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Dail and Hammar’s Pulmonary Pathology pp 767–795Cite as

Cytopathology of Pulmonary Neoplasia

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Abstract

Cytopathologic techniques have the potential to provide useful diagnostic information from specimens obtained through minimally invasive procedures including expectorated sputum, washings, lavages, brushings, and aspiration procedures. These procedures provide access to almost any site within the thorax. Given optimal conditions, many neoplasms can be diagnosed by cytology procedures. However, it is important to understand the strengths and limitations of cytopathologic evaluation. While pulmonary neoplastic classification is relatively stable, recent histopathologic, immunohistochemical, and molecular studies underscore the complexity of neoplasms. Cytologic sampling may be representative of the entire tumor or may represent the “tip of the iceberg.” An understanding of biologic complexity of pulmonary neoplasms helps to avoid overdiagnosing an entity. To provide an ideal cytopathologic diagnosis and report that accurately reflect the entire process, the pathologist should take a number of steps.

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References

  1. Travis WD, Brambilla E, Müller-Hermelink HK, Harris CC. Tumours of the lung, pleura, thymus, and heart. Lyon: IARC Press, 2004.

    Google Scholar 

  2. Johnston WW, Frable WJ. The cytopathology of respiratory tract: a review. Am J Pathol 1976;84:372–414.

    CAS  PubMed  Google Scholar 

  3. Sproul EE, Huvos A, Brisch C. A two-year follow up study of 261 patients examined by use of superheated aerosol induced sputum. Acta Cytol 1962;6:409–412.

    CAS  PubMed  Google Scholar 

  4. Koss LG, Melamed MR, Goodner JT. Pulmonary cytology: a brief survey of diagnostic results from July 1st, 1952 until December 31st, 1960. Acta Cytol 1964;8:104–113.

    CAS  PubMed  Google Scholar 

  5. Boecking A, Biesterfeld S, Chatelain R, Gien-Gerlach G, Esser E. Diagnosis of bronchial carcinoma on secretions of paraffin-embedded sputum. Sensitivity and specificity of an alteration to routine cytology. Acta Cytol 1992;36–47.

    Google Scholar 

  6. Greenstreet P, Purslow MJ, Kini SR. Respiratory specimen types for cytologic diagnoses, specimen procurement, collection methods, specimen submission, cytopreparation, and staining. In: Kini SR. Color atlas of pulmonary cytopathology. New York: Springer-Verlag, 2002:6–26.

    Google Scholar 

  7. Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Guidelines of the Papanicolaou Society of Cytopathology for the examination of cytologic specimens obtained from the respiratory tract. Diagn Cytopathol 1999;21:61–69.

    Article  Google Scholar 

  8. Rankin JA, Naegel GP, Reynolds HY. Use of a central laboratory for analysis of bronchoalveolar lavage fluid. Am Rev Respir Dis 1986;133:186–190.

    CAS  PubMed  Google Scholar 

  9. Chamberlain DW, Braude AC, Rebuck AS. A critical evaluation of bronchoalveolar lavage: criteria for identifying unsatisfactory specimens. Acta Cytol 1987;31:599–605.

    CAS  PubMed  Google Scholar 

  10. Taskinen EI, Tukiainen PS, Alitalo RL, Turunen J-P. Bronchoalveolar lavage: cytological techniques and interpretation of the cellular profiles. Pathol Annu 1994;29(pt 2):121–155.

    PubMed  Google Scholar 

  11. Robinson-Smith TM, Saad A, Baughman RP. Interpretation of the Wright-Giemsa stained bronchoalveolar lavage specimen. Lab Med 2004;35:553–557.

    Article  Google Scholar 

  12. Bedrossian CW. Diagnostic problems in serous effusions. Diagn Cytopathol 1998;19:131–137.

    Article  CAS  PubMed  Google Scholar 

  13. Bottles K, Reznicek MJ, Holly EA, et al. Cytologic criteria to diagnose adenocarcinoma in pleural effusions. Mod Pathol 1991;4:677–681.

    CAS  PubMed  Google Scholar 

  14. Yatabe Y, Mitsudomi T, Takahashi T. TTF-1 expression in pulmonary adenocarcinomas. Am J Surg Pathol 2002;26:767–773.

    Article  PubMed  Google Scholar 

  15. Shah RN, Badve S, Papreddy D, Schindler S, Laskin WB, Yeldandi AV. Expression of cytokeratin 20 in mucinous bronchioloalveolar carcinoma. Hum Pathol 2002;33:915–920.

    Article  CAS  PubMed  Google Scholar 

  16. Schreiber G, McCrory DC. Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence. Chest 2003;123:115S–128S.

    Article  PubMed  Google Scholar 

  17. Baba M, Iyoda A, Yasufuku K, et al. Preoperative cytodiagnosis of very small-sized peripheral-type primary lung cancer. Lung Cancer 2002;37:277–280.

    Article  PubMed  Google Scholar 

  18. Lachman MF, Schofield K, Cellura K. Bronchoscopic diagnosis of malignancy in the lower airway. A cytologic review. Acta Cytol 1995;39:1148–1151.

    CAS  PubMed  Google Scholar 

  19. Barbazza R, Toniolo L, Pinarello A, et al. Accuracy of bronchial aspiration cytology in typing operable (stage I–II) pulmonary carcinomas. Diagn Cytopathol 1992;8:3–7.

    Article  CAS  PubMed  Google Scholar 

  20. Dahlstrom JE, Langdale-Smith GM, James DT. Fine needle aspiration cytology of pulmonary lesions: a reliable test. Pathology 2001;33:13–16.

    Article  CAS  PubMed  Google Scholar 

  21. Roger V, Nasiell M, Linden M, Enstad I. Cytologic differential diagnosis of bronchiolo-alveolar carcinoma and bronchogenic adenocarcinoma. Acta Cytol 1976;20:303–307.

    CAS  PubMed  Google Scholar 

  22. Silverman JF, Finley JL, Park HK, Strausbauch P, Unverferth M, Carney M. Fine needle aspiration cytology of bronchioloalveolar-cell carcinoma of the lung. Acta Cytol 1985;29:887–894.

    CAS  PubMed  Google Scholar 

  23. Tao LC, Weisbrod GL, Pearson FG, Sanders DE, Donat EE, Filipetto L. Cytologic diagnosis of bronchioloalveolar carcinoma by fine-needle aspiration biopsy. Cancer 1986;57:1565–1570.

    Article  CAS  PubMed  Google Scholar 

  24. Lozowski W, Hajdu SI. Cytology and immunocytochemistry of bronchioloalveolar carcinoma. Acta Cytol 1987;31:717–725.

    CAS  PubMed  Google Scholar 

  25. Auger M, Katz RL, Johnston DA. Differentiating cytological features of bronchioloalveolar carcinoma from adenocarcinoma of the lung in fine-needle aspirations: a statistical analysis of 27 cases. Diagn Cytopathol 1997;16:253–257.

    Article  CAS  PubMed  Google Scholar 

  26. Zaman SS, van Hoeven KH, Slott S, Gupta PK. Distinction between bronchioloalveolar carcinoma and hyperplastic pulmonary proliferations: a cytologic and morphometric analysis. Diagn Cytopathol 1997;16:396–401.

    Article  CAS  PubMed  Google Scholar 

  27. MacDonald LL, Yazdi HM. Fine-needle aspiration biopsy of bronchioloalveolar carcinoma. Cancer 2001;93:29–34.

    Article  CAS  PubMed  Google Scholar 

  28. Ohori NP, Santa Maria. Cytopathologic diagnosis of bronchioloalveolar carcinoma. Does it correlate with the 1999 World Health Organization definition? Am J Clin Pathol 2004;122:44–50.

    Article  PubMed  Google Scholar 

  29. Hoshi R, Tsuzuku M, Horai T, et al. Micropapillary clusters in early-stage lung adenocarcinomas. A distinct cytologic sign of significantly poor prognosis. Cancer Cytopathol 2004;102:81–86.

    Google Scholar 

  30. Zhang H, Liu J, Cagle PT, et al. Distinction of pulmonary small cell carcinoma from poorly differentiated squamous cell carcinoma: an immunohistochemical approach. Mod Pathol 2005;18:111–118.

    Article  CAS  PubMed  Google Scholar 

  31. Edwards SL, Robert C, McKean ME, et al. Preoperative histological classification of primary lung cancer: accuracy of diagnosis and use of the non-small cell category. J Clin Pathol 2000;53:537–540.

    Article  CAS  PubMed  Google Scholar 

  32. Evans DM, Shelley G. Respiratory cytodiagnosis: study in observer variation and its relation to quality of material. Thorax 1982;37:259–263.

    Article  CAS  PubMed  Google Scholar 

  33. Dugan JM. Cytologic diagnosis of basal cell (basaloid) carcinoma of the lung. A report of two cases. Acta Cytol 1995;39:539–542.

    CAS  PubMed  Google Scholar 

  34. Chow LT, Chow WH, Tsui WM, et al. Fine needle aspiration cytologic diagnosis of lymphoepithelioma-like carcinoma of the lung. Report of two cases with immunohistochemical study. Am J Clin Pathol 1995;103:35–40.

    CAS  PubMed  Google Scholar 

  35. Hummel P, Cangiarella JF, Cohen J-M, et al. Transthoracic fine-needle aspiration biopsy of pulmonary spindle cell and mesenchymal lesions. A study of 61 cases. Cancer Cytopathol 2001;93:187–198.

    CAS  Google Scholar 

  36. Roggli VL, Vollmer RT, Greenberg SD, et al. Lung cancer heterogeneity: a blinded and randomized study of 100 consecutive cases. Hum Pathol 1985;16:569–579.

    Article  CAS  PubMed  Google Scholar 

  37. Caya JG, Wollenberg NJ, Clowry LJ, Tieu TM. The diagnosis of pulmonary small-cell anaplastic carcinoma by cytologic means: a 13-year experience. Diagn Cytopathol 1988;4:202–205.

    Article  CAS  PubMed  Google Scholar 

  38. Delgado PI, Jorda M, Ganjar-Azar P. Small cell carcinoma versus other lung malignancies: diagnosis by fine-needle aspiration cytology. Cancer Cytopathol 2000;90:279–285.

    CAS  Google Scholar 

  39. Sturgis CD, Nassar DL, D’Antonio JA, Raab SS. Cytologic features useful for distinguishing small cell from non-small cell carcinoma in bronchial brush and wash specimens. Am J Clin Pathol 2000;114:197–202.

    Article  CAS  PubMed  Google Scholar 

  40. Bavikatty NR, Michael CW. Cytologic features of smallcell carcinoma on ThinPrep. Diagn Cytopathol 2003;29:8–12.

    Article  PubMed  Google Scholar 

  41. Arora VK, Singh N, Chaturvedi S, Bhatia A. Significance of cytologic criteria in distinguishing small cell from non-small cell carcinoma of lung. Acta Cytol 2003;47:216–220.

    PubMed  Google Scholar 

  42. Zaharopoulos P, Wong JY, Stewart GD. Cytomorphology of the variants of small-cell carcinoma of the lung. Acta Cytol 1982;26:800–808.

    CAS  PubMed  Google Scholar 

  43. Szyfelbein WM, Ross JS. Carcinoids, atypical carcinoids, and small-cell carcinoma of the lung: differential diagnosis of fine-needle aspiration biopsy specimens. Diagn Cytopathol 1988;4:1–8.

    Article  CAS  PubMed  Google Scholar 

  44. Lin O, Olgac S, Green I, et al. Immunohistochemical staining of cytologic smears with MIB-1 helps distinguish lowgrade from high-grade neuroendocrine neoplasms. Am J Clin Pathol 2003;120:209–216.

    Article  PubMed  Google Scholar 

  45. Salhadin A, Nasiell M, Nasiell K, et al. The unique cytologic picture of oat cell carcinoma in effusions. Acta Cytol 1976;20:298–302.

    CAS  PubMed  Google Scholar 

  46. Chhieng DC, Ko EC, Yee HT, et al. Malignant pleural effusions due to small-cell lung carcinoma: a cytologic and immunohistochemical study. Diagn Cytopathol 2001;25:356–360.

    Article  CAS  PubMed  Google Scholar 

  47. Pilotti S, Rilke F, Lombardi L. Pulmonary carcinoid with glandular features. Report of two cases with positive fine needle aspiration biopsy cytology. Acta Cytol 1983;27:511–514.

    CAS  PubMed  Google Scholar 

  48. Evans H, Blaney R. Pulmonary carcinoid with papillary structure: report of a case with fine-needle aspiration cytology. Diagn Cytopathol 1994;11:178–181.

    Article  CAS  PubMed  Google Scholar 

  49. Wiatrowska BA, Krol J, Zakowski MF. Large-cell neuroendocrine carcinoma of the lung: proposed criteria for cytologic diagnosis. Diagn Cytopathol 2001;24:58–64.

    Article  CAS  PubMed  Google Scholar 

  50. Nguyen GK. Cytopathology of pulmonary carcinoid tumor in sputum and bronchial brushing. Acta Cytol 1995;39:1152–1160.

    CAS  PubMed  Google Scholar 

  51. Aron M, Kapila K, Verma K. Carcinoid tumors of the lung: a diagnostic challenge in bronchial washings. Diagn Cytopathol 2004;30:62–66.

    Article  PubMed  Google Scholar 

  52. Kakinuma H, Mikami T, Iwabuchi K, et al. Diagnostic findings of bronchial brush cytology for pulmonary large cell neuroendocrine carcinomas: comparison with poorly differentiated adenocarcinomas, squamous cell carcinomas, and small cell carcinomas. Cancer Cytopathol 2003;99:247–254.

    Google Scholar 

  53. Yang YJ, Steele CT, Ou XL, et al. Diagnosis of high-grade pulmonary neuroendocrine carcinoma by fine-needle aspiration biopsy: nonsmall-cell or small-cell type? Diagn Cytopathol 2001;25:292–300.

    Article  CAS  PubMed  Google Scholar 

  54. Nicholson SA, Ryan MR. A review of cytologic findings in neuroendocrine carcinomas including carcinoid tumors with histologic correlation. Cancer Cytopathol 2000;90:148–161.

    CAS  Google Scholar 

  55. Ordonez NG. The immunohistochemical diagnosis of mesothelioma: a comparative study of epithelioid mesothelioma and lung adenocarcinoma. Am J Surg Pathol 2003;27:1031–1051.

    Article  PubMed  Google Scholar 

  56. Illei PB, Ladanyi M, Rusch VW, Zakowski MF. The use of CDKN2A deletion as a diagnostic marker for malignant mesothelioma in body cavity effusions. Cancer Cytopathol 2003;99:51–56.

    CAS  Google Scholar 

  57. Shin HJ, Shin DM, Tarco E, Sneige N. Detection of numerical aberrations of chromosome 7 and 9 in cytologic specimens of pleural malignant mesothelioma. Cancer Cytopathol 2003;99:233–239.

    Google Scholar 

  58. Costa MBG, Siqueira SA, Saldiva PH, et al. Histologic patterns of lung infiltration of B-cell, T-cell, and Hodgkin lymphomas. Am J Clin Pathol 2004;121:718–726.

    Article  PubMed  Google Scholar 

  59. Crapanzano JP, Lin O. Cytologic findings of marginal zone lymphoma. Cancer Cytopathol 2003;99:301–309.

    Google Scholar 

  60. Orucevic A, Reddy VB, Selvaggi SM, et al. Fine-needle aspiration of extranodal and extramedullary hematopoietic malignancies. Diagn Cytopathol 2000;23:318–321.

    Article  CAS  PubMed  Google Scholar 

  61. Wakely PE, Menezes G, Nuovo GJ. Primary effusion lymphoma: cytopathologic diagnosis using in situ molecular genetic analysis for human herpesvirus 8. Mod Pathol 2002;15:944–950.

    Article  PubMed  Google Scholar 

  62. Dusenbery D, Nalesnik MA, Locker J, Swerdlow SH. Cytologic features of post-transplant lymphoproliferative disorder. Diagn Cytopathol 1997;16:489–496.

    Article  CAS  PubMed  Google Scholar 

  63. Ohori NP, Whisnant RE, Nalesnik MA, Swerdlow SH. Primary pleural effusion posttransplant lymphoproliferative disorder: distinction from secondary involvement and effusion lymphoma. Diagn Cytopathol 2001;25:50–53.

    Article  CAS  PubMed  Google Scholar 

  64. Cordes BG, Collins BT, McDonald JW, et al. Fine needle aspiration biopsy of primary leiomyosarcoma arising from pulmonary vein. Acta Cytol 1999;43:523–526.

    CAS  PubMed  Google Scholar 

  65. Lazure T, Essamet W, Palazzo L, et al. Cytological findings of a primary mediastino-pulmonary leiomyosarcoma. Report of a case diagnosed by endoscopic ultrasonographyguided fine needle aspiration. Cytopathology 2001;12:410–413.

    Article  CAS  PubMed  Google Scholar 

  66. Yamaguchi T, Imamura Y, Nakayama K, et al. Primary pulmonary leiomyosarcoma. Report of a case diagnosed by fine needle aspiration cytology. Acta Cytol 2002;46:912–916.

    PubMed  Google Scholar 

  67. Gray J, Ngyugen G. Primary pulmonary Rhabdomyosarcoma diagnosed by fine-needle aspiration cytology. Diagn Cytopathol 2003;29:181–182.

    Article  PubMed  Google Scholar 

  68. Hummel P, Yang GCH, Kumar A, et al. PNET-like features of synovial sarcoma of the lung: a pitfall in the cytologic diagnosis of soft-tissue tumors. Diagn Cytopathol 2001;24:283–288.

    Article  CAS  PubMed  Google Scholar 

  69. Hsiu JG, Kreuger JK, D’Amato NA, Morris JR. Primary malignant fibrous histiocytoma of the lung. Fine needle aspiration cytologic features. Acta Cytol 1987;31:345–350.

    CAS  PubMed  Google Scholar 

  70. Hummel P, Cangiarella JF, Cohen J. Transthoracic fineneedle aspiration biopsy of pulmonary spindle cell and mesenchymal lesions. Cancer Cytopathol 2001;93:187–188.

    CAS  Google Scholar 

  71. Ryan MR, Stasny JF, Wakely PE. The cytopathology of synovial sarcoma. A study of six cases, with emphasis on architecture and histopathologic correlation. Cancer Cytopathol 1998;84:42–49.

    CAS  Google Scholar 

  72. Slagel DD, Raab SS, Silverman JF. Fine needle biopsy of metastatic malignant melanoma with “rhabdoid” features. Frequency, cytologic features, pitfalls, and ancillary studies. Acta Cytol 1997;41:1426–1430.

    CAS  PubMed  Google Scholar 

  73. Tao LC, Robertson DI. Cytologic diagnosis of bronchial mucoepidermoid carcinoma by fine needle aspiration. Acta Cytol 1978;22:221–224.

    CAS  PubMed  Google Scholar 

  74. Brooks B, Baandrup U. Peripheral low-grade mucoepidermoid carcinoma of the lung. Fine needle aspiration cytologic diagnosis and histology. Cytopathology 1992;3:259–265.

    Article  CAS  PubMed  Google Scholar 

  75. Segletes LA, Steffee CH, Geisinger KR. Cytology of primary pulmonary mucoepidermoid and adenoid cystic carcinoma. A report of four cases. Acta Cytol 1999;43:1091–1097.

    CAS  PubMed  Google Scholar 

  76. Anderson RJ, Johnston WW, Szpak CA. Fine needle aspiration of adenoid cystic carcinoma metastatic to the lung. Cytologic features and differential diagnosis. Acta Cytol 1985;29:527–532.

    CAS  PubMed  Google Scholar 

  77. Smith RC, Amy RW. Adenoid cystic carcinoma metastatic to the lung: report of a case diagnosed by fine needle aspiration biopsy. Acta Cytol 1985;29:533–534.

    CAS  PubMed  Google Scholar 

  78. Radhika S, Dey P, Rajwanshi A, et al. Adenoid cystic carcinoma in a bronchial washing: a case report. Acta Cytol 1993;37:97–99.

    CAS  PubMed  Google Scholar 

  79. Risse EK, Vooijs GP, van’t Hof MA. Diagnostic significance of “severe dysplasia” in sputum cytology. Acta Cytol 1988;32:629–634.

    CAS  PubMed  Google Scholar 

  80. Pelosi G, Pasini F, Olsen Stenholm C, et al. p63 immunoreactivity in lung cancer: yet another player in the development of squamous cell carcinoma? J Pathol 2002;198:100–109.

    Article  CAS  PubMed  Google Scholar 

  81. Dunbar F, Leiman G. The aspiration cytology of pulmonary hamartomas. Diagn Cytopathol 1989;5:174–180.

    Article  CAS  PubMed  Google Scholar 

  82. Hughes JH, Young NA, Wilbur DC, et al. Fine-needle aspiration of pulmonary hamartoma. A common source of false-positive diagnoses in the College of American Pathologists interlaboratory comparison program in nongynecologic cytology. Arch Pathol Lab Med 2005;129:19–22.

    PubMed  Google Scholar 

  83. Chow LT, Chan SK, Chow WH, Tsui MS. Pulmonary sclerosing hemangioma. Report of a case with diagnosis by fine needle aspiration. Acta Cytol 1992;36:287–292.

    CAS  PubMed  Google Scholar 

  84. Gal AA, Nassar VH, Miller JI. Cytopathologic diagnosis of pulmonary sclerosing hemangioma. Diagn Cytopathol 2002;26:163–166.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology, University of Pittsburgh Medical Center—Presbyterian, Pittsburgh, PA, 15213, USA

    N. Paul Ohori MD (Medical Director of Cytopathology) & Elise R. Hoff MD

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  1. N. Paul Ohori MD
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  2. Elise R. Hoff MD
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Editors and Affiliations

  1. Department of Pathology, Case Western Reserve University School of Medicine, USA

    Joseph F. Tomashefski Jr. MD (Professor, Chairman) (Professor, Chairman)

  2. Department of Pathology, MetroHealth Medical Center, Cleveland, OH, USA

    Joseph F. Tomashefski Jr. MD (Professor, Chairman) (Professor, Chairman)

  3. Department of Pathology, Weill Medical College of Cornell University, New York, NY

    Philip T. Cagle MD (Professor, Director) (Professor, Director)

  4. Pulmonary Pathology, Department of Pathology, The Methodist Hospital, Houston, TX, USA

    Philip T. Cagle MD (Professor, Director) (Professor, Director)

  5. Pulmonary Pathology, Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Carol F. Farver MD (Director) (Director)

  6. Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA

    Armando E. Fraire MD (Professor) (Professor)

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Ohori, N.P., Hoff, E.R. (2008). Cytopathology of Pulmonary Neoplasia. In: Tomashefski, J.F., Cagle, P.T., Farver, C.F., Fraire, A.E. (eds) Dail and Hammar’s Pulmonary Pathology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-72114-9_14

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