Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.
Department of Pathology, Texas Children's Hospital, Houston, TX, USA.
Ann Clin Lab Sci. 2021 Jan;51(1):120-123.
The value of bronchoalveolar lavage (BAL) in the diagnosis of pulmonary diseases of diverse etiologies is widely accepted. Cytospin and cell-block preparations for cytomorphological (CM) evaluation and for immunohistochemical studies are the standard method to evaluate BAL, though it may be time-consuming. Flow cytometric (FC) evaluation, on the other hand, has a short turnaround time, and is a useful methodology to differentiate reactive processes from hematological neoplasms, or detect a small aberrant population in an inflammatory background. BAL specimens provide an excellent source for FC studies.
We describe two cases of critically ill patients with no history of hematolymphoid neoplasms, who presented with non-specific symptoms. Abnormal pulmonary imaging studies prompted bronchoscopic evaluation and collection of BAL during the initial evaluation. FC analysis of the BAL fluid aided to the early diagnosis of aggressive NK cell leukemia and adult T cell leukemia/lymphoma, respectively.
Flow cytometric immunophenotyping in addition to the CM assessment increases the diagnostic value and provides timely diagnosis from BAL specimens, which is especially important for critically ill patients.
支气管肺泡灌洗（BAL）在诊断多种病因的肺部疾病中的价值已被广泛认可。为了进行细胞形态学（CM）评估和免疫组织化学研究，细胞离心涂片和细胞块制备是评估 BAL 的标准方法，但可能耗时较长。另一方面，流式细胞术（FC）评估具有较短的周转时间，是区分反应性过程与血液系统肿瘤，或在炎症背景下检测小的异常细胞群的有用方法。BAL 标本是 FC 研究的极好来源。
我们描述了两例无血液淋巴肿瘤病史的重症患者，他们表现出非特异性症状。异常的肺部影像学研究促使在初始评估时进行支气管镜检查和 BAL 采集。BAL 液的 FC 分析分别有助于早期诊断侵袭性 NK 细胞白血病和成人 T 细胞白血病/淋巴瘤。
除了 CM 评估外，FC 免疫表型分析可提高诊断价值，并从 BAL 标本中提供及时诊断，这对重症患者尤为重要。
