PULMONARY ALVEOLAR PROTEINOSIS - DIAGNOSIS USING ROUTINELY PROCESSED SMEARS OF BRONCHOALVEOLAR LAVAGE FLUID

Aims-For the diagnosis of pulmonary alveolar proteinosis from bronchoa lveolar lavage specimens it is normally necessary to make an ultrastru ctural examination. However, this is thought to be impractical for bro nchoalveolar lavage specimens that have been routinely fixed in ethano l. In the present study, bronchoalveolar lavage cytology smears on sli de glasses were examined directly ultrastructurally to make a diagnosi s of pulmonary alveolar proteinosis. Methods-Bronchoalveolar lavage sm ears from three pulmonary alveolar proteinosis patients were stained w ith Papanicolaou and periodic acid-Schiff (PAS) for identification of amorphous globular structures. Subsequently, they were refixed with gl utaraldehyde and osmium tetroxide, and embedded in epoxy resin. Ultrat hin sections were cut and examined ultrastructurally. Results-Papanico laou stained specimens from pulmonary alveolar proteinosis patients co ntained scattered amorphous or granular globules, 20-50 mu m in diamet er, which were PAS positive. Ultrastructural examination of the globul es revealed multilamellated structures, characteristic of pulmonary al veolar proteinosis, in all cases. Conclusions-In general, it is though t that the morphological diagnosis of pulmonary alveolar proteinosis f rom bronchoalveolar lavage specimens requires both cytological and ult rastructural examination. However, the amorphous globules evident on c ytology smears proved to contain multilamellated structures so that th ey can themselves be used as diagnostic evidence.