CASE N°17 – Bronchial washing: Charcot-Leyden crystals & fungal microorganisms

Clinical History:

Age: 65

Sex: Female

1/2012 Clinical history of bronchial asthma. Physical examination; patient with chronic obstructive pulmonary disease. Persisten dry cough, fever

1/2012 CT-SCAN; upper right pulmonary lobe: compact thikening about 3 cm. in diameter

2/2012 Tratment with Paracetamolo

4/2012 CT-SCAN; complete resolution of the clinical picture previously observed. No other pathological findings.

4/2012 Bronchoscopy; Normal right bronchial system. Left bronchial system, superior segments: evidence of a neoformation vegetans of 2 cm which originates from the lingula.

Cytological Images:

Cytological material: Brochial washing – Cytoblock

A) Charcot-Leyden Crystals

B) Charcot-Leyden Crystals

C) fungal hyphae (H/E 200x)

D) fungal hyphae (H/E 400x)

E) Crystals & fungal hyphae

Cytological Report:

Negative for malignancy: Presence of Charcot-Leyden Crystals and fungal hyphae, NOS

Discussion:

Charcot-Leyden crystals are microscopic crystals found in people who have allergic diseases such as asthma or sometimes are noted in association with a fungal infection. Is interesting to note the morphological difference between this two entities. In my opinion the better thing to do is to use the microscope increasing the contrast or lowering the condenser.

Compare the following picture with all the precedents

You will note that is more diffucult to appreciate the two different entities. In fact, in the picture above the contrast is normal and the condenser is not lower.

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