Naslov
Role of cytology in the clinical management of diffuse lung disease

Autori
Peroš-Golubičić, Tatjana

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Abstracts of the 37th European Congress of Cytopathology ; u: Cytopathology 23 (2012) (S1) ; Cytologists & Clinicians, str. 50–58 / - , 2012, 50-50

Skup
European Congress of Cytopathology (37 ; 2012)

Mjesto i datum
Cavtat, Hrvatska; Dubrovnik, Hrvatska, 30.09.2012. - 03.10.2012

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
diffuse lung disease; lung lavage cytology

Sažetak
A large number of diseases diffusely affect the lung. The groups of diseases are: interstitial, bronchitis, bronchiectasis, bronchiolitis and emphysema. In many instances the term diffuse lung disease is used as a synonym for interstitial lung disease. The truth is that there is no border to confine almost any interstitail lung disease (ILD) to interstitium only ; these diseases often involve other lung structures, the vasculature and airways, even surrounding organs like pleura or regional lymph nodes. Another difficulty in dealing with this group of diseases is that there is enormous number of entities that involve the interstitium of the lung. The group of known cause ILDs consists of: infectious diseases, disease caused by organic or inorganic substances (pneumoconiosis, hypersensitivity pneumonitis, drug- induced lung disease), vasculitis and diffuse connective tissue diseases. The second group constitute the idiopathic interstitial pneumonias: idiopathic pulmonary fibrosis(IPF/UIP), nonspecific interstitial pneumonia(NSIP), organizing pneumonia( OP), acute interstitial pneumonia(AIP), respiratory bronchiolitis interstitial lung disease(RB-ILD), desquamative interstitial pneumonia(DIP) and lymphoid interstitial pneumonia(LIP) and other ILDs of unknown origin (sarcoidosis, idiopathic pulmonary fibrosis, Langerhan’s cell histiocytosis, lymphangioleiomyomatosis, alveolar proteinosis). In addition to the large number of different entities there is lack of experience of many clinicians. Also, the lung parenchyma has a limited repertoire of responses to damage, and so the same histology and cytology can be due to different diseases ; conversely, the same disease can result in different histology and cytology findings. Diagnosis requires a propulsive multidisciplinary approach to aggregate clinical, radiological, cytological and pathological data. The most rewarding material is bronchoalveolar lung lavage fluid (BAL). Other cytological materials are all also very valuable, like sputum, transbronchial and bronchial mucosa biopsy imprints, catheter aspirated, brushing, fine needle aspiration of mediastinal lymph nodes, pleural fluid, and so on...in some particular instances. The lung lavage fluid is obtained during fiberbronchoscopy. BAL fluid white blood cell profiles are analyzed, malignant cells looked for, and in certain circumstances particular stains are performed to detect yet other cell types. Cytological analysis of BAL is diagnostic for malignant and infectious diseases, Langerhans cell histiocytosis( >5% Langerhan’s cells – CD1a and protein 100 positive calls), alveolar proteinosis (PAS – periodic acid-Schiff positive material) and pneumoconioses. The findings of the lung lavage cells may be indicative of numerous other ILD diseases. Lymphocyte alveolitis is the feature of sarcoidosis, hypersensitivity pneumonitis, beriliosis, tuberculosis, drug induced lung disese and several other disorders. Neutrophilic alveolitis is found in usual interstitial pneumonias(UIP/IPF or collagen tissue diseases), ARDS and infection. Mixed alveolitis, with high percent of neutrophilic and eosinophilic granulocytes, is characteristic finding in organizing pneumonia, nonspecific interstitial pneumonia and desquamative inetrstitial pneumonia. Eosinophilic pneumonias have more than 25% of eosinophils in the differential cell count. The ratio of CD4/CD8 T lymphocytes higher than 4.0 is found in sarcoidosis. Interstitial lung disease are a group that remains a challenge for the clinician, radiologist, cytologist and pathologist. The skilled and experienced clinical cytologist is a very valuable member of the team that manages the interstitial lung diseases.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

Napomena
DOI: 10.1111/cyt.1200

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