Color Atlas of Pulmonary Cytopathology

318 Pages·2002·35.26 MB·English

by  Sudha R. Kini MD (auth.)

Color Atlas
of Pulmonary Cytopathology
Springer
New York
Berlin
Heidelberg
Barcelona
Hong Kong
London
Milan
Paris
Singapore
Tokyo
Sudha R. Kini, MD
Division Head Cytopathology
Department of Pathology, Henry Ford Hospital
Detroit, Michigan, USA
Color Atlas
of Pulmonary Cytopathology
Foreword by Samuel P. Hammar, MD
With Contributions by Patricia Greenstreet
and M. J ane Purslow
Illustrations by Pathology Images, Inc.
With 1312 Figures, 1302 in Full Color
Springer
Sudha R. Kini, MD
Division Head Cytopathology
Department of Pathology
Henry Ford Hospital
Detroit, MI 48202, USA
skini I @hfhs.org
Cover illustrations:
Front cover: Central, keratinizing squamous carcinoma cells in bronchial brushings (Fig. 6C-20A): right
upper corner, adenosquamous carcinoma with malignant cells exhibiting both glandular and squamous
differentiation (Fig. IOC-50) (used with permission from Lippincott-Williams and Wilkins); left lower
corner, carcinoid tumor cells in bronchial brushings demonstrating uniform small cells with salt and pep
per chromatin (Fig. 8C-4); background, fine needle aspiration biopsy of a keratinizing squamous cell
carcinoma of the lung (Fig. 6C-31).
Back cover: Adenosquamous carcinoma in bronchial brushings with malignant cells exhibiting both
glandular and squamous differentiation (Fig. IOC-50) (used with permission from Lippincott-Williams
and Wilkins); background, fine needle aspiration biopsy of keratinizing squamous cell careinoma of the
lung (Fig. 6C-31).
Library of Congress Cataloging-in-Publication Data
Kini, Sudha R.
Color atlas of pulmonary eytopathology / Sudha R. Kini.
p. ; cm.
Includes bibliographie al referenees and index.
ISBN 978-1-4419-2977-8
I. Lungs-Cytopathology-Atlases. 1. Title.
[DNLM: I. Lung Diseases-Pathology-Atlases. 2. Cytological Techniques-Atlases.
3. Lung Neoplasms-Pathology-Atlases. WF 17 K55c 2002J
RC756 .K564 2002
616.2'407-dc21 2001054920
Printed on aeid-free paper.
© 2002 Springer-Verlag New York, Inc.
Softcover reprint ofthe hardcover Ist edition 2002
All rights reserved. This work may not be translated or copied in whole or in part without the written
permission of the publisher (Springer-Verlag New York, Tnc., 175 Fifth Avenue, New York, NY 10010,
USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with
any form of information storage and retrieval, electronic adaptation, computer software, or by similar or
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The use in this publication of trade names, trademarks, service marks, and similar terms, even if they
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subject to proprietary rights.
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to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any
errors or omissions that may be made. The publisher makes no warranty, express or implied, with re
spect to the material contained herein.
Production coordinated by Chernow Editorial Services, Ine., and managed by Lesley Poliner;
manufacturing supervised by Jacqui Ashri.
Typeset by Matrix Publishing Service, Inc., York, PA.
9 8 765 432 1
ISBN 978-1-4419-2977-8 ISBN 978-0-387-21641-6 (eBook)
DOI 10.1007/978-0-387-21641-6
Springer-Verlag New York Berlin Heidelberg
A member oi BertelsmannSpringer Science+Business Media GmbH
To my late husband, Ratnakar Kini, MD,
whose enthusiasm and encouragement is always with me in spirit,
and
to my daughters, Sarita and Sunita,
in appreciation of their support and encouragement
Foreword
Only once in a while does a pathology book arrive on the scene that all diagnostic
pathologists should own. Color Atlas of Pulmonary Cytopathology, by Sudha R.
Kini, MD, is such a book. It can best be described as concise yet detailed. There is
more useful information packed into its 15 chapters than seen in most books three
times its size. Thus it gives me a great pleasure to contribute this foreword.
As I reviewed the manuscript prior to writing this Foreword, I was impressed by
many unique features that I would like to share with you. The chapter covering the
standard cytopreparatory techniques, specimen procurement methodology, and stain
ing techniques contains detailed information that many pathologists once knew but
have forgotten. It is a good refresher course and reference resource. Near the be
ginning of this chapter, Dr. Kini states a fact weil known to experienced diagnos
tic pathologists, namely that communication between pathologists and clinicians is
essential. It is akin to a favorite saying of one of my partners that the best special
stain in pathology is a telephone call to the appropriate clinician. This chapter also
contains especially useful information on the expected diagnostic yield from vari
ous specimen types, for example, FNA, BAL, and wh ich type of specimen is most
useful for making a specific diagnosis.
Another chapter discusses tli.e anatomy, histology, and cytology of the normal
components of the lower respiratory tract. The tables in this chapter are represen
tative of the superb tables throughout this book. They are packed with detailed use
ful information and are easy to refer to.
One of my favorite chapters discusses nonneoplastic lesions. Perhaps this is be
cause as the longer one practices diagnostic pathology, the more one realizes the
difficulties in differentiating reactive nonneoplastic cells and tissue process from
malignant ones. This chapter should be required reading for all pathology residents
and pathologists. It also illustrates the extensive experience of Dr. Kini has and her
exceptional understanding of the morphogenesis of disease processes as weil as clin
ical features associated with such diseases. This chapter contains many pearls.
Several chapters dealing with the cytopathology of common and uncommon lung
neoplasms have a standard format consisting of an introduction of the gross and his
tologie features of a given tumor followed by a detailed discussion of the cy
topathologic findings. Specimens most likely to obtain diagnostic cells are discussed.
The seetion on differentiating adenocarcinoma from epithelial mesothelioma is
especially straightforward, detailed and honest. It provides the reader with a back
ground and puts the cytopathology aspects in perspective. There is extremely use
ful information in all these chapters about specificity and sensitivity of cytologic
findings and differential diagnoses.
There is useful immunohistochemical and ultrastructural information throughout
the book. The book contains detailed chapters on the histology and cytopathology
vii
VIJI Foreword
of Iymphoproliferative lesions of the lung and an unusual amount of detail on
metastatic neoplasms to lung.
This book contains so mush useful information that it could have been written
without a single illustration. That is not the case however and, in fact, the color
photographs are numerous and the quality is the best I have seen in any pathology
book. As a result, this book will serve as a companion volume to another Springer
Verlag publication, Pulmonary Pathology, where due to size constraints, the chap
ter on pulmonary cytopathology had to be eliminated in current edition.
A Color Atlas of Pulmonary Cytopatholgy is a book that should not only be on
the desk of all cytotechnologists/cytopathologists, but also on the desk of all pathol
ogists/surgical pathologists and pulmonologists. This atlas reveals what many di
agnostic pathologists already know, namely that cytopathology provides a superb
insight into the morphology of neoplastic and nonneoplastic lung disease.
Samuel P. Hammar, MD
Director
Diagnostic Specialities Laboratory
Bremerton, Washington
Preface
The purpose of this atlas is to provide a comprehensive, pictorial resource of pul
monary cytopathology. Although pulmonary cytopathology is enriched with myr
iad of individual case reports, review articles, seminars, and monographs on an in
dividual topic or topics, there is not currently a single text devoted entirely to all of
its fractions with adequate illustrations. More than two decades have passed since
the book Diagnostic Respiratory Cytology, by W.W. Johnston and W.J. Frable, was
published, and more than one decade since D.L. Rosenthal's monograph, Cy
topathology of Pulmonary Diseases. Both are still excellent references. The last few
years have seen several publications of atlases; however, they encompass only as
piration cytopathology of lungs and other thoracic organs. The chapters on pul
monary cytopathology in some of the newer textbooks are excellent but limited by
the small number of illustrations. With major advances in our understanding of lung
cancers, the addition of newer diagnostic entities, revised classifications of lung tu
mors, and newer diagnostic techniques, there appeared to be a need for all of this
information to be under one cover.
I have compiled this atlas with that in mind by including the current information
in both exfoliative and aspiration cytopathology, both of malignant neoplasms as
weIl as of nonneoplastic lesions, infections, and pulmonary involvement in im
munodeficient and immunosuppressed patients, as weIl as pulmonary cytopathol
ogy in neonatal and pediatric age group. I have tried to provide liberal illustrations
of common lung malignancies as weIl as of unusual and uncommon ones, so that
the reader does not have to search the literature when confronted with an unusual
case. Because I did not have many of these unusual cases in our files, I am im
mensely grateful to my professional colleagues-Iocally, within the United States,
and globally-who readily responded to my request for glass slides or images. I
have also focused on nonneoplastic entities, including noninfectious and infectious
disease processes, that often demonstrate cytologic changes in respiratory speci
mens. Bronchoalveolar lavage has gained tremendous popularity because of its suc
cess in the detection of infectious agents, especially in immunocompromised pa
tients. Many of the nonneoplastic disease processes described in this text mandate
that the final diagnoses be established by means other than cytology, and rightfully
so. The cytologic changes, however, can often provide clues for further investiga
tions.
I have opted to discuss only primary intrapulmonary malignancies in this atlas,
thereby excluding pleural diseases and tumors, specifically malignant mesothe
liomas. The decision was made because malignant mesothelioma could not be dis
cussed alone without devoting an entire chapter to pleuraliesions. I feIt this to be
beyond the scope of the atlas; however, diffuse malignant mesothelioma has been
discussed and illustrated in considerable detail in the differential diagnoses of ade-
ix
x Preface
nocarcinomas. The sarcomatous variant is also discussed, along with spindie cellle
sions of the lung. I do hope that omission of a chapter devoted to mesothelial le
sions will not detract from the completeness of this atlas.
No publication in pathology is complete without discussions on diagnostic accu
racy and pitfalls. I have tried to emphasize the differential diagnoses in every chap
ter and attempted to highlight the cytologic differences in tables and in illustrations.
The chapter on cytopreparatory techniques is rather comprehensive. No one will
disagree with the fact that proper cytologic evaluation and diagnostic interpretation
is directly proportional to the quality of the prepared and stained smears. The il
lustrations in this atlas can attest to it. I hope that the information provided in that
chapter will help those who are facing difficulties in cytopreparation. As far as
choice of fixation and staining is concerned, Papanicolaou is fortunately the stan
dard method for exfoliative cytology and will not cause any debate. The preferred
staining method for fine needle aspiration biopsies is a different issue. I have al
ways been a proponent of Papanicolaou stain, which explains why most of the im
ages presented in this atlas are wet-fixed and stained by Papanicolaou method.
The value of any atlas depends on the quality of its color images. The credit for
these goes entirely to Ms. Jane Purslow for her excellence in photomicrography.
Her enthusiasm knows no bounds. I will always be indebted to Jane for her encour
agement, support, and relentless energy, and for taking hundreds of photomicrographs.
I am very pro ud of my cytopathology technical staff, both cytotechnologists and med
icallaboratory technicians, for the excellent quality of cytopreparation. Their dedica
tion is unsurpassed. I am very grateful to Dr. Irving Dardick of Pathology Images,
Toronto, Canada, for the superb reproduction and color balance of the images. Work
ing with Dr. Dardick is always a very pleasant experience. The art and photography
department staff at Henry Ford Hospital has been very gracious, helpful, and cooper
ative in taking several of the photographs related to cytopreparation. I am truly ap
preciative of their services. I gratefully acknowledge the secretarial assistance pro
vided by Ms. Laure Porzondek and Ms. Linda Brandt. Ms. Susan Dingler, the education
coordinator of Henry Ford School of Cytotechology, was always willing to review
the manuscript and offer helpful advice, especially in reference to students' needs. I
have always kept the interest of cytotechology students in the back of my mind, and
for that reason the text in some chapters is rather quite detailed.
It is my hope that this atlas will be a welcome addition to the field of cytopathology
and be useful both to those who practice cytopathology as weil as to those practic
ing pulmonary medicine.
Sudha R. Kini, MD
Acknowledgments
Acknowledgments are due for the following copyrighted material:
Acta Cytologica for Fig. 6C-39B, from: Dugan MJ. Cytologic diagnosis of basal
cell (basaloid) carcinoma of the lung. Acta Cytol 1995; 39:539-542.
Acta Cytologica for Figs. lOC-41-lOC-43. Nguyen GK. Aspiration biopsy cytol
ogy of benign clear cell ("sugar") tumor of the lung. Acta Cytol 1989; 33:511-515.
Acta Cytologica for Fig. lOC-99. Kumar PV, Monabati A. Bronchial oncocytoma
diagnosed by brushing cytology. Acta Cytol 1998; 42:1056-1057.
Diagnostic Cytopathology for Fig. lOC-48. Weynand B, Collard PH, Galant C. Cy
topathological features of solitary fibrous tumor of the pleura. Diagn Cytopathol
1998; 18:118-124.
Diagnostic Cytopathology for Fig. 10C-1O. Machicao CN, Sorenson KL, Abdul
Karim FM, Somrak TM. Transthoraeie needle aspiration biopsy in inflammatory
pseudotumor of the lung. Diagn Cytopathol 1989; 5:400-403.
Diagnostic Cytopathology for Fig. 4C-87 and 4C-88. Gordon SM, Gal AA, Hertzier
GL, Bryan JA, Perlino C, Kanter KR. Diagnosis of pulmonary toxoplasmosis by
bronchoalveolar lavage in cardiac transplant recipient. Diagn Cytopathol 1993;
9:650-654.
W.B. Saunders and Co. for Table 4-13. Bedrossian CWM, Mason MR, Gupta PK.
Rapid cytologic diagnosis of Pneumocystis. Semin Diagn Pathol 1989; 6:245-261.
Springer-Verlag, Inc., for Table 4-2. Meyers JL, Colby TV; Yosem SA. Common
pathways and patterns of injury, In: Dail DH, Hammer SP, editors. Pulmonary
Pathology, second edition. New York: Springer-Verlag, 1993:59. For Table 5-1.
Travis WD, Corrin B, Shimoshoto Y, Brambilla E. Histologie Classification ofLung
and Pleural Tumors, third edition. New York: Springer-Verlag, 1999;21-24.
Armed Forces Institute of Pathology for Table 3-2. Colby TV, Koss MN, Travis
WD. Tumors ofthe Lower Respiratory Tract, third edition. Washington, D.C.: AFIP,
1995:10.
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