Pulmonary alveolar proteinosis: diagnosis using routinely processed smears of bronchoalveolar lavage fluid.
Open Access
- 1 December 1997
- journal article
- Published by BMJ in Journal of Clinical Pathology
- Vol. 50 (12), 981-984
- https://doi.org/10.1136/jcp.50.12.981
Abstract
AIMS: For the diagnosis of pulmonary alveolar proteinosis from bronchoalveolar lavage specimens it is normally necessary to make an ultrastructural examination. However, this is thought to be impractical for bronchoalveolar lavage specimens that have been routinely fixed in ethanol. In the present study, bronchoalveolar lavage cytology smears on slide glasses were examined directly ultrastructurally to make a diagnosis of pulmonary alveolar proteinosis. METHODS: Bronchoalveolar lavage smears from three pulmonary alveolar proteinosis patients were stained with Papanicolaou and periodic acid-Schiff (PAS) for identification of amorphous globular structures. Subsequently, they were refixed with glutaraldehyde and osmium tetroxide, and embedded in epoxy resin. Ultrathin sections were cut and examined ultrastructurally. RESULTS: Papanicolaou stained specimens from pulmonary alveolar proteinosis patients contained scattered amorphous or granular globules, 20-50 microns in diameter, which were PAS positive. Ultrastructural examination of the globules revealed multilamellated structures, characteristic of pulmonary alveolar proteinosis, in all cases. CONCLUSIONS: In general, it is thought that the morphological diagnosis of pulmonary alveolar proteinosis from bronchoalveolar lavage specimens requires both cytological and ultrastructural examination. However, the amorphous globules evident on cytology smears proved to contain multilamellated structures so that they can themselves be used as diagnostic evidence.Keywords
This publication has 9 references indexed in Scilit:
- Bronchoalveolar Lavage Cytology in Pulmonary Alveolar ProteinosisAmerican Journal of Clinical Pathology, 1996
- Secondary alveolar proteinosis is a reversible cause of respiratory failure in leukemic patients.American Journal of Respiratory and Critical Care Medicine, 1994
- Cytology of Bronchoalveolar Lavage In Some Rare Pulmonary Disorders: Pulmonary Alveolar Proteinosis and Amiodarone Pulmonary ToxicityCytopathology, 1994
- Pulmonary alveolar proteinosis. A cytomorphological histochemical and ultrastructural study of one case.1989
- Ultrastructural, histochemical, and freeze‐fracture evaluation of multilamellated structures in human pulmonary alveolar proteinosisJournal of Anatomy, 1987
- The recognition of Pneumocystis carinii in routine Papanicolaou-stained smears.1985
- Fluorescence of Pneumocystis carinii in papanicolaou smearsHuman Pathology, 1984
- Multilamelled structures from the lungs of patients with pulmonary alveolar proteinosis.1984
- Pulmonary Alveolar ProteinosisNew England Journal of Medicine, 1958