MULTIVESICULATED MACROPHAGES - THEIR IMPLICATION IN FINE-NEEDLE ASPIRATION CYTOLOGY OF LUNG MASS LESIONS

Alveolar macrophages are almost invariably present in percutaneous fin e-needle aspiration cytology of the lung. They may predominate. appear foamy and finely vesiculated, or may reflect the cellular composition of the lung mass lesion. In a review of 172 cases of ''negative for m alignant cells ''from the percutaneous lung fine-needle aspiration cyt ology file in an 8-year period at Hines VA Hospital, the vacuolated ma crophages were evaluated qualitatively and quantitatively. Among the 5 3 cases (34%) showing vacuolated macrophages, only 5-25% of the cells were multivesiculated, the cytoplasmic vacuoles were few focal, and oc casionally global, and the majority of the vacuolated macrophages cont ained anthracotic or hemosiderin pigments. One case exhibited striking multivesiculation in at least 95% of macrophages and also in bronchia [ and alveolar cells, fibroblasts, and endothelial and inflammatory ce lls, a finding consistent with amiodarone toxicity (index case 1). The diagnosis was confirmed on subsequent transbronchial hmg biopsy In an other patient with clinical HIV infection, the multivesiculation was a lso seen in 95% of the macrophages with associated acute inflammatory exudate, coccobacilli, and a positive culture for Rhodococcus equi tin der case 2). in most cases, the vacuolated macrophages are reactive an d inflammatory. Occasionally, as in our index cases they may actually indicate a specific diagnosis. Diagn. Cytopathol. 1998;19:98-101. (C) 1998 Wiley-Liss, Inc.