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Exfoliative sputum cytology of cancers metastatic to the lung.Diagn
Cytopathol. 2005 Sep;33(3):147-51.
Although
largely replaced by fine-needle aspiration (FNA) and bronchoscopy,
cytological examination of sputum for exfoliated malignant cells still
is considered a valuable initial diagnostic test in patients
presenting with a lung mass. Thirty-five cases of secondary/metastatic
tumors involving the lung and diagnosed on sputum were retrospectively
reviewed from our cytopathology files for a period of 22 yr
(1980-2001). Clinical history and the relevant histopathological
material were examined and correlated with the cytological findings.
In all cases, a history of malignancy was known. Cytological diagnoses
included colonic adenocarcinoma (7 cases); non-Hodgkin's lymphoma
(NHL; 5 cases); malignant melanoma (MM; 5 cases); breast carcinoma (5
cases); Hodgkin's lymphoma (HL; 3 cases); pancreatic adenocarcinoma (2
cases); prostatic adenocarcinoma (2 cases); and 1 case each of
urothelial carcinoma, endometrial carcinoma, renal cell carcinoma,
hepatic small-cell carcinoma, squamous-cell carcinoma (cervix), and
leiomyosarcoma (LMS). Cellular preservation was optimal in all cases.
The smear background was relatively clean in 25 (71%) cases and
predominantly inflamed and/or necrotic in 10 (29%) cases. In
non-lymphoid tumors (27 cases), isolated single malignant cells were
seen in 7 (26%) cases (all cases of MM and prostatic adenocarcinoma),
whereas 20 (74%) cases displayed fragments with intact tumor
architecture. Overall, only 10/35 (29%) cases showed noticeable
tumor-cell necrosis. In one case (LMS), cell block sections were used
for immunoperoxidase (IPOX) studies with positive staining for desmin
and actin. Exfoliation of cancer cells in sputum from secondary tumors
in the lung is a rare phenomenon in current-day practice, with
metastatic colonic adenocarcinoma seen most commonly. Intact tumor
architecture was observed in exfoliated cells in 75% of the cases.
Two cases of
metastatic lung cancer examined by bronchoscopic cytology.Rinsho
Byori. 1996 Apr;44(4):390-5.
We herein report
two cases of metastatic lung cancer examined with bronchoscopic
cytology. The first case involved a 43-year-old female, who had
undergone low anterior resection of the rectum for rectal cancer three
years earlier. Routine chest X-ray showed a nodular lesion in the left
upper area. Bronchoscopic examination revealed a mass occluding the
left upper bronchus. Simultaneous bronchoscopic biopsy and washing
cytology were performed. The cytological specimen consisted of cell
clusters with tall columnar epithelium arranged in a palisading
manner. The cytological findings strongly suggested metastatic
adenocarcinoma originating from the colorectal region. The patient
died from respiratory failure. Autopsy confirmed metastatic deposit of
adenocarcinoma in the lung. Histologically, the tumor invaded the
overlying bronchial wall and was exposed in the lumen. The second case
was an 80-year-old female, who had been diagnosed as gastric cancer by
the endoscopic examination one year earlier. She had refused surgical
treatment. Routine chest X-ray showed reticulonodular lesions
disseminated throughout the bilateral lungs. Bronchial endoscopy
presented edematous mucosa of the right lower bronchus. Brushing
cytology as well as punch biopsy were taken. Cytological examination
revealed atypical cells with increased N/C ratio and reduced
cohesiveness. The lesion was diagnosed as metastatic adenocarcinoma of
gastric origin from cytological findings and clinical history. The
patient died from respiratory failure. Postmortem examination revealed
cancer cells in the lymphatic channels of the bronchial wall. Our two
cases indicate that bronchoscopic cytology is useful for estimating
the origin of metastatic cancer.
Metastatic metaplastic carcinoma of the breast: diagnosis by bronchial
brush cytology.Diagn
Cytopathol. 1989;5(4):396-9.
Metaplastic
carcinoma of the female breast is an uncommon lesion that may
metastasize to body sites. To our knowledge, this is the first
reported case of pulmonary metastasis diagnosed on bronchial brush
cytology. The patient presented with pulmonary symptomatology 1 yr and
3 mo after a left modified radical mastectomy for breast carcinoma.
Bronchoscopic examination revealed an endobronchial lesion partially
obstructing the bronchus intermedius. Bronchial brush cytology showed
the presence of nonkeratinizing squamous tumor cells admixed with a
few scattered clusters of tumor cells with glandular features.
Histologic review of the original breast lesion showed a metaplastic
carcinoma of the breast with a predominant squamous-cell component.
Accurate knowledge of a patient's clinical history is necessary to
differentiate a second primary lesion from a metastatic one,
particularly when the original lesion is so uncommon.
Diagnostic value of fiberoptic bronchoscopy in metastatic pulmonary
tumors.Chest. 1978
Oct;74(4):369-71.
The fiberoptic
bronchoscopic procedure (with brushings, washings, and biopsies) was
performed and specimens of sputum were obtained before the procedure
in 37 patients with cancer metastatic to the lung. Of the 37 patients
studied, endobronchial lesions were visualized at bronchoscopic
examination in 14 (group 1), and no endobronchial lesion was seen in
23 (group 2). The yield of bronchial brushing and washings was not
significantly different in group 1 and 2, whereas examination of
sputum obtained before the bronchoscopic procedure and bronchial
biopsy in group 1 yielded higher results than the same procedures in
group 2. The radiographic findings did not influence the yield with
any of the bronchoscopic procedures. The overall positive diagnostic
yield from fiberoptic bronchoscopic procedures among these patients
was 54 percent (20/37), regardless of their bronchoscopic or
radiologic findings.
Sputum cytology of
metastatic carcinoma of the lung.Acta
Cytol. 1976 Nov-Dec;20(6):514-20.
The cytopathology
of 47 cases of metastatic carcinoma of the lung and of 28 cases of
recurrent or metastatic bronchogenic carcinoma is reviewed. The
diagnostic yield was better for recurrent than for metastatic
carcinoma but overall was comparable to that of primary bronchogenic
carcinomas. The metastatic tumors were located in all areas of the
lung and included single as well as multiple lesions. The positive
yield did not differ significantly in relation to any of the
pathologic features but was somewhat higher if the metastases were
large and centrally located. A definite differentiation of the
metastatic tumors, usually adenocarcinomas, from new primary
bronchogenic carcinomas is often possible particularly if the
cytopathology can be compared with that of the primary lesion.
Specific cytologic features include the relative lack of cohesion and
the formation of columns in metastatic breast carcinomas, the
formation of larger cohesive well circumscribed nodules composed of
tall columnar cells in metastatic colon carcinomas, clear cell
features in some metastatic adenocarcinomas of the kidney, and the
small cell size and uniform, regular nuclear features in the often
cytologically well differentiated metastatic carcinomas of the
prostate. |
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