FINE-NEEDLE ASPIRATION CYTOLOGY OF BRONCHOCENTRIC GRANULOMATOSIS - A POTENTIAL DIAGNOSTIC PITFALL

Bronchocentric granulomatosis (BCTG) is a rare disease associated with bronchial asthma and bronchopulmonary aspergillosis. Idiopathic forms are rarely encountered. We report on a case of BCTG showing clinical, radiological, and cytological evidence suggestive of adenocarcinoma o f the lung. The patient is a 69-yr-old female, lifetime nonsmoker with multiple sclerosis who was admitted with a history of ascending chola ngitis. Admission chest X-ray documented a 1.5-cm nodule in the left u pper lobe of the lung. This was confirmed by CT scan. The lesion was s lowly growing. Bronchoscopic examination was normal. Bronchial brushin gs were inconclusive. A transthoracic fine-needle aspiration showed sh eets of highly atypical epithelium with occasional small dyshesive clu sters. There was an inflammatory background that was believed to repre sent tumor diathesis. The cytological interpretation was ''suspicious for adenocarcinoma.'' The patient underwent left upper lobectomy. The lung showed multiple peribronchial granulomas with intense peribronchi al lymphoid infiltrate extending into the bronchial mucosa, causing cy tological atypia and focal ulceration. Special stains for microorganis ms were negative. The patient recovered from surgery and shows no sign s of infection. We conclude that BCTG and related lesions can give cyt ological features that are suggestive of malignancy. Cytological mater ial obtained from these lesions should be interpreted with caution. (C ) 1996 Wiley-Liss, Inc.