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Advances in Anatomic Pathology:
doi: 10.1097/PAP.0b013e318229bfcd
Letter to the Editor

Detached Respiratory Cilia: An Organism Mimicker in BAL Specimens

Almarzooqi, Saeeda MBBS; Kahwash, Samir B. MD

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Department of Pathology, Nationwide Children's Hospital, Columbus, OH

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To the Editor:

We encountered a case of a 13-year-old boy with a history of refractory asthma and eosinophilic esophagitis, who underwent a bronchoalveolar lavage. Stained cytospin slides demonstrated a mixed inflammatory infiltrate, ciliated respiratory epithelial cells, and areas showing numerous filamentous rod-like structures in the background mucus. The inflammatory infiltrate was composed of lymphocytes (47%), macrophages (40%), eosinophils (8%), and neutrophils (5%). The background showed variable numbers of free floating filamentous structures that resembled bacterial bacilli in size and shape. In fields in which these structures were close to tufts of cilia on intact cells, they appeared similar in dimensions and staining characteristics (Fig. 1B). Additional search revealed areas where some of these filaments showed a terminal bulge consistent with a terminal bars (Fig. 1C). Special stains including a Gram stain and Gomori-Methenamine-Silver were negative in these structures (Fig. 1D show Gram-stained cytospin). We concluded that these structures represent detached scattered individual cilia separated from the respiratory epithelium. Microbiological culture that revealed no growth supports this conclusion.

Figure 1
Figure 1
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Ciliocytophthoria or detached ciliary tufts of respiratory epithelium have been mentioned in the literature as mimickers of ameboflagellate.1 The identification of the terminal bar of respiratory cilia, lack of perinuclear halo, and straight cilia of same length in contrast to wavy flagella of different length are some helpful features to differentiate the two entities.

Awareness of this morphologic mimicker will help in avoiding diagnostic errors and/or unnecessary work up.

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1. Ribas A, Jou C, Escobar J. Ciliocythophthoria and ameboflagellates. Acta Cytol. 2003;47:705–708

© 2011 Lippincott Williams & Wilkins, Inc.


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