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Respiratory Cytology

Techniques and Applications Fiber-Optic Bronchoscopy—Fact Sheet Indications for Fiber-Optic Bronchoscopy ▪ Persistent cough ▪ New solitary pulmonary nodule ▪ Persistent chest radiographic infiltrate ▪ Hemoptysis ▪ Bronchial obstruction ▪ Atelectasis ▪ Persistent localized wheezing ▪ Confirmation of abnormal sputum cytology The major role of respiratory cytology is in diagnosis of malignant neoplasms involving the lung, both primary and metastatic. Cytologic techniques are also useful for staging…

Pulmonary Manifestations of Systemic Diseases

Introduction Many systemic diseases are associated with lung or pleural injury, either as a component of the disease itself or as a consequence of other types of injury induced by the disease or its treatment. This chapter focuses on systemic diseases that can involve the lung or pleura as a direct component of the disorder. Secondary lung disease can develop as an immunologic or inflammatory reaction…

Inflammatory and Fibrosing Pleural Processes

Organization of Pleural Effusion Organization of Pleural Effusion—Fact Sheet Definition ▪ Nonspecific repair reaction of an exudative or bloody pleural effusion Clinical Features ▪ Symptoms are related to the primary disease or the presence of fluid and include cough, chest pain, sputum production, and varying degrees of shortness of breath Prognosis and Therapy ▪ The course of the effusion depends on its etiology and the responsiveness…

Pleural Involvement by Extrapleural Neoplasms

Introduction Over 150,000 malignant pleural effusions occur each year in the United States, the majority of which result from pleural involvement by extrapleural malignancies. Although pleural involvement generally occurs at an advanced stage of disease, in some cases symptoms related to pleural involvement are the presenting manifestation of the neoplastic process. Occasionally, it is difficult to determine the site of origin of pleural metastases; in as…

Primary Pleural Neoplasms

Introduction In contrast to the common pleural metastases from pulmonary and extrapulmonary malignancies, primary tumors of the pleura constitute a relatively rare group of benign and malignant neoplasms, with different pathways of differentiation and histogenesis reflecting the complexity of the serosal membrane lining the thoracic cavity. The pleura contains not only a mesothelial lining but also a subjacent matrix of elastic fibroconnective tissue containing blood vessels,…

Benign Neoplasms of the Lungs

Benign Mesenchymal Neoplasms Not surprisingly, the lung is a source of virtually all described mesenchymal tumors. Although leiomyomas, schwannomas, lipomas, neurofibromas, hemangiomas, and lymphangiomas can originate in the lung, one should be certain that such lesions are not metastatic low-grade sarcomas, especially the smooth muscle tumors. Pulmonary hamartomas are the most common benign lung tumors and warrant further discussion. Chondromas are discussed within the differential diagnosis…

Precursors of Malignancy

Introduction There are several pulmonary diseases discussed elsewhere in this book that, among the many effects they have upon the patient, convey a recognized predisposition to lung cancer development. These diseases include many forms of diffuse pulmonary fibrosis (idiopathic pulmonary fibrosis, connective tissue disease–associated pulmonary fibrosis, asbestosis), congenital adenomatoid malformations, juvenile tracheobronchial squamous papillomatosis, pleomorphic adenoma, and other acquired and congenital cystic lung lesions. Readers are…

Pulmonary Involvement by Extrapulmonary Neoplasms

Introduction Metastases to the lung are the most common malignancy, with incidence ranging from 30% to 55% in various series. This is not surprising because the entire cardiac output and lymphatic fluid produced by the body flow through the pulmonary vascular system. If direct invasion of lung and trachea is included, then the incidence is even higher. In autopsy series, the most common primary sites with…

Unusual Primary Malignant Lung Neoplasms

Introduction A variety of uncommon or rare tumors develop in the lung, with incidence rates of 1 in 100,000 people or fewer. For this group of neoplasms, most published accounts take the form of case reports and small series. Given the unusual nature of these processes, it is likely that some examples will be classified as other, more common, types of neoplasms due to lack of…