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Lung and Respiratory Tract Cytology

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Practical Cytopathology

Part of the book series: Practical Anatomic Pathology ((PAP))

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Abstract

Lung and respiratory tract cytology evaluates specimens including sputum, bronchial washings, bronchial brushings, bronchoalveolar lavage, and transbronchial or transthoracic fine-needle aspirations, to diagnose non-neoplastic processes and neoplastic lesions of the lung. This chapter discusses commonly encountered questions in lung cytology practice and encompasses the whole spectrum of morphologic findings from normal elements, reactive conditions, infectious lesions, and neoplasms. Common differential diagnoses, immunohistochemical staining utilization, and diagnostic pitfalls are emphasized. The updated knowledge on molecular testing in lung cancer is reviewed. Five illustrative cases are presented with take-home messages from each case.

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References

  1. Cameron SE, Andrade RS, Pambuccian SE. Endobronchial ultrasound-guided transbronchial needle aspiration cytology: a state of the art review. Cytopathology. 2010;21:6–26.

    Article  CAS  Google Scholar 

  2. Medford AR, Bennett JA, Free CM, Agrawal S. Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy. Curr Opin Pulm Med. 2009;15:334–42.

    Article  Google Scholar 

  3. Heron M, Grutters JC, ten Dam-Molenkamp KM, Hijdra D, van Heugten-Roeling A, Claessen AM, et al. Bronchoalveolar lavage cell pattern from healthy human lung. Clin Exp Immunol. 2012;167:523–31.

    Article  CAS  Google Scholar 

  4. Pirozynski M. Bronchoalveolar lavage in the diagnosis of peripheral, primary lung cancer. Chest. 1992;102:372–4.

    Article  CAS  Google Scholar 

  5. Semenzato G, Poletti V. Bronchoalveolar lavage in lung cancer. Respiration. 1992;9(suppl 1):44–6.

    Article  Google Scholar 

  6. Baughman RP, Dohn MN, Frame PT. The continuing utility of bronchoalveolar lavage to diagnose opportunistic infection in AIDS patients. Am J Med. 1994;97:515–22.

    Article  CAS  Google Scholar 

  7. Witt BL, Wallander ML, Layfield LJ, Hirschowitz S. Respiratory cytology in the era of molecular diagnostics: a review. Diagn Cytopathol. 2012;40:556–63.

    Article  Google Scholar 

  8. Pierce CH, Knox AW. Ciliocytophthoria in sputum from patients with adenovirus infections. Proc Soc Exp Biol Med. 1960;104:492–5.

    Article  CAS  Google Scholar 

  9. Trapnell BC, Whitsett JA, Nakata K. Pulmonary alveolar proteinosis. N Engl J Med. 2003;349:2527–39.

    Article  CAS  Google Scholar 

  10. Meza R, Meernik C, Jeon J, Cote ML. Lung cancer incidence trends by gender, race, and histology in the United States, 1973–2010. PLoS One. 2015;10:e0121323.

    Article  Google Scholar 

  11. Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. World Health Organization classification of tumours of the lung, pleura, thymus and heart. Lyon, France: IARC Press; 2015.

    Google Scholar 

  12. Couraud S, Zalcman G, Milleron B, Morin F, Souquet PJ. Lung cancer in never smokers-a review. Eur J Cancer. 2012;48:1299–311.

    Article  CAS  Google Scholar 

  13. Shigematsu H, Lin L, Takahashi T, Nomura M, Suzuki M, Wistuba II, et al. Clinical and biological features associated with epidermal growth factor receptor gene mutations in lung cancers. J Natl Cancer Inst. 2005;97:339–46.

    Article  CAS  Google Scholar 

  14. Pao W, Miller V, Zakowski M, Doherty J, Politi K, Sarkaria I, et al. EGF receptor gene mutations are common in lung cancers from “never smokers” and are associated with sensitivity of tumors to gefitinib and erlotinib. Proc Natl Acad Sci USA. 2004;101:13306–11.

    Article  CAS  Google Scholar 

  15. Soda M, Choi YL, Enomoto M, Takada S, Yamashita Y, Ishikawa S, et al. Identification of the transforming EML4-ALK fusion gene in non-small-cell lung cancer. Nature. 2007;448:561–6.

    Article  CAS  Google Scholar 

  16. Rikova K, Guo A, Zeng Q, Possemato A, Yu J, Haack H, et al. Global survey of phosphotyrosine signaling identifies oncogenic kinases in lung cancer. Cell. 2007;131:1190–203.

    Article  CAS  Google Scholar 

  17. Pao W, Wang TY, Riely GJ, Miller VA, Pan Q, Ladanyi M, et al. KRAS mutations and primary resistance of lung adenocarcinomas to gefitinib or erlotinib. PLoS Med. 2005;2:e17.

    Article  Google Scholar 

  18. Jayaram G, Yaccob R, Liam CK. Mucinous carcinoma (colloid carcinoma) of the lung diagnosed by fine needle aspiration cytology: a case report. Malays J Pathol. 2003;25:63–8.

    PubMed  Google Scholar 

  19. Park SK, Cho LY, Yang JJ, Park B, Chang SH, Lee KS, et al. Lung cancer risk and cigarette smoking, lung tuberculosis according to histologic type and gender in a population based case-control study. Lung Cancer. 2010;68:20–6.

    Article  Google Scholar 

  20. Martinez VD, Buys TP, Adonis M, Benítez H, Gallegos I, Lam S, et al. Arsenic-related DNA copy-number alterations in lung squamous cell carcinomas. Br J Cancer. 2010;103:1277–83.

    Article  CAS  Google Scholar 

  21. Srinivasan M, Taioli E, Ragin CC. Human papillomavirus type 16 and 18 in primary lung cancers – a meta-analysis. Carcinogenesis. 2009;30:1722–8.

    Article  CAS  Google Scholar 

  22. French CA. Respiratory tract and mediastinum. In: Cibas ES, Ducatman BS, editors. Cytology-diagnostic principles and clinical correlates. 4th ed. Philadelphia: Saunders; 2014. p. 59–104.

    Google Scholar 

  23. Lawrence B, Perez-Atayde A, Hibbard MK, Rubin BP, Dal Cin P, Pinkus JL, et al. TPM3-ALK and TPM4-ALK oncogenes in inflammatory myofibroblastic tumors. Am J Pathol. 2000;157:377–84.

    Article  CAS  Google Scholar 

  24. Habermann TM, Ryu JH, Inwards DJ, Kurtin PJ. Primary pulmonary lymphoma. Semin Oncol. 1999;26:307–15.

    CAS  PubMed  Google Scholar 

  25. Myers JL, Kurtin PJ, Katzenstein AL, Tazelaar HD, Colby TV, Strickler JG, et al. Lymphomatoid granulomatosis. Evidence of immunophenotypic diversity and relationship to Epstein-Barr virus infection. Am J Surg Pathol. 1995;19:1300–12.

    Article  CAS  Google Scholar 

  26. Zaman MB, Hajdu SI, Melamed MR, Watson RC. Transthoracic aspiration cytology of pulmonary lesions. Semin Diagn Pathol. 1986;3:176–87.

    CAS  PubMed  Google Scholar 

  27. Lin O, Olgac S, Green I, Zakowski MF, Klimstra DS. Immunohistochemical staining of cytologic smears with MIB-1 helps distinguish low-grade from high-grade neuroendocrine neoplasms. Am J Clin Pathol. 2003;120:209–16.

    Article  Google Scholar 

  28. Stoll LM, Johnson MW, Burroughs F, Li QK. Cytologic diagnosis and differential diagnosis of lung carcinoid tumors a retrospective study of 63 cases with histologic correlation. Cancer Cytopathol. 2010;118:457–67.

    Article  Google Scholar 

  29. da Cunha Santos G, Saieg MA, Geddie W, Leighl N. EGFR gene status in cytological samples of nonsmall cell lung carcinoma: controversies and opportunities. Cancer Cytopathol. 2011;119:80–91.

    Article  Google Scholar 

  30. Sigel CS, Moreira AL, Travis WD, Zakowski MF, Thornton RH, Riely GJ, et al. Subtyping of non-small cell lung carcinoma: a comparison of small biopsy and cytology specimens. J Thorac Oncol. 2011;6:1849–56.

    Article  Google Scholar 

  31. Rekhtman N, Brandt SM, Sigel CS, Friedlander MA, Riely GJ, Travis WD, et al. Suitability of thoracic cytology for new therapeutic paradigms in non-small cell lung carcinoma: high accuracy of tumor subtyping and feasibility of EGFR and KRAS molecular testing. J Thorac Oncol. 2011;6:451–8.

    Article  Google Scholar 

  32. Zakowski MF. Lung cancer in the era of targeted therapy: a cytologist’s perspective. Arch Pathol Lab Med. 2013;137:1816–21.

    Article  Google Scholar 

  33. Hagiwara K, Kobayashi K. Importance of the cytological samples for the epidermal growth factor receptor gene mutation test for non-small cell lung cancer. Cancer Sci. 2013;104:291–7.

    Article  CAS  Google Scholar 

  34. Hartmann B, Koss M, Hui A, Baumann W, Athos L, Boylen T. Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome (AIDS): diagnosis with bronchial brushings, biopsy, and bronchoalveolar lavage. Chest. 1985;87:603–7.

    Article  Google Scholar 

  35. Naryshkin S, Daniels J, Freno E, Cunningham L. Cytology of treated and minimal Pneumocystis carinii pneumonia and a pitfall of the Grocott methenamine silver stain. Diagn Cytopathol. 1991;7:41–7.

    Article  CAS  Google Scholar 

  36. Delgado P, Merce J, Ganjei-Azhar P. Small cell carcinoma versus other lung malignancies-diagnosis by fine needle aspiration cytology. Cancer Cytopathol. 2000;90:279–85.

    Article  CAS  Google Scholar 

  37. Ahmed T, Vial MR, Ost D, Stewart J, Hasan MA, Grosu HB. Non-small cell lung cancer transdifferentiation into small cell lung cancer: a case series. Lung Cancer. 2018;122:220–3.

    Article  Google Scholar 

  38. Murali R, Thompson JF, Uren RF, Scolver RA. Fine-needle biopsy of metastatic melanoma: clinical use and new applications. Lancet Oncol. 2010;11:391–400.

    Article  Google Scholar 

  39. Lowenthal BM, Mahooti S. EBUS-FNA of a station seven lymph node: an unusual presentation of a young nonsmoker male with hemoptysis and subcarinal lymphadenopathy. Diagn Cytopathol. 2015;43:238–42.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, University of Kansas Hospital, Kansas City, KS, USA

    Katie Dennis

  2. Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA

    Fang Fan

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  1. Katie Dennis
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  2. Fang Fan
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Correspondence to Fang Fan .

Editor information

Editors and Affiliations

  1. VA Boston Healthcare System, Boston, MA, USA

    Huihong Xu

  2. Brigham and Women’s Hospital, Boston, MA, USA

    Xiaohua Qian

  3. Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

    He Wang

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Dennis, K., Fan, F. (2020). Lung and Respiratory Tract Cytology. In: Xu, H., Qian, X., Wang, H. (eds) Practical Cytopathology . Practical Anatomic Pathology. Springer, Cham. https://doi.org/10.1007/978-3-030-24059-2_7

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  • DOI: https://doi.org/10.1007/978-3-030-24059-2_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24058-5

  • Online ISBN: 978-3-030-24059-2

  • eBook Packages: MedicineMedicine (R0)

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