Pulmonary lymphangiomyomatosis diagnosed by effusion cytology. A case report

BACKGROUND

Pulmonary lymphangiomyomatosis (P-LAM) is a rare disease, characterized by an abnormal proliferation of smooth muscle throughout the lung and occurring in females of reproductive age. The typical clinical picture in P-LAM is progressive dyspnea, often punctuated by episodes of chylothorax or pneumothorax, with eventual death from respiratory failure. The definitive diagnosis is usually performed on open lung biopsies.

CASE

The cytologic findings in a chylous pleural effusion from a patient with P-LAM are presented. The effusion contained an abundance of globular cell clusters composed of two distinct cell types, inner core spindle cells and surface flat cells. Immunocytochemical examination revealed that the core cells were derived from immature smooth muscle cells and the surface cells from endothelium. Histologic examination of the excised specimen showed the typical findings of P-LAM, and the dilated peripheral lymphatics contained cell clusters similar to those in the pleural effusion. The cell clusters in the lymphatics in the P-LAM lung tissue appeared to have ruptured into the thoracic cavity.

CONCLUSION

Cell clusters seem to be pathognomonic of P-LAM, and cytologic examination can obviate the need to perform open lung biopsy to confirm the diagnosis.

Double primary lung cancers: with special reference to their exfoliative cytology and to the rare, malignant "mixed" tumor of the salivary-gland type

Two autopsy cases are reported in which double primary cancers of the lung had been strongly or definitely suspected before death by demonstration of two different types of malignant cells in the sputum as well as in smears of aspirates from pleural fluid and/or mediastinal tumor. By exfoliative cytology, one case was characterized by carcinoma cells of the small-cell type plus the large-cell and/or adenocarcinoma type; the other displayed small-cell-type and squamous-cell-type malignant cells. The autopsies definitely revealed in the first case an anaplastic carcinoma of the small-cell type in the left bronchus and a salivary-gland-type malignant "mixed" tumor in the right lower lobe and in the second case an anaplastic carcinoma of the small-cell type in the right upper lobe and a squamous-cell carcinoma in the left upper lobe. The frequence of occurrence and pathologic diagnosis of double primary lung cancers are reviewed and discussed. A rare type of lung cancer, salivary-gland-type malignant "mixed" tumor, is given special reference.