Rounded atelectasis: diagnosis by fine-needle aspiration cytology

Our plain-English summary of Rounded atelectasis: diagnosis by fine-needle aspiration cytology, by W.T. Miller, P.K. Gupta, M.A. Grippi, et al (Diagnostic Cytopathology, 1992).

The study

• Authors: W.T. Miller, P.K. Gupta, M.A. Grippi, W.T. Miller
• Journal: Diagnostic Cytopathology
• Published: 1992;8(6):617-20
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Rounded atelectasis, a rare, benign mass lesion, is most often seen in association with asbestos-related pleural changes. Often a presumptive diagnosis can be made on the basis of characteristic CT and chest radiographic findings. However, not infrequently radiographic imaging fails to differentiate rounded atelectasis from primary bronchogenic carcinoma, a disease which is seen with increased frequency in patients with asbestos exposure. We describe two cases where the diagnosis of rounded atelectasis was made by fine-needle aspiration (FNA) cytology. The cytologic features included abundant pulmonary parenchymal material with thickened alveolar walls containing pulmonary macrophages and connective tissue. It is important to realize that this is a useful positive finding indicating rounded atelectasis, rather than a negative finding suggesting the absence of neoplasm. Needles with a cutting action may be necessary to obtain sufficient material to make the diagnosis of rounded atelectasis.

In plain English

This article was a report of two cases. Two men had masses in the lower lobe of a lung, and doctors needed to tell rounded atelectasis, a benign mass of collapsed lung, apart from lung cancer. Case 1 was a 75-year-old man with no known asbestos exposure and a 50 pack-year smoking history. His chest CT showed pleural disease on both sides and a nonspecific mass. Case 2 was a 65-year-old man with a 30 pack-year smoking history who had been exposed to asbestos as a construction worker. His CT showed bilateral pleural plaques and a mass suggestive of, but not diagnostic of, rounded atelectasis. Both had fine-needle aspiration. The samples looked similar in both cases: lung tissue with distinct air spaces and walls thickened by dense connective tissue. The authors concluded that, in the appropriate clinical situation, finding collapsed lung tissue in the sample should count as a positive diagnosis of rounded atelectasis, not just as an absence of cancer cells. They suggested that needles with a cutting action may be needed. They noted that no tissue feature distinguishes rounded atelectasis from other collapsed lung.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (two cases)
• Who was studied: Two men with lower lobe lung masses who underwent fine-needle aspiration. Case 1: a 75-year-old man with no known asbestos exposure, a 50 pack-year smoking history, left-sided pleuritic chest pain, a mass radiographically stable for 8 months, two normal bronchoscopies, and bilateral pleural disease on CT. Case 2: a 65-year-old man with a 30 pack-year smoking history and asbestos exposure as a construction worker, whose asymptomatic mass was found on an abdominal plain film. His CT showed bilateral pleural plaques. The authors were at the University of Pennsylvania Medical Center, Philadelphia.
• Exposure: Asbestos exposure as a construction worker in Case 2 (no fiber type given). Case 1 had no known asbestos exposure. Both were smokers.
• Main results:
  • The cytologic features of the aspirates were similar in both cases.
  • The aspirates showed distinct alveolar (air) spaces of somewhat varying size.
  • The alveolar walls were thickened with dense connective tissue, with few pulmonary macrophages.
  • In the paraffin-processed cell blocks, some septa appeared hyalinized and acellular. One case showed a focal accumulation of lymphoid mononuclear cells.
  • The authors suggested that the cutting action of the Wescott needle they used may be important for making the positive diagnosis.
• The authors' conclusion: The authors concluded that, in the appropriate clinical situation, the appearance of atelectatic lung in fine-needle aspiration specimens should be considered a positive diagnosis of rounded atelectasis. They described this as a more definitive result than the mere absence of cancer cells, and said needles with a cutting action may be necessary.
• Limitations the authors state:
  • The authors stated that no histologic feature distinguishes rounded atelectasis from other atelectatic lung, so clinical and radiographic characteristics are also essential.

Topics

Medical terms in this study, explained in our Lexicon: Rounded Atelectasis, Fine-Needle Aspiration, Cytology, Bronchogenic Carcinoma, Asbestos Exposure, Macrophage, Neoplasm.

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