184 Cytology of Organ Biopsies and Exudates

Branchial Cysts and Bronchoalveolar

Lavage

Branchial Cysts

A (usually unilateral) swollen neck nodule below the mandibular angle that feels firm to pressure, but is without external signs of inflammation, should suggest the presence of a branchial cyst. Surprisingly, aspiration usually produces a brownish-yellow liquid. In addition to partially cytolysed granulocytes and lymphocytes (cell detritus), a smear of this liquid, or the centrifuged precipitate, shows cells with small central nuclei and wide light cell centers which are identical to epithelial cells from the floor of the mouth. Biopsies from a soft swelling around the larynx show the same picture; in this case it is a retention cyst from another developmental remnant, the ductus thyroglossus.

Cytology of the Respiratory System,

Especially Bronchoalveolar Lavage

Through the development of patient-friendly endoscopic techniques, diagnostic lavage (with 10–30 ml physiological saline solution) and its cytological workup are now in widespread use. This method is briefly mentioned here because of its broad interest for all medical professionals with an interest in morphology; the interested reader is referred to the specialist literature (e.g. Costabel, 1994) for further information. Table 31 lists the most important indications for bronchoalveolar lavage.

Table 31 Clinical indications for bronchoalveolar lavage (according to Costabel 1994)

Interstitial infiltrates	Alveolar infiltrates	Pulmonary infiltrates in
		patients with immune
		deficiency
Sarcoidosis (Boeck disease)	Pneumonia	HIV Infection
Exogenous allergic alveolitis	Alveolar hemorrhage	Treatment with cytostatic
Drug-induced alveolitis	Alveolar proteinosis	agents
Idiopathic pulmonary fibrosis	Eosinophilic pneumonia	Radiation sickness
Collagen disease	Obliterating bronchiolitis	Immunosuppressive therapy
Histiocytosis X		Organ transplant
Pneumoconioses
Lymphangiosis carcino-
matosa

Accessible cysts (e.g., branchial cysts) should be aspirated. Bronchial lavage is a cytological new discipline

a
b
c	d

Fig. 66 Cyst biopsy and bronchoalveolar lavage. a Cytology of a lateral neck cyst: no lymphatic tissue, but epithelial cells from the floor of the mouth. b Normal ciliated epithelial cells with typical cytoplasmic processes. c Tumor cell conglomeration in small-cell bronchial carcinoma: conglomeration is typical of tumor cells. d Bronchoalveolar lavage in purulent bronchitis: a macrophage with pigment inclusion (arrow) is surrounded by segmented neutrophilic granulocytes.

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