Necrosis
• CK+
• Chromogranin+
• NSE+/-
• Synaptophysin+/-
• TTF-1+
Small cell
carcinoma
Small cell
carcinoma
Adenocarcinoma
Adenocarcinoma
Hypercellular
Hypercellular
Often crowded with
Often crowded with
scant or vacuolated
scant or vacuolated
cytoplasm
cytoplasm
Pale chromatin
Pale chromatin
Nuclear irregularity
Nuclear irregularity
Prominent nucleoli
Prominent nucleoli
• TTF-1+
• CK7+
• CK20-
• CEA+
• B72.3+
• BerEp4+
• MOC31+
Adenocarcinoma
Adenocarcinoma
Bronchioloalveolar
Bronchioloalveolar
Carcinoma (BAC)
Carcinoma (BAC)
Cohesive group of
Cohesive group of
small tumor cells (1.5
small tumor cells (1.5
to 2.5 times of
to 2.5 times of
bronchial basal cell
bronchial basal cell
nuclei)
nuclei)
Less cytoplasm
Less cytoplasm
Uniform
Uniform
hyperchromatic
hyperchromatic
nuclei
nuclei
• TTF-1+
• CK7+
• CEA+
• B72.3+
• BerEp4+
• MOC31+
Bronchioloalveolar
carcinoma
(type I and II)
Bronchioloalveolar
Carcinoma, Type II
Type I
Giant cell Carcinoma
Giant cell Carcinoma
Pleomorphic
Pleomorphic
cells
cells
Giant cells
Giant cells
Spindle cells
Spindle cells
• CK+
• EMA+
• LCA-
• CD30-
• S-100-
• HMB45-
Giant Cell Carcinoma
Carcinoid
Carcinoid
Tumor
Tumor
Dyshesive
Dyshesive
Round cells
Round cells
Salt and pepper
Salt and pepper
chromatin
chromatin
No to rare mitosis
No to rare mitosis
No necrosis
No necrosis
No molding
No molding
• Chromogranin+
• NSE+
• Synaptophysin+
• CK+
• TTF-1+
Carcinoid
Tumor
Atypical
Atypical
Carcinoid
Carcinoid
Tumor
Tumor
Dyshesive
Dyshesive
Atypical nuclei
Atypical nuclei
Salt and pepper
Salt and pepper
chromatin
chromatin
Rare mitosis
Rare mitosis
No necrosis
No necrosis
No molding
No molding
• Chromogranin+
• NSE+
• Synaptophysin+
• CK+
• TTF-1+
Atypical Carcinoid
Granular cell tumor
Granular cell tumor
Dyshesive
Dyshesive
Large cells
Large cells
Granular
Granular
cytoplasm
cytoplasm
Round nuclei
Round nuclei


Naked
Naked


nuclei
nuclei
• CK+ (variable)
• S-100+
• CD68+
• HMB45-
Granular Cell
Tumor
Hamartoma
Hamartoma
Myxohyaline
Myxohyaline
material
material
Small blue cells
Small blue cells
Scant cytoplasm
Scant cytoplasm
No mitosis
No mitosis
No necrosis
No necrosis
No molding
No molding
• CK+
Hamartoma
Hamartoma
Metastatic Colon Carcinoma
Metastatic Breast
Carcinoma
Metastatic
Renal
Carcinoma
Metastatic Urothelial
Carcinoma
Metastatic
Melanoma
Treatment
Treatment
---
---
SCLC
SCLC
Pts with extensive
Pts with extensive
-
-
stage SCLC: Platinum
stage SCLC: Platinum
-
-
based chemotherapy, follow by PCI
based chemotherapy, follow by PCI
(prophylactic cranial irradiation)
(prophylactic cranial irradiation)
Relapsed or refractory SCLC: further
Relapsed or refractory SCLC: further
chemotherapy
chemotherapy
Pts with limited
Pts with limited
-
-
stage SCLC: Chemotherapy
stage SCLC: Chemotherapy
+ radiation
+ radiation
Pts with very limited
Pts with very limited
-
-
stage SCLC: surgical
stage SCLC: surgical
resection, follow by Chemotherapy
resection, follow by Chemotherapy
Pts with CR: PCI
Pts with CR: PCI
Treatment
Treatment
---
---
NSCLC
NSCLC
Pt with EGFR mutation: medial
Pt with EGFR mutation: medial
survial
survial
time
time
31 months, others 7 months
31 months, others 7 months
EGFR and KRAS mutation tend to mutually
EGFR and KRAS mutation tend to mutually
exclusive
exclusive
Limit staged NSCLC: surgical resection +
Limit staged NSCLC: surgical resection +
chemotherapy
chemotherapy
Advanced NSCLC : initial treat with
Advanced NSCLC : initial treat with
chemotherapy, follow by radiation
chemotherapy, follow by radiation
EGFR mutations are present frequently in
EGFR mutations are present frequently in
BACs
BACs
, treat with
, treat with
Tarceva
Tarceva

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