- •Preface
- •Contents
- •Procedures, Assays, and Normal Values
- •Normal Cells of the Blood and Hematopoietic Organs
- •The Individual Cells of Hematopoiesis
- •Bone Marrow: Cell Composition and Principles of Analysis
- •Abnormalities of the White Cell Series
- •Predominance of Mononuclear Round to Oval Cells
- •Prevalence of Polynuclear (Segmented) Cells
- •Erythrocyte and Thrombocyte Abnormalities
- •Hypochromic Anemias
- •Normochromic Anemias
- •Hyperchromic Anemias
- •Erythrocyte Inclusions
- •Thrombocyte Abnormalities
- •Cytology of Organ Biopsies and Exudates
- •Lymph Node Cytology
- •Branchial Cysts and Bronchoalveolar Lavage
- •Cytology of Pleural Effusions and Ascites
- •Cytology of Cerebrospinal Fluid
- •Introduction to the Physiology and Pathophysiology of the Hematopoietic System
- •Cell Systems
- •Principles of Regulation and Dysregulation in the Blood Cell Series and their Diagnostic Implications
- •Procedures, Assays, and Normal Values
- •Taking Blood Samples
- •Erythrocyte Count
- •Hemoglobin and Hematocrit Assay
- •Calculation of Erythrocyte Parameters
- •Red Cell Distribution Width (RDW)
- •Reticulocyte Count
- •Leukocyte Count
- •Thrombocyte Count
- •Significance of the Automated Blood Count
- •Bone Marrow Biopsy
- •Lymph Node Biopsy and Tumor Biopsy
- •Step-by-Step Diagnostic Sequence
- •The Individual Cells of Hematopoiesis
- •Eosinophilic Granulocytes (Eosinophils)
- •Basophilic Granulocytes (Basophils)
- •Monocytes
- •Lymphocytes (and Plasma Cells)
- •Megakaryocytes and Thrombocytes
- •Bone Marrow: Medullary Stroma Cells
- •Abnormalities of the White Cell Series
- •Predominance of Mononuclear Round to Oval Cells
- •Reactive Lymphocytosis
- •Relative Lymphocytosis Associated with Granulocytopenia (Neutropenia) and Agranulocytosis
- •Monocytosis
- •Acute Leukemias
- •Neutrophilia without Left Shift
- •Reactive Left Shift
- •Osteomyelosclerosis
- •Elevated Eosinophil and Basophil Counts
- •Clinically Relevant Classification Principle for Anemias: Mean Erythrocyte Hemoglobin Content (MCH)
- •Hypochromic Anemias
- •Iron Deficiency Anemia
- •Hypochromic Infectious or Toxic Anemia (Secondary Anemia)
- •Hypochromic Anemia with Hemolysis
- •Normochromic Anemias
- •Normochromic Hemolytic Anemias
- •Cytomorphological Anemias with Erythrocyte Anomalies
- •Bone Marrow Aplasia
- •Hyperchromic Anemias
- •Erythrocyte Inclusions
- •Hematological Diagnosis of Malaria
- •Thrombocyte Abnormalities
- •Thrombocytopenia
- •Lymph Node Cytology
- •Sarcoidosis and Tuberculosis
- •Non-Hodgkin Lymphoma
- •Metastases of Solid Tumors in Lymph Nodes or Subcutaneous Tissue
- •Branchial Cysts
- •Cytology of Pleural Effusions and Ascites
- •Cytology of Cerebrospinal Fluid
- •References
- •Index
184 Cytology of Organ Biopsies and Exudates
Branchial Cysts and Bronchoalveolar
Lavage
Branchial Cysts
A (usually unilateral) swollen neck nodule below the mandibular angle that feels firm to pressure, but is without external signs of inflammation, should suggest the presence of a branchial cyst. Surprisingly, aspiration usually produces a brownish-yellow liquid. In addition to partially cytolysed granulocytes and lymphocytes (cell detritus), a smear of this liquid, or the centrifuged precipitate, shows cells with small central nuclei and wide light cell centers which are identical to epithelial cells from the floor of the mouth. Biopsies from a soft swelling around the larynx show the same picture; in this case it is a retention cyst from another developmental remnant, the ductus thyroglossus.
Cytology of the Respiratory System,
Especially Bronchoalveolar Lavage
Through the development of patient-friendly endoscopic techniques, diagnostic lavage (with 10–30 ml physiological saline solution) and its cytological workup are now in widespread use. This method is briefly mentioned here because of its broad interest for all medical professionals with an interest in morphology; the interested reader is referred to the specialist literature (e.g. Costabel, 1994) for further information. Table 31 lists the most important indications for bronchoalveolar lavage.
Table 31 Clinical indications for bronchoalveolar lavage (according to Costabel 1994)
Interstitial infiltrates |
Alveolar infiltrates |
Pulmonary infiltrates in |
|
|
patients with immune |
|
|
deficiency |
Sarcoidosis (Boeck disease) |
Pneumonia |
HIV Infection |
Exogenous allergic alveolitis |
Alveolar hemorrhage |
Treatment with cytostatic |
Drug-induced alveolitis |
Alveolar proteinosis |
agents |
Idiopathic pulmonary fibrosis |
Eosinophilic pneumonia |
Radiation sickness |
Collagen disease |
Obliterating bronchiolitis |
Immunosuppressive therapy |
Histiocytosis X |
|
Organ transplant |
Pneumoconioses |
|
|
Lymphangiosis carcino- |
|
|
matosa |
|
|
|
|
|
Accessible cysts (e.g., branchial cysts) should be aspirated. Bronchial lavage is a cytological new discipline
a |
|
b |
|
c |
d |
Fig. 66 Cyst biopsy and bronchoalveolar lavage. a Cytology of a lateral neck cyst: no lymphatic tissue, but epithelial cells from the floor of the mouth. b Normal ciliated epithelial cells with typical cytoplasmic processes. c Tumor cell conglomeration in small-cell bronchial carcinoma: conglomeration is typical of tumor cells. d Bronchoalveolar lavage in purulent bronchitis: a macrophage with pigment inclusion (arrow) is surrounded by segmented neutrophilic granulocytes.
185