The cytologic features of Wegener's granulomatosis

To evaluate the role of cytopathology and its different sampling techniques in the diagnosis of Wegener's granulomatosis, we retrospectively reviewed 52 cytologic specimens from 21 patients with an established diagnosis of Wegener's granulomatosis. The smear background, cellular composition, and accompanying reactive changes were evaluated. The majority of the smears were characterized by a bloody background with necrotic debris and extensive acute inflammation. Large sheets of exfoliated reactive pneumocytes and bronchial epithelium were commonly present. Multinucleated giant cells and epithelioid histiocytes were present in 10 and 20 specimens, respectively. Numerous hemosiderin-laden histiocytes were present in variable numbers in most cases and were abundant in 15 cases. Bronchial brush and lavage were the best sampling techniques. Although fine-needle aspiration best demonstrated the granulomas, only 2 of the 6 aspirates were diagnostic. The combination of cytologic findings, negative cultures, and elevated titers of antineutrophil cytoplasmic antibody with a cytoplasmic pattern may serve to establish a presumptive diagnosis of Wegener's granulomatosis.