Bardales R H, Powers C N, Frierson H F, Suhrland M J, Covell J L, Stanley M W
Department of Pathology, John L. McClellan Memorial Veterans Hospital, University of Arkansas for Medical Sciences, Little Rock 72205-5484, USA.
Diagn Cytopathol. 1996 Mar;14(2):108-13. doi: 10.1002/(SICI)1097-0339(199603)14:2<108::AID-DC2>3.0.CO;2-F.
Leukemias and lymphomas involving the lung were diagnosed by means of exfoliative cytology in 31 specimens from 20 patients. Initial diagnostic categorizations included 29 specimens "positive for malignancy," including two thought to represent "carcinoma vs. lymphoma," and two considered suspicious for lymphoma. Previous diagnoses of lymphoma (13 patients) and acute myelogenous leukemia (AML) (2 patients) were available. In 5 additional patients, exfoliative respiratory cytology yielded the first diagnosis of hematopoietic malignancy. Cytologic diagnosis included nine large-cell and six small-cell non-Hodgkin's lymphomas (NHL), three Hodgkin's lymphomas (HD), and two AML. Key cytologic features included markedly pleomorphic and monomorphic cell populations in HD and NHL, respectively, as well as lack of tumor cell cohesion and necrosis in all cases. Cytologically, acute leukemia may be difficult to differentiate from large-cell NHL, and small-cell NHL from reactive/benign small lymphocytes. Blood, scant cellularity, crush artifacts, and apparent molding may affect diagnostic accuracy. Immunocytochemistry in cell block sections of sputa and washings is useful in the diagnostic workup in selected cases. Although involvement of the respiratory system by leukemias and lymphomas is uncommon and not always preceded by a history of malignancy, cytologic diagnosis is usually prompt, reliable, and accurate.
通过脱落细胞学检查，对20例患者的31份标本进行了累及肺部的白血病和淋巴瘤诊断。初始诊断分类包括29份“恶性肿瘤阳性”标本，其中2份被认为代表“癌与淋巴瘤鉴别”，2份疑似淋巴瘤。此前有13例淋巴瘤和2例急性髓系白血病（AML）的诊断记录。另外5例患者通过脱落呼吸道细胞学检查首次诊断为造血系统恶性肿瘤。细胞学诊断包括9例大细胞和6例小细胞非霍奇金淋巴瘤（NHL）、3例霍奇金淋巴瘤（HD）和2例AML。关键细胞学特征包括HD和NHL中分别明显的多形性和单形性细胞群，以及所有病例中肿瘤细胞均无黏附性和坏死。在细胞学上，急性白血病可能难以与大细胞NHL区分，小细胞NHL也难以与反应性/良性小淋巴细胞区分。血液、细胞稀少、挤压伪像和明显的塑形可能影响诊断准确性。痰液和冲洗液细胞块切片的免疫细胞化学检查在部分病例的诊断检查中很有用。尽管白血病和淋巴瘤累及呼吸系统并不常见，且并非总是有恶性肿瘤病史在先，但细胞学诊断通常迅速、可靠且准确。
