Year
A 62-year-old man from Tamil Nadu presented with a six-month history of nocturnal cough with shortness of breath. He was previously diagnosed with chronic rhinosinusitis, and uncontrolled diabetes mellitus. Blood investigations revealed eosinophilia. A transbronchial lung biopsy revealed adenocarcinoma with mucinous features.
Cytological analysis of BAL sample is provided below.
- What is seen in the Gomorri-methenamine silver (GMS) stained BAL smear?
- What is the significance?
Figure: GMS stain of BAL sample, 40X (Source: Drs Meera Thomas and Reshma Kurian and evaluated with Dr Joy Sarojini, CMC, Vellore)
Answer
- What is seen in the Gomorri-methenamine silver (GMS) stained BAL smear?
The GMS stain shows a 105 µm long, thick-walled, structure with a tapering end suggestive of either plant or fungal material. Possible sources include food particles, cellulose fibers, or environmental contaminants that have been aspirated or inhaled. - What is the significance?
Plant or fungal material that was aspirated or inhaled and is probably an artifact with no clinical significance. In this instance a structure with irregular width and a tapering end with structures suggestive of plant cells were seen. In case of repeated isolation, with granulomatous inflammation aspiration-related complications can be considered.