{"id":45006,"date":"2025-08-05T13:38:10","date_gmt":"2025-08-05T05:38:10","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=45006"},"modified":"2025-08-05T16:35:08","modified_gmt":"2025-08-05T08:35:08","slug":"thor-4","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thor-4\/","title":{"rendered":"Mystery cases &#8211; Thoracic 4"},"content":{"rendered":"\n<h2>\n\t\tThoracic case 4\n\t<\/h2>\n\t<h1>Strange finding in a bronchoalveolar lavage fluid<\/h1>\n\t<p><strong>Clinical history:\u00a0<\/strong>A 50-year-old lady underwent bronchoscopy and bronchoalveolar lavage fluid was collected. What are the findings from the following images?<\/p>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THOR17.jpg\" alt=\"THOR17\" itemprop=\"image\" height=\"576\" width=\"768\" title=\"THOR17\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THOR18.jpg\" alt=\"Thoracic case 4\" itemprop=\"image\" height=\"576\" width=\"768\" title=\"THOR18\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THOR19.jpg\" alt=\"THOR19\" itemprop=\"image\" height=\"576\" width=\"768\" title=\"THOR19\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">Cytologic findings<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\nThere are several ovoid to rectangular lamellated bodies, with some cracking artifact. There are no striations to suggest skeletal muscle (from ingested meat), or definite cell wall-like structures (from ingested vegetable).\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-1\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-1\">Diagnosis<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-1\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\n<strong>Corpora amylacea<\/strong>\n<p>The objects seen are non-calcified, round lamellated bodies which would be consistent with corpora amylacea. Cracking artifact may be seen. They are normally found in alveolar spaces.<\/p>\n<em>What is the clinical significance of corpora amylacea?<\/em><br \/>\nPulmonary corpora amylacea is an incidental finding seen in patients of increasing age and its clinical significance is unknown.\n<em>What is the theory on the pathogenesis?<\/em><br \/>\nIn this particular study by Ohsutki et al., the core of pulmonary corpora amylacea was found to contain PAS-positive glycoproteins and the surfaces contain surfactant protein-A. The findings suggest formation of corpora amylacea likely begins as nidus-forming PAS-positive glycoproteins with concentric deposition of surfactant protein-A.\n<p>Ohtsuki, Y., Maeda, T., Soga, Y., Furuya, K., Okada, Y., Lee, G. H., &amp; Furihata, M. (2010). Case report: Immunohistochemical characterization of pulmonary corpora amylacea in an autopsy case, with special reference to its pathogenesis.<\/p>\n<em>Are these objects associated with degradation of epithelial cells?<\/em><br \/>\nThese objects are unlikely to have been derived from degradation of epithelial cells, although they have been found to stain superficially for EMA and KL-6 antigens, which are fundamental components of the surface of airways.\n<p>Ohtsuki, Y., Maeda, T., Soga, Y., Furuya, K., Okada, Y., Lee, G. H., &amp; Furihata, M. (2010). Case report: Immunohistochemical characterization of pulmonary corpora amylacea in an autopsy case, with special reference to its pathogenesis.<\/p>\n<em>Are these different from those commonly found in the prostate?<\/em><br \/>\nA comparative immunohistochemical study showed different constituents between corpora amylacea of different sites, suggesting the pathogenesis is dependent on local and not systemic factors.\n<p>R\u00f6cken, C., Linke, R. P., &amp; Saeger, W. (1996). Corpora amylacea in the lung, prostate and uterus: a comparative and immunohistochemical study.\u00a0Pathology-Research and Practice,\u00a0192(10), 998-1006.<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-2\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-2\">Differential diagnoses<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-2\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<p>What are some other objects that can be encountered in a bronchoalveolar lavage fluid specimen?<\/p>\n<table cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"top\">\n<p><strong>Objects<\/strong><\/p>\n<\/td>\n<td valign=\"top\">\n<p><strong>Description<\/strong><\/p>\n<\/td>\n<td valign=\"top\">\n<p><strong>Clinical associations<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">\n<p>Psammoma bodies<\/p>\n<\/td>\n<td valign=\"top\">\n<p>Lamellated calcifications<\/p>\n<\/td>\n<td valign=\"top\">\n<p>Neoplasms with papillary morphologies; association with surrounding neoplastic cells a key differentiating factor from microliths<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">\n<p>Microliths<\/p>\n<\/td>\n<td valign=\"top\">Lamellated calcifications<\/td>\n<td valign=\"top\">Autosomal recessive syndrome of pulmonary alveolar microlithiasis; corroborating clinical history is important<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">\n<p>Food particles<\/p>\n<\/td>\n<td valign=\"top\">\n<p>Vegetable matter with refractive cell walls; fragments of skeletal muscle<\/p>\n<\/td>\n<td valign=\"top\">\n<p>Often oral contaminant but may be a result of aspiration<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">\n<p>Ferruginous bodies<\/p>\n<\/td>\n<td valign=\"top\">\n<p>Elongated iron-containing concretion<\/p>\n<\/td>\n<td valign=\"top\">\n<p>If present in large numbers, it is associated with asbestosis and increased risk of lung cancer and mesothelioma<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">\n<p>Charcot-Leyden crystals<\/p>\n<\/td>\n<td valign=\"top\">\n<p>Elongated diamond-shaped crystals formed from lysophospholipase of eosinophils<\/p>\n<\/td>\n<td valign=\"top\">\n<p>Increased eosinophil activity, as in asthma and eosinophilic pneumonia<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">\n<p>Curschmann spiral<\/p>\n<\/td>\n<td valign=\"top\">\n<p>Spiral-shaped aggregates of mucus, derived from the sub epithelial mucus ducts<\/p>\n<\/td>\n<td valign=\"top\">\n<p>Excess of mucus, classically present in asthma<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><em>Table adapted from Diagnostic Cytopathology, 2nd Edition by Mody et al.<\/em><\/p>\n\t<p><em>Case writer: Dr Noel Chia<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>Thoracic case 4 Strange finding in a bronchoalveolar lavage fluid Clinical history:\u00a0A 50-year-old lady underwent bronchoscopy and bronchoalveolar lavage fluid was collected. What are the findings from the following images? Cytologic findings Expand &nbsp; There are several ovoid to rectangular lamellated bodies, with some cracking artifact. There are no striations to suggest skeletal muscle (from [&hellip;]<\/p>\n","protected":false},"author":828,"featured_media":0,"parent":44933,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-45006","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NUS Pathweb<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thor-4\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"Thoracic case 4 Strange finding in a bronchoalveolar lavage fluid Clinical history:\u00a0A 50-year-old lady underwent bronchoscopy and bronchoalveolar lavage fluid was collected. 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