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Pulmonary Pathology Online

Exfoliative Pulmonary Pathology

Dr Sampurna Roy MD


Examination of cytological samples from the respiratory tract or lung parenchyma forms a large proportion of the diagnostic cytology workload in many laboratories.

The majority of requests are concerned with the diagnosis of lung cancer but a substantial minority involve identification of infective or inflammatory conditions and benign tumors.

As in many branches of cytology,  the recognition of malignancy in cells obtained from the respiratory tract is more straightforward than identification of tumor cell type.

Well-differentiated tumors may have characteristic cytoplasmic and nuclear abnormalities enabling firm categorization, as in squamous cell or adenocarcinoma,  but some moderately and most poorly differentiated tumors show few distinctive features.

Current management of carcinoma of the lung depends on distinguishing small cell carcinoma from other  cell types.

A cytological report of non-small cell carcinoma is, therefore, a clinically helpful diagnostic category, on the understanding that the tissue samples may clarify the tumor type more precisely.

Sputum, bronchial washings, brushings, trap samples and bronchoalveolar lavages should be alcohol fixed and stained by the Papanicolaou method.

Indiscriminate use of sputum cytology by clinicians should be discouraged, as the diagnostic yield is low in these circumstances.

The hallmark of a good exfoliative specimen is the presence of alveolar macrophages.

In cases of acute inflammation, however , polymorphs predominate at the expense of macrophages.

Direct sampling by brushing should yield abundant well preserved  ciliated bronchial epithelial cells.

Squamous Cell Carcinoma


Bronchioloalveolar Cell Carcinoma

Small Cell Carcinoma

Large Cell Carcinoma

Carcinoid Tumours

Metastatic Tumours


Fine Needle Aspiration Cytology ; FNAC -Squamous Cell Carcinoma and Adenocarcinoma ; FNAC - Bronchioloalveolar Cell Carcinoma ; FNAC - Small Cell Carcinoma; FNAC - Non Small Cell and Large Cell Carcinoma; FNAC - Carcinoid Tumours; Cytological Pitfalls in the Diagnosis of Lung Cancer.


Impressive Macroscopic Specimens for those in Love with Pulmonary Pathology

Further reading:

Cytopathologic diagnosis of pulmonary neoplasms in sputum and bronchoscopic specimens.

The value of cytology in the diagnostics of lung cancer.

Correlations between the results of the histological and cytological examination in the diagnostic of the broncho-pulmonary cancer.

Diagnosis and typing of lung carcinomas by cytopathologic methods. A review of 108 cases.



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)







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