Macroscopy: Bronchoalveolar lavage - 5ml of blood-stained fluid. Cellblock prepared.
Microscopy: The prepared smears are cellular and contain low numbers of a predominantly dispersed population of atypical cells which possess enlarged hyperchromatic nuclei with irregular nuclear contours and variably prominent nucleoli. Binucleate forms are frequently observed. The cells possess a moderate amount of cytoplasm which is occasionally granular with fine vacuolisation. Occasional atypical cohesive clusters are seen, but there is no gland formation identified. There is no keratin identified. Unequivocal pigment is not identified. Pulmonary macrophages and the bronchial epithelium are seen in the background and no fungi identified. There is no acute inflammation or granulomatous inflammation identified. Small numbers of benign squamous cells are also present.
Very small numbers of atypical cells are present in the cell block demonstrating a similar morphology and may be insufficient for adequate assessment by immunohistochemistry which is being attempted. A separate report will be issued if contributory.
Conclusion: Bronchoalveolar lavage: Suspicious for malignancy; see comment below.
Comment: Small numbers of atypical cells are identified which are suspicious for malignancy. Limited material is present in the cell block which may be insufficient for further assessment. Immunohistochemistry is being attempted and a supplementary report will be issued if contributory.