title: Bronchoalveolar lavage fluid analysis provides diagnostic information on pulmonary Langerhans cell histiocytosis.
abstract: Histiocytes of Langerhans cell type are recovered from the bronchoalveolar lavage fluid (BALF) of patients with interstitial lung diseases in a nonspecific manner. Langerhans cells (LCs) can be identified through immunostaining for S-100, CD1a, and, more specifically, langerin. To evaluate the diagnostic value of BALF in pulmonary Langerhans cell histiocytosis (PLCH), we performed a retrospective clinicopathological study of 5 patients with biopsy-confirmed PLCH or Hand-Schüller-Christian disease involving the lung. As a control study, we examined BALF cells from 23 patients with various diseases, including sarcoidosis, hypersensitivity pneumonitis, collagen vascular disease, idiopathic pulmonary fibrosis, and adenocarcinoma of the lung. Cytospins obtained from BALF were stained with Giemsa or Papanicoloau and others were immunostained. In general, cytospins showed a monomorphous and dispersed cell population containing mononucleated or binucleated and occasionally multinucleated histiocytes. LCs recovered from BALF were characterized by clear and velvety cytoplasm; oval or kidney-shaped, vesicular nuclei with irregular shapes; nucleoli; and frequent grooves and indentations. Radiography and high-resolution computed tomography showed multiple bilateral nodular or cystic lesions in the middle and upper lung zones. The mean percentage of LCs in 9 lavages from the 5 patients was 8.0%, whereas that from the control group was only 0.3% (maximum, 1.6%). The percentage of cells positive for S-100 or CD1a was comparable to the percentage of Langerhans-like histiocytes stained with Giemsa stain. The present results indicate that the survey of LCs in BALF with the aid of immunocytochemical evaluation and corresponding clinical data could play a critical role in establishing the diagnosis of PLCH, thus providing a less invasive approach than lung biopsy, which carries a risk of complications.
authors.affiliation: Department of Molecular Pathology, Graduate School of Medicine, Nippon Medical School, Kawasaki, Kanagawa, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Takizawa
authors.forename: Namiko
authors.initials: N
authors.lastname: Taniuchi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ghazizadeh
authors.forename: Tatsuji
authors.initials: T
authors.lastname: Enomoto
authors.forename: Masashi
authors.initials: M
authors.lastname: Sato
authors.forename: Enjing
authors.initials: E
authors.lastname: Jin
authors.forename: Arata
authors.initials: A
authors.lastname: Azuma
authors.forename: Akihiko
authors.initials: A
authors.lastname: Gemma
authors.forename: Shoji
authors.initials: S
authors.lastname: Kudoh
authors.forename: Oichi
authors.initials: O
authors.lastname: Kawanami
mesh_terms: D000293:Adolescent; D000328:Adult; D015703:Antigens, CD; D018949:Antigens, CD1; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D005260:Female; D006644:Histiocytes; D006646:Histiocytosis, Langerhans-Cell / Q000175:diagnosis*; D006801:Humans; D007150:Immunohistochemistry; D037181:Lectins, C-Type; D008297:Male; D037241:Mannose-Binding Lectins; D008875:Middle Aged; D009418:S100 Proteins; D013194:Staining and Labeling; D055815:Young Adult
chemical_list: D015703:Antigens, CD; D018949:Antigens, CD1; C419393:CD1a antigen; C121916:CD207 protein, human; D037181:Lectins, C-Type; D037241:Mannose-Binding Lectins; D009418:S100 Proteins