Pulmonary microvascular cytology in the diagnosis of lymphangitic carcinomatosis
| Autor: | Richard G. Masson, Jacqueline McGrath, John G. Krikorian, Gerald L. Evans, Peter Lukl |
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| Rok vydání: | 1989 |
| Předmět: |
Male
medicine.medical_specialty Pathology Lung Neoplasms Cytological Techniques Lung biopsy Pulmonary Artery Metastasis Catheterization Diagnosis Differential medicine.artery medicine Carcinoma Humans Lung Aged Aged 80 and over Staining and Labeling Pulmonary Infarction business.industry Microcirculation Respiratory disease General Medicine Middle Aged medicine.disease Neoplastic Cells Circulating medicine.anatomical_structure Lymphangitic Carcinomatosis Pulmonary artery Female Radiology business Pulmonary Embolism Megakaryocytes |
| Zdroj: | The New England journal of medicine. 321(2) |
| ISSN: | 0028-4793 |
| Popis: | The diagnosis of lymphangitic spread of carcinoma in the lungs is sometimes difficult. We studied the cytologic characteristics of blood drawn through a wedged pulmonary-artery catheter from eight patients in whom lymphangitic carcinomatosis was confirmed by subsequent autopsy, lung biopsy, or clinical evaluation. The sites of the primary tumors were the prostate, breast, esophagus, and lung. Malignant cells were found in seven of the eight patients. Cytologic findings were normal in 16 of 17 patients with cancer but without pulmonary metastases and in 22 of 23 patients with nonmalignant pulmonary disorders. In a patient with cancer with tumor embolism to the lungs, the findings were positive, probably because of extensive intravascular tumor in large hepatic veins. One false positive finding occurred in a patient with extensive pulmonary infarction. Megakaryocytes, which are present in large numbers in the pulmonary capillary bed, are the hallmark of a satisfactory pulmonary vascular blood sample for pulmonary microvascular cytologic study. Familiarity with the cytologic characteristics of these cells in Papanicolaou preparations is essential to avoid mistakenly identifying them as malignant. Although transbronchial lung biopsy remains the diagnostic procedure of choice in this disorder, our findings suggest that the presence of malignant cells in pulmonary microvascular-cytology preparations in patients with cancer and unexplained dyspnea constitutes presumptive evidence of lymphangitic carcinomatosis. Pulmonary microvascular cytology may be particularly valuable when lung biopsy is refused or is thought to be too hazardous. |
| Databáze: | OpenAIRE |
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