THE CYTOLOGIC FEATURES OF WEGENERS GRANULOMATOSIS

To evaluate the role of cytopathology and its different sampling techn iques in the diagnosis of Wegener's granulomatosis, we retrospectively reviewed 52 cytologic specimens from 21 patients with an established diagnosis of Wegener's granulomatosis. The smear background cellular c omposition, and accompanying reactive changes were evaluated. The majo rity of the smears were characterized by a bloody background with necr otic debris and extensive acute inflammation. Large sheets of exfoliat ed reactive pneumocytes and bronchial epithelium were commonly present . Multinucleated giant cells and epithelioid histiocytes were present in 10 and 20 specimens, respectively. Numerous hemosiderin-laden histi ocytes were present in variable numbers in most cases and were abundan t in 15 cases. Bronchial brush and lavage were the best sampling techn iques. Although fine-needle aspiration best demonstrated the granuloma s, only 2 of the 6 aspirates were diagnostic. The combination of cytol ogic findings, negative cultures, and elevated titers of antineutrophi l cytoplasmic antibody with a cytoplasmic pattern may serve to establi sh a presumptive diagnosis of Wegener's granulomatosis.