Cytodiagnostic aspects of bronchioloalveolar carcinoma manifesting with small cell morphology on respiratory specimens: a case report.
BACKGROUND
Exfoliation of bronchioloalveolar carcinoma (BAC) cells with small cell morphology in respiratory specimens can cause a diagnostic dilemma, particularly in patients with a history of bronchorrhea.


METHODS
A 59-year-old man presented with cough, breathlessness, and bronchorrhea. Clinically, he was diagnosed to have right-sided pulmonary consolidation. His sputum and bronchial washing specimens examined on multiple occasions revealed a varied number of single and loose aggregates of atypical cells, along with rare micropapillary and glandlike structures. The cells were small, round, and fairly monomorphic with a high nucleus to cytoplasm ratio and scant to moderate cytoplasm. Chromatin was uniformly distributed, with no appreciable nucleoli. At places, a vague nuclear molding was noted. Clinically, bronchorrhea and the diffuse infiltrative nature of the lesion favored BAC. Cytologically, prominent small cell morphology and nuclear molding suggested a possibility of small cell neuroendocrine tumor. However, careful cytologic examination of subsequent respiratory samples and biopsy revealed features of a nonmucinous type of BAC.


CONCLUSIONS
Despite the small cell morphology of neoplastic cells on exfoliative respiratory cytology, a clinical history of bronchorrhea should prompt a cytodiagnosis of BAC. A glandlike arrangement of cells and greater amount of cytoplasm should also assist avoiding misinterpretation in such instances.
Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India. rajusiddaraju@yahoo.com
Neelaiah
N
Siddaraju
Gopi Krishna
GK
Yedlapati
Tanmaya
T
Talukdar
Vinod Kumar
VK
Saka
Femila
F
Padmavathy
Debdatta
D
Basu
D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000175:diagnosis* / Q000473:pathology*; D018288:Carcinoma, Small Cell / Q000175:diagnosis* / Q000473:pathology*; D002449:Cell Aggregation; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D013048:Specimen Handling; D013183:Sputum / Q000166:cytology*