Eosinophilic Globules in Bronchoalveolar Lavage Fluid of Patients With Systemic Sclerosis-Related Interstitial Lung Disease: A Diagnostically Useful, Previously Unreported Finding

Giulio Rossi, MD; Alessandro Andreani, MD; Paola Morandi, MD; Alessandro Marchioni, MD; Paolo Corradini, MD; Gaia Cappiello, MD; Monica Bortolotti, MD; Ardian Qosja, MD; Carlo Manzini, MD; Clodoveo Ferri, MD; Luca Richeldi, MD; Alberto Cavazza, MD


Am J Clin Pathol. 2008;130(6):927-933. 

In This Article

Abstract and Introduction

Bronchoalveolar lavage (BAL) is a minimally invasive method possibly representing a diagnostic tool in the evaluation of interstitial lung diseases (ILDs) of different causes. We first describe herein the morphologic, histochemical, and immunohistochemical features of previously unreported eosinophilic globular deposits of acellular amorphous material of uncertain nature in a relatively large series of 227 BAL samples obtained from patients with various ILDs. Overall, eosinophilic globules were detected in 18 cases (7.9%), 16 of which were in patients with systemic sclerosis (SSc)-related ILD (16/50 [32%]) and in 2 cases of apparently idiopathic usual interstitial pneumonia. Apart from the possible diagnostic information of this finding, in patients with SSc, the globules were significantly related to BAL neutrophilia or eosinophilia and extensive ILD in high-resolution computed tomography (P < .0001). Differential diagnosis with other types of acellular globular materials observed in BAL samples is also discussed.

Interstitial lung diseases (ILDs) may be idiopathic or sustained by a broad spectrum of causes, such as infectious agents, drug toxicity, fume inhalation, collagen-vascular diseases (CVDs), hypersensitivity pneumonia (HP), sarcoidosis, vasculitides, and neoplasms.[1] Diagnosis of ILD requires integration of clinical, laboratory, radiologic, and histopathologic features. In ILD assessment, bronchoalveolar lavage (BAL) fluid examination is a minimally invasive and routinely performed step.[2,3,4,5] BAL is often used to rule out some infections (Pneumocystis, mycobacteria, viruses, fungi, Nocardia) and cancer or to identify diagnostic acellular components (eg, asbestos bodies, alveolar hemorrhage, and alveolar proteinosis [AP]).[6,7,8,9] The cell count on BAL specimens is operator-dependent and usually performed by properly trained cytotechnologists or biologists. Although the differential cell count seems to be a helpful parameter for discriminating usual interstitial pneumonia (UIP) from nonspecific interstitial pneumonia (NSIP),[3,4,5,10] controversial results have been reported on the prognostic value of the differential cell count in some systemic diseases involving the lungs, such as systemic sclerosis (SSc).[11,12,13,14,15]

In daily practice, we recently observed in BAL samples the presence of round, globular deposits of eosinophilic, homogeneous, amorphous material in a subset of patients with ILD secondary to SSc. To the best of our knowledge, this preliminary observation has not been described in the literature.

We report the morphologic, histochemical, and immunohistochemical features of these unusual BAL deposits and describe our analysis of the possible diagnostic and prognostic value of their presence in a relatively large series of patients with ILDs of various causes.


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