Lang Tee U, Khalbuss Walid E, Monaco Sara E, Pantanowitz Liron
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Cytojournal. 2011 Mar 3;8:6. doi: 10.4103/1742-6413.77286.
Solitary tracheobronchial papilloma (STBP) is a rare benign tumor that primarily involves the tracheobronchial tree. Human papilloma virus (HPV) infection is associated with dysplasia and a high risk of carcinoma in these lesions. The cytomorphology of STBP is not well established in the literature. Our aim is to characterize the cytomorphologic features of STBP, with histologic correlation in a series of 6 patients - 4 males and 2 females - with a mean age of 67 years (range, 53-88 years). There were 5 biopsy-proven squamous papillomas and 1 glandular papilloma. On surgical biopsy, squamous papillomas exhibited cytological atypia (4 graded mild and 1 graded moderate with focal severe dysplasia), surface erosion, and inflammation. Cytology specimens available for review included a combination of 4 fine-needle aspirations (FNAs), 2 bronchoalveolar lavages and 2 (of 3) bronchial brushings. Cytologic findings associated with squamous papillomas included atypical squamous cells and rare squamous cell resembling koilocyte in 1 bronchial brushing. Sheets of squamous cells were identified in another specimen. Several cases had a prominent background of acute inflammation, and candida was present in 1 specimen. HPV in-situ hybridization was positive in 1 case and negative in 2 cases. A p16 immunocytochemical stain performed on 1 cell block was negative. In conclusion, although STBP is a rare neoplasm, these cases may be encountered in respiratory cytology samples. FNA of papillomas yields fewer lesional cells compared to exfoliative samples. These lesions may be mistaken in cytology specimens for squamous cell carcinoma, squamous-lined cavitary lesions, an infectious (fungal) process, reactive squamous metaplasia, or oral contamination.
孤立性气管支气管乳头状瘤（STBP）是一种罕见的良性肿瘤，主要累及气管支气管树。人乳头瘤病毒（HPV）感染与这些病变中的发育异常和癌变高风险相关。STBP的细胞形态学在文献中尚未明确。我们的目的是描述STBP的细胞形态学特征，并对一系列6例患者（4例男性和2例女性，平均年龄67岁，范围53 - 88岁）进行组织学相关性分析。其中有5例经活检证实为鳞状乳头状瘤，1例为腺性乳头状瘤。手术活检时，鳞状乳头状瘤表现为细胞学非典型性（4例为轻度分级，1例为中度分级伴局灶性重度发育异常）、表面糜烂和炎症。可供复查的细胞学标本包括4例细针穿刺抽吸（FNA）、2例支气管肺泡灌洗和3例支气管刷检中的2例。与鳞状乳头状瘤相关的细胞学表现包括非典型鳞状细胞，1例支气管刷检中可见罕见的类似挖空细胞的鳞状细胞。在另一个标本中发现了成片的鳞状细胞。几例病例有明显的急性炎症背景，1例标本中存在念珠菌。HPV原位杂交1例阳性，2例阴性。对1个细胞块进行的p16免疫细胞化学染色为阴性。总之，尽管STBP是一种罕见的肿瘤，但在呼吸细胞学样本中可能会遇到这些病例。与脱落性样本相比，乳头状瘤的FNA产生的病变细胞较少。这些病变在细胞学标本中可能被误诊为鳞状细胞癌、鳞状内衬空洞性病变、感染性（真菌）过程、反应性鳞状化生或口腔污染。
