The best book would be The Art and Science of cytopathology Volume 1 by DE MAY.

Start off by assessing whether the lavage is good enough ie has lots of alveolar macrophages (although there is no numerical value as for how many macrophages equate to an adequate lavage specimen). In general, we report these by commenting on presence/absence of malignancy; presence or absence of fungal organisms (in conjunction with silver stain) and presence/absence of viral inclusions. If there is any suspicion of aspiration (especially children), then an oil red O stain for lipid is done and semi quantitatively commented on. Finally, if there is suspicion of diffuse alveolar hemorrhage, then an iron stain can assess for the presence of hemosiderin (indicative of old blood ie congestive heart failure).

Thank you! I will try to get this book. I use to report the same issues but the fungal or viral inclusions that I only report them when are present.

We are usually asked to report lymphoid subpoblations by immunohistochemistry, and that's the hardest to me.

We follow the same basic steps in reporting:

1- Adequacy: assessed by many alveolar macrophages (not columnar and certainly not oral squamous). Number is not absolute and depends on method of preparation, but ~50 per slide would be a minimum for me

2- Presence or absence of evidence of viral, fungal or bacterial infection, such as inclusions, inflammatory cells, frothy background of Pneumocystis. etc. Abundance of neutrophils, eosinophils is noted.

3- Presence or absence of Atypical or malignant cells and type.

4- Specific comments in case of possible aspiration, allergy or pulmonary hemorrhage (as outlined in the previous response)

The typing of lymphocytes as to T and B by immuno is not reliable. It should be done by Flow cytometry and needs a separate sample, specifically processed for that, This is unlike FNA, where the samples are much more cellular and can be preserved rapidly, thus preserving the integrity of surface markers.

(see Erozan: Pulmonary Cytopathology, just published by Springer, 2014)