The morphological elements of the sputum

White blood cells

Neutrophilic granulocytes at high magnification (7x eyepiece, Lens 40x) take the form of round, sometimes irregularly shaped cells with granular cytoplasm and the nucleus, consisting of several segments.

Appear they sputum in various inflammatory processes in the respiratory; most of them are observed in purulent inflammation, in which they are often subjected to fatty degeneration and decay. Number of neutrophilic granulocytes, often mixed with mucus, determines the nature of sputum. Depending on the predominance of white blood cells or mucus distinguish purulent mucous or muco-purulent sputum.

Eosinophilic granulocytes found in the sputum as single cells, as well as groups and clusters. The cells have a rounded shape and are filled with the same grit size and the same shape. In native preparation eosinophilic granulocytes easily distinguished from other cells of uniform grain.

For a small increase in groups and clusters of eosinophilic granulocytes are darker or yellowish tint. In large groups eosinophilic granulocytes are often split into a large number of similar grains, among which we can find some preserved cells. Often there are rhombic Charcot-Leyden crystals, formed from decayed eosinophilic granulocytes. A large number of eosinophilic granulocytes observed in the sputum or bronchial asthma and other allergic reactions.

Red blood cells

Red blood cells found in sputum mainly unchanged. In purulent or muco-purulent sputum may show individual cells. Under the influence of putrefaction red blood cells can be destroyed, and then burookrashennyh sputum particles are not detected. In such cases it is necessary to carry out the reaction hemosiderin.

Alyveolyarnыe macrophages

Alyveolyarnыe macrophages - Cell size from a circular shape 10 to 25 m. In stained preparations of their foamy cytoplasm, pale blue, with distinct contours, sometimes more pronounced cytoplasmic basophilia. A characteristic feature is the presence of alveolar macrophages in their cytoplasm phagocytosed coal dust, tobacco pigment and other impurities.

The nucleus compared to the cytoplasm small, bean-shaped, often located eccentrically. One cell may have two or more core. Microscopic examination of sputum alveolar macrophages are found in separate clusters in the mucus. On gross examination of sputum in a petri dish in these cases are detected translucent fine grains, representing a slimy mold alveoli, containing alveolar macrophages incorporated with coal dust and tobacco pigment. If there are a lot of beans in the sputum, it acquires a granular form.

Sometimes alveolar macrophages mucous sputum contain in their cytoplasm of myelin in the form of circular, pear and other bizarre formations gray matt, located not only intracellularly, but free. Myelin is a phospholipid membrane of the surfactant. His appearance in the sputum, probably, It should be seen as a result of degradation of this part of the surfactant or its formation with excessive consequences.

In various pathological processes in the lung alveolar macrophages contain large amounts of fat droplets. However, they can grow and be subject to decay. These alveolar macrophages in large numbers are found in the sputum in the early stages of pneumonia, when it was still slimy character with blood. With stagnation in the pulmonary circulation alveolar macrophages resulting pigmentation gemoside- Rene become golden-brown color. They can be detected unchanged erythrocytes and phagocytized.

Alyveolyarnыe macrophages, contain haemosiderin or erythrocytes, called cells, heart disease. Hemosiderin gives a positive reaction to the iron (reaction Perlsa), Unlike tobacco pigment, also coloring alveolar macrophages in the brownish-yellow color.

On slide coated particles somewhat suspicious sputum (if the native drug, the cover glass is removed), end of the coverslip and stretch them slightly dried in the air. Then the drug is poured into a mixture of equal parts of 5 % solution of potassium ferrocyanide and 3 % hydrochloric acid. Both solutions were mixed in vitro, washed with distilled water (the mixture should have a blue hue). After 8-10 minutes, the reagent is decanted and the drug is covered with a cover glass. To accelerate the reaction smear reagent can be heated over the flame of the burner.

Microscopic examination revealed alveolar macrophages, containing hemosiderin, painted in blue color. If the cells, containing hemosiderin, They form large clusters, they can identify and macroscopically. In these cases, a cover glass detected blue, sometimes numerous sites.

The functions of alveolar macrophages diverse. In its role as protective mechanisms in the peripheral respiratory tract, they absorb from the inhaled air contaminants and microorganisms, thus preventing damage to the alveolar epithelium and bronchi. Foreign proteins and antigens of bacterial origin, getting in alveolar macrophages, catalyzed by them, thereby preventing the expressed antigenic stimulation. Alveolar macrophages are involved in the reactions of cellular and humoral immunity, secrete lysosomal enzymes, prostaglandins, interferon, cyclic nucleotides, some complement components and other substances, can affect reproduction and activation of lymphocytes, fibroblasts and other cell elements. They also play a leading role in the destruction of the elastic tissue and respiratory bronchioles end, that can lead to the development of emphysema tsentrolobulyarnoy.

The mechanism of destruction of elastic tissue of the lungs can be represented as follows:: influenced oxidants, contained in air pollution and tobacco smoke, increased secretion of proteolytic enzymes by alveolar macrophages, including elastase and chemotaxic factor, inducing migration of neutrophilic granulocytes. The latter also secrete elastase. At the same time capable of inactivating oxidants agantitripsin, is an inhibitor of elastase. Thus the conditions for the formation of an excess of elastase and the destruction of elastic tissue in the lungs. This happens especially in places where the alveolar macrophages and neutrophils, t. it is. in the terminal and respiratory bronchioles. At catarrhal inflammation in the respiratory department of pulmonary alveolar epithelium cells inevitably fall with inflammatory exudate in the lumen of the alveoli, but to distinguish them from the alveolar macrophage is possible only with the help of electron microscopy. Since the pathological processes in these areas in the lumen of the lungs alveoli detected as alveolar epithelial cells, and alveolar macrophages, and to distinguish between them is impossible, it is more correct to describe them in the analysis of sputum cells of the alveoli.

Epithelium bronxov

For epithelial cells characteristic shape of a tall glass, one end of which a, and the other - narrowed hvostoobrazno. They have cuticular rim, sometimes cilia, the core of the round or oval with a thin granular chromatin, sometimes forming large clumps, which are located close to the tapered end of the cell.

In sputum epithelial cells of the bronchi may undergo various morphological changes, It is depending on the location of cells in the preparation, autolitičeskih processes, irritation of the bronchial mucosa due to inflammation and changes ; after irradiation. Depending on the location of the epithelial cells may have a triangular, irregular or rounded shape. In the upper pole clusters of epithelial cells of the bronchi are the net, reminiscent of a honeycomb structure, round large nuclei, located in the cells of the grid.

The number of epithelial cells of the bronchi in the sputum also depends on the stage of bronchitis. Especially a lot of them at the beginning of the disease in nature catarrhal inflammation of mucous and phlegm. Bronchial epithelial cells are arranged separately and clusters in the form of layers, often resembling a palisade. Where, when the process becomes purulent, bronchial epithelial cell number decreases, a number of leukocytes increases. In some cases bronchitis along with mucopurulent particles, containing a small amount of epithelial cells of the bronchi, You can identify particles with large accumulations of mucus ciliary epithelium. This may indicate the beginning of the inflammatory process in the other bronchi. When bronchitis bronchus epithelial cells often undergo fatty degeneration and vacuolization.

In some pathological processes in the airways (chronic bronchitis, asthmatic bronchitis, bronchial asthma, bronchiectasis, bronchopneumonia and so on.) possible bronchial epithelial cell hyperplasia, which entails their qualitative and quantitative changes, namely: increase in the number of epithelial cells of the bronchi, increasing the size of cells and their nuclei, occurrence of nucleoli. Occurrence in hyperplastic epithelium signs of atypia, expressed in varying degrees, rated as mild dysplasia, moderate to severe.

When mild dysplasia there is an increase in cell size without changing the nuclear-cytoplasmic ratio, but may appear dual cell. In some cells there are signs of fat or vacuolar degeneration.

In patients with moderate dysplasia It appears individual cells with larger nuclei, containing nucleoli.

Severe dysplasia of the bronchial epithelium characterized by cellular and nuclear anisocytosis, changes in nuclear-cytoplasmic ratio due to enlargement of the nuclei, which sometimes can be significant. Marked thickening of the shell of the nucleus (karioteki) and hyperchromia coarse and unevenly distributed chromatin. There are two cells, three or more cores. Ownership changed to such an extent to the bronchial epithelial cells is confirmed by the presence of cilia or cuticular rims. Has the value and location of the altered epithelial cells with monomorphic cylindrical pseudostratified ciliated epithelium.

At lapillomatoznoy hypertrophy of the bronchial mucosa, growing mainly in bronchiectasis, as well as chronic bronchitis sputum may appear fragments of hypertrophic mucosa. On the periphery of these fragments are placed in a stockade hyperplastic ciliated cells often visible from the outside cuticular rim and sometimes cilia, in the middle of slots are small basal cells. Such fragments of bronchial mucosa in sputum resemble the glandular structure, but monomorphic cells, normal nuclear-cytoplasmic ratio and the presence of cuticular rim or cilia make it easy to identify them as belonging to the bronchial epithelium.

Cores of ciliated cells in sputum are often subjected pyknosis. In such cases, they are reduced, become hyperchromic, sometimes completely deprived of internal structures. The cytoplasm of the cells is sealed, but retains its shape.

Squamous metaplasia of the bronchial epithelium develops focally in the form of more extensive changes, mainly in chronic inflammation in the respiratory tract, bronchiectasis, chronic fibrous pulmonary tuberculosis, asthma, pulmonary infarction. It can be observed in smokers, sometimes there is no apparent reason. There are large and small cells metaplazirovannye (Cells Pap).

Large metaplazirovannye cells

Large metaplazirovannye cells more similar to the parabasal squamous cells of the vagina. But the oral mucosa has no parabasal layer, therefore, the presence of such cells in the sputum may be regarded as a uniquely metaplasia of the bronchial epithelium.

Metaplazirovannye bronchial epithelium cells round or oval, with clearly outlined opaque cytoplasm. The nuclei of fairly large, hyperchromatic, sometimes contain nucleoli. At full squamous metaplasia of the cytoplasm of epithelial cells exposed keratinization (acquires a vitreous luster).

Small cells metaplazirovannye

Small cells metaplazirovannye slightly more white blood cells, size and shape similar to each other.

They also have a round or oval, clearly defined opaque cytoplasm and nucleus of a fairly large hyperchromic. Metaplazirovannye cells may also be subject to dysplasia.

Goblet cells

Goblet cells sputum less common, than ciliated. In form they resemble ciliated, However, the peripheral part of the cell have swollen and contains many large and small vacuoles.

Goblet cells have no cilia and cuticular rim. These cells produce mucus. Due to the difficulty in differentiating sputum cells columnar epithelium and goblet they are designated as bronchial epithelial cells. Hyperplasia of goblet cells and dysplasia is characterized by changes, similar to those in the epithelial cells of the bronchi.

Multilayer (flat) epithelium

Neorogovevayuschy multilayer (flat) epithelium lines the front part of the nasal cavity, oral cavity, mouth and hypopharynx, the upper part of the epiglottis, vocal folds and the bifurcation of the trachea and bronchi. This epithelium consists of a basal, and prickly surface (flat) layers. In the process of maturing squamous cells in them increases the cytoplasm and the nucleus decreases. In sputum always found admixture of exfoliated cells of the squamous epithelium of the oral mucosa. On its surface are usually bacteria.

Elastic fibers

Elastic fibers are connective elements, and their appearance in any object indicates the destruction (decay) cloth. In sputum elastic fibers appear more often in tuberculosis, but may also occur in cancer, abscess, echinococcosis lung and other diseases. They are a long shining combi, often crimped fiber formation.

Location elastic fibers depends on the structure of the fabric, the decay of which they are formed. In sputum frequent congestion fibers alveolar structure, repeating their location in the walls of the alveoli, and accumulation of elastic fibers, reticular or densely settling in fine particles of the decaying vessel or bronchus.

Elastic fibers are found in the sputum in groups and clusters of various sizes, as well as individual fibers and their fragments. The discovery of these fragments and single fiber is essential for the diagnosis of active TB. Mycobacterium tuberculosis is often possible to identify only stained by Ziehl-Nelsenu preparations, particles prepared from sputum, in which the elastic fibers have been found. Elastic fibers, lying in a cheesy decay (accumulation of small shiny seeds among structureless mass), It is usually seen in tuberculosis. The elastic fiber dissolves tubercle resolve, and there are only scraps. During application of these sections can be found Mycobacterium tuberculosis.

Staghorn fiber

Staghorn fibers are elastic fibers, covered soaps. They dim, thicker elastic fibers, found in the form of individual fragments and various skoleny. Sometimes, not all the fibers or clusters covered soaps. They are formed in old tuberculous cavities, that as a result of the collapse of the tissue, the conditions for the formation of soaps (the presence of fat, calcium and magnesium salts). Detection of such fibers in sputum indicates the presence of cavities.

Staghorn fiber found in mucopurulent rather compact and small particles of sputum, especially a lot of them happen in risovidnyh beans. When exposed to fibers staghorn 10 % caustic solution of soap are removed and identified conventional elastic fibers.

Calcification of elastic fibers are part of the tetrad Ehrlich. These fibers, impregnated with calcium salts, usually take the form of rod-shaped formations thickened, resembling strands of sticks anthrax (cm. incl., rice. 17). Located in the sputum of groups and clusters with amorphous calcium salts, among which there are small droplets of fat, indicating the presence of calcifying curd or fat necrosis.

In the treatment of sputum caustic elastic fibers lose their luster and shape, and staghorn and calcified fiber not detected. Single fibers and their fragments with other elements, caseation, giant cells, tubercles, etc..), have important diagnostic value, This destroys.

It will be appreciated, that the elastic fibers can get into the mucus from food.

Fibrin

Fibrin is a reticular spaced parallel thin fibrils. A considerable amount of fibrin attaches mucopurulent or purulent sputum density scrap, that is found in the selection of material for research. Fibrin in the sputum is often observed in inflammatory processes.

Spirals Kurshmana

Spirals are Kurshmana mucous formation of various sizes.

With a significant amount of mucus in the small bronchi and bronchioles strong cough shock, it is pushed out and helically twisted. Sometimes they spiral visible to the naked eye in the sputum. Microscopic spiral Kurshmana look like swirling mucus (Mantle) the central thread, contain white blood cells, chastichno eozinofilinyye granulocytes, Leyden crystals sometimes Sharko-. It can be seen only the mantle or just the central thread. Spirals are easily detected at low magnification. There are at different bronchitis and particularly common in asthma.

Druze actinomycetes

Druze actinomycetes are clusters of radiant fungus in the form of small yellowish grain size of a pinhead (sometimes larger or smaller). Under low magnification, they have a rounded shape, sharply defined contours, yellowish, amorphous middle and darker at the edges. With a large increase in the middle of the Druze is a dense cluster of radial strands of radiant fungus grained, that are on the periphery of an end cone-shaped bulges in the form of blisters.

In some cases, flask-shaped formation can not be identified. I visited with friends preparations necessary to Gram-staining. In stained preparations actinomycetes are dichotomously dividing filamentous Education, stained by Gram-positive and are located in separate threads or thick branching clusters. On examination of sputum should always pay attention to the presence of grain and take them in the first place for the study of the native preparation, and then, if necessary, prepare them for drug microscopy studies. When aktinomnkome in native lung sputum specimens except drusen actinomycetes usually found large foam cells, sometimes in large quantities.

Therefore, the presence of these cells is necessary to look for friends aktinomitsetoa.

Elements echinococcus

Elements echinococcus detected in sputum in lung echinococcosis. The selection of material for the study of sputum revealed a whole small bubbles, or visible to the naked eye, small gray-whitish membranous Education, which are particles of chitin shell bubble, which on microscopic examination revealed pronounced parallel striations.

When festering cyst smallest particles of chitin shell, echinococcus and hooks can be detected by microscopic examination, mucopurulent sputum particles. When echinococcosis lung sputum can also reveal foam cells and cholesterol crystals.

Crystals gematoidina

The crystals are formed when gematoidina hemorrhages in necrotic tissue. This needle and rhombic crystals, color varies from golden yellow to brownish-orange. In sputum are often observed in abscess, cuts - with gangrene legkogo.

Cholesterol crystals

Cholesterol crystals have the form of colorless, often overlapping rectangular shapes or rhombic shape with one step or break down the angle. Formed from the breakdown of fat in a closed cavity. In sputum they occur in tumors, echinococcosis and are part of the tetrad Ehrlich.

Charcot-Leyden crystals

Charcot-Leyden crystals are brilliant colorless octahedra of different shape with pointed ends.

Formed from decaying eosinophilic granulocytes (sometimes you can see small crystals inside eoznnofilyyu granulocyte). Especially a lot of them in the sputum of patients with bronchial asthma, where these crystals are yellowish plotnovata rassypchatyhtyh with scraps of eosinophilic granulocytes. The crystals were dissolved in hot water, alkalis acids.

Corks Dietrich

Corks Dietrich are whitish-grayish education rounded shape size of a pinhead to a millet grain. They are formed when standing sputum due to exposure to bacterial enzymes. Microscopic examination of traffic jams Dietrich visible detritus with bacteria, skoplennyamn needles fatty acid and neutral fat droplets.

Corks Dietrich found in the sputum mainly abscess, gangrene lung bronchiectasis. Sometimes they can be confused with prints of tongue papillae, containing laminate (flat) epithelium and bakterïï.

Rysovydnыe grain

Risovidnye grains look like grayish-whitish plotnovata rounded education. On microscopic examination, they found clusters of staghorn fibers, detritus, soap and a lot of micro-organisms. At coloring of Ziehl-Nelsenu revealed huge cluster of Mycobacterium tuberculosis. Risovidnye grains are formed in the cavities of old, where as a result of the collapse of the tissues and the presence of alkaline earth metal salts are formed soap, impregnating elastic fibers. As a result of an extended stay of these particles in a cavity on them, as medium, develop Mycobacterium tuberculosis.

Tetrad Ehrlich

Tetrad Ehrlich consists of calcified elastic fibers, Calcification cheesy (caseous) decay, cholesterol crystals and Mycobacterium tuberculosis in fragments, also calcify.

In sputum tetralogy Ehrlich can be represented in whole or in elements, which can be detected with unchanged elastic fibers and caseation or, more usually, independently. In the latter case, to identify Mycobacterium tuberculosis is very difficult. Under the microscope, the particles of sputum, containing elements tetrad Ehrlich, They have a kind of grayish-whitish nitochek, Klochkov, tracks. Since they are produced from old calcified or not yet fully compacted tuberculosis foci, reveals various reasons (eg, the accession of infection with influenza, pneumonia and others.), then we have a great diagnostic and prognostic value.

Foam cells are round formations of different sizes, typically three - five times more leukocytes, colorless contain droplets of fat. The cells of connective tissue origin, sputum found mainly in various inflammatory processes (abscess, aktinomikoze, echinococcosis of lungs and others.).

When tumors of lung sputum may occur as cells with pronounced fatty degeneration, Similar to the above described. The presence in the sputum cells ksantomnyh indicates the need of further research.