Williams W L, Clark D A, Saiers J H
Department of Pathology, Veteran's Affairs Medical Center, Albuquerque, New Mexico.
Acta Cytol. 1992 Jan-Feb;36(1):91-4.
The diagnosis of lymphomatoid granulomatosis (LG) of the lung depends on obtaining adequate histologic material to demonstrate the characteristic angioinvasive, polymorphous, lymphoid infiltrate and normally requires an open lung biopsy. Fine needle aspiration biopsy (FNAB), if only smeared directly, does not allow an assessment of the lymphoid infiltrate in relation to blood vessels. However, we report a case diagnosed by FNAB in which the specimen was processed by an alternative method that allows cell blocks to be made from all visible particles. Percutaneous FNAB of a nodular pulmonary infiltrate was performed after bronchoscopy and transbronchial needle biopsy failed to yield a diagnosis. The FNAB specimen was placed in 50% alcohol and submitted for processing. The specimen was then filtered through a fine sieve, and all visible tissue was embedded in bacteriologic agar and processed as a standard surgical specimen. The filtrate was processed as standard fluid cytology. The atypical, angioinvasive, lymphoid infiltrate was clearly demonstrated on the cell blocks, and the diagnosis of LG was made. This diagnosis was confirmed by subsequent open lung and skin biopsies.
肺淋巴瘤样肉芽肿病（LG）的诊断依赖于获取足够的组织学材料以显示特征性的血管侵袭性、多形性、淋巴样浸润，通常需要进行开胸肺活检。细针穿刺活检（FNAB），如果仅直接涂片，则无法评估淋巴样浸润与血管的关系。然而，我们报告了1例通过FNAB诊断的病例，其中标本采用了另一种方法进行处理，该方法可从所有可见颗粒制作细胞块。在支气管镜检查和经支气管针吸活检未能得出诊断后，对肺部结节性浸润进行了经皮FNAB。将FNAB标本置于50%酒精中送检处理。然后将标本通过细筛过滤，所有可见组织均包埋于细菌学琼脂中，并作为标准手术标本进行处理。滤液按标准液基细胞学方法处理。在细胞块上清晰显示出非典型、血管侵袭性、淋巴样浸润，从而做出LG的诊断。随后的开胸肺活检和皮肤活检证实了该诊断。
