Color Atlas of Hematology - Practical Microscopic and Clinical ...

184Cytology of Organ Biopsies and ExudatesBranchial Cysts and BronchoalveolarLavageBranchial CystsA (usually unilateral) swollen neck nodule below the mandibular anglethat feels firm to pressure, but is without external signs of inflammation,should suggest the presence of a branchial cyst. Surprisingly, aspirationusually produces a brownish-yellow liquid. In addition to partially cytolysedgranulocytes and lymphocytes (cell detritus), a smear of this liquid,or the centrifuged precipitate, shows cells with small central nuclei andwide light cell centers which are identical to epithelial cells from the floorof the mouth. Biopsies from a soft swelling around the larynx show thesame picture; in this case it is a retention cyst from another developmentalremnant, the ductus thyroglossus.Cytology of the Respiratory System,Especially Bronchoalveolar LavageThrough the development of patient-friendly endoscopic techniques, diagnosticlavage (with 10–30 ml physiological saline solution) and its cytologicalworkup are now in widespread use. This method is briefly mentionedhere because of its broad interest for all medical professionals withan interest in morphology; the interested reader is referred to thespecialist literature (e.g. Costabel, 1994) for further information. Table 31lists the most important indications for bronchoalveolar lavage.Table 311994)Clinical indications for bronchoalveolar lavage (according to CostabelInterstitial infiltrates Alveolar infiltrates Pulmonary infiltrates inpatients with immunedeficiencySarcoidosis (Boeck disease)Exogenous allergic alveolitisDrug-induced alveolitisIdiopathic pulmonary fibrosisCollagen diseaseHistiocytosis XPneumoconiosesLymphangiosis carcinomatosaPneumoniaAlveolar hemorrhageAlveolar proteinosisEosinophilic pneumoniaObliterating bronchiolitisHIV InfectionTreatment with cytostaticagentsRadiation sicknessImmunosuppressive therapyOrgan transplant