Cytologic findings in allogeneic and autologous bone marrow transplant patients with pulmonary symptoms: A 9-year follow-up study

Objective: To evaluate cytologic findings in patients who underwent bone marrow transplant (BMT) and correlate with the clinical, radiologic and histologic findings. Study Design: Cytologic findings of the BMT patients with pulmonary symptoms from 1998 to 2007 were reviewed for the presence of malignancies, infectious organisms, inflammation and reactive changes, including treatment-related cellular atypia. Corresponding clinical history, radiologic findings and histologic follow-up when available were also reviewed. Results: In 313 patients who underwent BMT, 89 (71 allogeneic, 18 autologous) had pulmonary symptoms. Of these, 47 specimens from 28 patients had abnormal cytologic findings. Reactive bronchial epithelial cells were found in 4 specimens and reactive squamous cells in 1 specimen. Four patients had markedly atypical cells in 4 specimens - atypical epithelial and mesothelial cells in 3 and 1 specimens, respectively. No malignancy was seen in any specimens examined. Acute inflammation was present in 6 specimens. Candida was the most common microorganism found (21 specimens). The cytologic findings were felt to correlate with clinical and radiologic findings and histologic follow-up. Conclusion: Clinical and radiologic correlation and awareness of the range of cellular atypia are important for preventing potential diagnostic pitfalls and establishing an accurate cytologic diagnosis in BMT patients.