Epithelial cell atypia in bronchoalveolar lavage specimens from lung transplant recipients
1Department of Pathology, University of Pittsburgh Medical Center, PA 15213, USA.
Insights
Bronchoalveolar lavage (BAL) in lung transplant recipients can show atypical epithelial cells. Cytologic features alone cannot distinguish these from cancer, requiring clinical and biopsy correlation for accurate diagnosis.
Area of Science:
- Pulmonary Medicine
- Transplant Pathology
- Cytopathology
Background:
- Bronchoalveolar lavage (BAL) is crucial for diagnosing infections in lung transplant recipients.
- Epithelial cell atypia in BAL can be challenging to interpret, necessitating further investigation.
Purpose of the Study:
- To evaluate the significance of epithelial cell atypia in BAL specimens from lung transplant recipients (LTRs).
- To compare cytologic features of atypical cells in LTRs with carcinoma in non-transplant patients (NTPs).
Main Methods:
- Analysis of 10 BAL specimens from LTRs with significant cytologic atypia (1991-1998).
- Comparison with 4 BAL specimens from NTPs with carcinoma.
- Evaluation of 14 cytologic parameters and correlation with clinical and biopsy data.
Main Results:
- Significant overlap in cytologic features was observed between atypical LTRs and NTP carcinomas.
- Atypical cells in LTRs originated from nonneoplastic conditions like graft injury, rejection, and infections.
- Cytologic evaluation alone was insufficient to differentiate atypical cells in nonneoplastic conditions from malignant ones.
Conclusions:
- Distinguishing atypical epithelial cells in LTRs from malignancy requires more than cytologic assessment.
- Clinical history and histologic correlation are vital for accurate interpretation of post-transplant cytologic findings.
- Awareness of the spectrum of atypia in post-transplant syndromes is essential for correct diagnosis.
Abstract:
In lung transplant recipients, bronchoalveolar lavage (BAL) is mainly performed to detect infectious agents. However, in addition to microorganisms, epithelial cell atypia may be identified, and determination of its significance is necessary. Specimens obtained at BAL in lung and heart-lung transplant recipients (LTRs) between 1991 and 1998 were examined for the presence of significant cytologic atypia in epithelial cells. Ten cases in 9 patients were identified, and these composed the core of our study. These transplant BAL specimens were compared with 4 BAL specimens with carcinoma from non-transplant patients (NTPs). Fourteen cytologic parameters were evaluated, and clinical and biopsy correlation was made in each case. Significant overlap in cytologic features, including background cellularity, number of atypical cell clusters, number of cells in each cluster, size of cell clusters, contour of clusters, 3-dimensionality, tenacious intercytoplasmic connections, multinucleation, nuclear size, nuclear/cytoplasmic ratio, nuclear membrane irregularity, chromatin pattern, intranuclear inclusions, and nucleolar characteristics, was observed between atypical LTR cases and NTP carcinoma cases. Clinically, all LTR cases derived from nonneoplastic conditions including harvest injury (diffuse alveolar damage), acute cellular rejection, and infections. Our study results show that evaluation of cytologic features alone does not permit differentiation of atypical cells found in nonneoplastic conditions from those in malignant conditions. Clinical and histologic correlation and awareness of the range of atypia seen in posttransplant syndromes is important in correct interpretation of these cases.
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