Chest
Volume 87, Issue 1, January 1985, Pages 129-131
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Bronchoalveolar Lavage in Lymphangitic Spread of Adenocarcinoma to the Lung

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We report the results of bronchoalveolar lavage in a patient who had pulmonary lymphangitic spread of adenocarcinoma from an unknown primary. The lavage specimen was remarkable for a large increase in the number of lymphocytes. This observation extends the differential diagnosis of a lymphocyte-predominant lavage specimen. The recovery of large numbers of lymphocytes associated with malignancy in this case suggests that bronchoalveolar lavage may also be useful to study aspects of the immune response to interstitial lymphangitic spread of malignancy to the lung.

Section snippets

CASE REPORT

A 58-year-old physician underwent fiberoptic bronchoscopic examination with bronchoalveolar lavage (BAL) and transbronchial biopsy for evaluation of an abnormal chest roentgenogram and a six-week history of dyspnea and nonproductive cough. He was taking no medicines prior to the onset of these symptoms and experienced no improvement following one week of tetracycline administration. He had not smoked cigarettes in eight years, and gave no history of exposure to toxic fumes, allergens,

DISCUSSION

In normal smoking and nonsmoking subjects, lymphocytes comprise less than 10 percent of BAL cells.1,2 An elevated percentage of lymphocytes on BAL has primarily been associated with granulomatous lung diseases and hypersensitivity pneumonitis.1, 2, 3, 4 These disorders were unlikely in our patient in view of his history, physical examination, laboratory evaluation and results of bronchoscopically obtained biopsies, and culture data. The marked elevation of lymphocytes on BAL from our patient is

ACKNOWLEDGMENT

The authors wish to thank David Shayne for his excellent technical assistance.

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