title: Ultrastructural abnormalities of respiratory cilia: a 25-year experience.
abstract: BACKGROUND
  Ciliary dyskinesia is a rare, but significant, cause of chronic respiratory infections, and transmission electron microscopy is a critical adjunct to making the diagnosis.
  
  
  OBJECTIVE
  To investigate a single institution's experience with patients demonstrating abnormal ciliary ultrastructure.
  
  
  METHODS
  Retrospective clinicopathologic review of 278 bronchial or nasal turbinate brushings or biopsies from 1983 through 2007.
  
  
  RESULTS
  There were 12 women and 9 men (mean age, 19.6 years; range, 1-54 years) with abnormal ciliary ultrastructure. Clinical history was unavailable in 3 patients, 15 (83%) of 18 patients presented with chronic or recurrent upper respiratory infections, and 3 (17%) presented with infertility. Seven (39%) of 18 patients had findings of Kartagener syndrome with situs inversus, dextrocardia, and bronchiectasis. Truncation or absence of inner or outer dynein arms occurred in 15 (71%) of 21 cases, and 5 (24%) revealed transposition defects with displacement of the central microtubules and peripheral doublets in 9 + 0 and 8 + 1 patterns. Radial spoke defects with microtubular disarray occurred in 4 (19%) of 21 cases. Compound cilia with multiple axonemes within a single outer sheath and supernumerary microtubules each occurred in 2 (10%) of the cases. Random ciliary orientation was also found in 2 (10%) of the cases, and dense granular basal body inclusions occurred in 1 case (5%). Multiple abnormalities occurred in 6 (29%) of the 21 cases.
  
  
  CONCLUSIONS
  Most patients presented with chronic respiratory tract infections or infertility. Dynein arm defects, transposition defects, and radial spoke defects were the most commonly encountered abnormal findings. Less-frequent abnormal findings included compound cilia, supernumerary microtubules, and dense granular basal body inclusions.
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Plesec
authors.forename: Angela
authors.initials: A
authors.lastname: Ruiz
authors.forename: James T
authors.initials: JT
authors.lastname: McMahon
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prayson
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D001980:Bronchi / Q000473:pathology / Q000648:ultrastructure*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D002923:Cilia / Q000648:ultrastructure*; D004398:Dyneins / Q000648:ultrastructure*; D005260:Female; D006801:Humans; D007223:Infant; D007246:Infertility / Q000473:pathology; D007619:Kartagener Syndrome / Q000150:complications / Q000175:diagnosis / Q000648:ultrastructure; D008297:Male; D008870:Microtubules / Q000648:ultrastructure*; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology / Q000648:ultrastructure; D012141:Respiratory Tract Infections / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D004398:Dyneins