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Context.-Cytologic examination of the respiratory tract has been a useful diagnostic tool when evaluating neoplastic lesions of the respiratory tract. However, we have limited experience in the application of this technique in the management of nonneoplastic occupational and environmental diseases of the lung and pleura. This review focuses on the cytologic characteristics of a variety of occupational lung diseases, grouping them into 2 broad diagnostic categories: reactive cellular changes and noncellular elements. The former includes entities such as reactive mesothelial proliferation, goblet cell metaplasia, Creola bodies, and reserve cell hyperplasia, and the latter encompasses Curschmann spirals, Charcot-Leyden crystals, and asbestos bodies.
Objective.-To illustrate the cytologic features of several nonneoplastic occupational and environmental diseases and correlate the cytology with various etiologic agents.
Data Sources.-Case-derived material and literature review.
Conclusions.-The role of cytology in the diagnosis of nonneoplastic occupational and environmental lung diseases is limited. This may be because more than one agent can elicit a similar host reaction and/or the offending agent can be associated with more than one pathologic process. However, in the appropriate clinical and radiographic setting, the cytology can render valuable diagnostic information. Examples include pulmonary alveolar proteinosis in patients with acute silicoproteinosis and asbestos bodies in bronchoalveolar lavage samples of patients with asbestos exposure.
(Arch Pathol Lab Med. 2007;131:1700-1708)
There are numerous occupational and environmental agents that can injure the lung and pleura. They include mineral dusts, gases and fumes, synthetic fibers, smoking, and air pollution. Table 1 lists many of the mineral dusts associated with occupational lung diseases. This review discusses the cytologic manifestations of a variety of occupational and environmental lung diseases, including mineral dust diseases, smoking, occupational asthma, drug-induced lung disease, and hypersensitivity pneumonitis (HP).
Whether we are discussing the histologic or cytologic features of occupational and environmental lung diseases, there are general clinical and diagnostic considerations that need to be addressed. It is desirable that one obtain a detailed occupational and exposure history. This should include the suspected agent(s), temporal sequence of the exposure with the onset of illness, and other risk factors (such as smoking) that may impact on the disease process. Radiologic assessment using criteria established by the International Labor Office1 is also important to determine the extent of parenchymal and pleural abnormalities. This classification...