Respiratory Cytology and Ancillary diagnostic techniques Dr Alex Rice Royal Brompton Hospital Overview • Specialist Cardiothoracic centre – BAL specimens and cell differential counts – EBUS • Diagnostic pitfalls • Subtyping lung cancer • Molecular techniques – Recent advances pleural fluids Bronchiolo-alveolar Lavage (BAL) specimens BAL Cytology • Indications (Acute or Chronic LD) – Interstitial and alveolar lung disease – Infections • E.g Pneumocystis, fungi, viral – Drug reactions – Malignancy • Techniques – Cell differential count – Fat laden macrophage – Immunofluorescence Lymphocytosis • ILDs associated with lymphocytosis include • Sarcoidosis • Hypersensitivity pneumonitis • NSIP/CTD • OP • Drug related • Infection: TB, viral pneumonia • Lymphoma Neutrophilia • ILDs associated with neutrophilia – IPF/UIP • Infection – Fungal stains – Correlate with microbiology • Vasculitis – Leukocytoclasis – haemosiderin laden macrophages Eosinophilia • Eosinophilic pneumonia • Asthma • ABPA • Drug reaction • Parasitic infection • Vasculitis (Churg Strauss) • Langerhans cell histiocytosis ITU – Acutely sick patient • Neutrophilia • +/- intracytoplasmic organisms (special stains) • Leukocytoclasis ->capillaritis? • Eosinophilia • Eosinophilic pneumonia/drug reaction/infection • Infectious agents • PCJ, fungi, CMV, HSV, TB • Gram, grocott, IHC, IF stains • Iron • Pulmonary haemorrhage syndrome/vasculitis • Reactive type 2 pneumocytes, debris, fibrin Reactive cytological atypia Post radiotherapy interstitial infiltrates Infection Pneumocystis