College of American Pathologists
Printable Version

  PAP/NGC Program Review





cap today

May 2002
Q & A

Q.  We disagree with your diagnosis on the bronchial alveolar lavage case. The fluid is supposed to have PCP, which we cannot find even after careful review of the slide. The slide has very few cells. We would call this slide unsatisfactory.

A.  This type of comment has come up many times under a variety of circumstances. Whenever the slide quality is compromised, the committee will remove it from circulation. This is much easier to determine than the question posed by this participant, that is, unsatisfactory because the slide is paucicellular. Marked decreased cellularity could make the evaluation challenging, but it does not necessarily make the smear unsatisfactory. Each smear must be viewed in the clinical context. Rare cytologic findings can be important to a proper diagnosis.

We reviewed this bronchial alveolar lavage fluid with the given history of an HIV-positive adult male with bilateral lung infiltrates. Although the committee agreed with the participant that the slide was paucicellular, there were rare fluffy exudates characteristic of Pneumocystis carinii. Followup information was that a GMS stain confirmed the diagnosis of PCP. Other laboratories in the non-gyn program had also made the correct diagnosis of PCP.

Conclusion: The slide continues to circulate in the program because it is challenging and valuable for education.

Mike Schulte, MD
Department of Pathology
St. Michael Hospital
Milwaukee, Wis.