Australian Society of Cytology

CEC Resources

Journal Based Learning - Quiz

Bronchioloalveolar carcinoma: diagnostic pitfalls and immunocytochemical contribution.
Saleh HA et al, Diagn Cytopathol. 1998;18:301-306.

1. Conventional lung adenocarcinoma (CLA) and bronchioloalveolar (BAC) have a different biological and clinical prognosis.
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2. Nuclei of BAC are pleomorphic with coarsely dispersed chromatin.
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3. Non-mucinous forms of BAC exhibits tight papillary clusters with smaller cuboidal cells having dense basophilic cytoplasm.
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4. Nucleoli are infrequent in the mucinous variant of BAC.
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5. Most cases of CLA and BAC are positive for CEA.
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6. Most cases of BAC exhibit positive staining for p53.
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7. Benign reactive bronchial epithelial cells and type II pneumocytes are negative for p53.
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8. There is evidence that BAC originates from clara cells and type II pneumocytes.
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9. BAC tends to be more centrally located and is more easily diagnosed by fibreoptic bronchoscopy.
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10. The differential diagnosis of BAC includes reactive bronchial or alveolar cells and well differentiated bronchogenic adenocarcinoma.
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11. Pulmonary hyperplastic lesions are more commonly associated with tissue fragments, "tenacious cytoplasmic borders" and intranuclear cytoplasmic inclusions compared with BAC.
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12. Numerous pleomorphic single tumour cells, prominent nucleoli and less "depth of focus" are the characteristics that favour bronchogenic adenocarcinoma.
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13. Papillary groupings are more commonly seen in BAC than bronchogenic adenocarcinoma.
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14. A diagnosis of metastatic renal (clear cell) carcinoma (RCC) versus BAC can be suggested on the basis of staining with vimentin.
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15. Pulmonary sclerosing hemangioma (PSH) can mimic BAC on FNA. The presence of a two cell population in this lesion is helpful in diagnosis. The two cell population comprises stromal and malignant alveolar cells.
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