Abstracts from USCAP 2021: Cytopathology (158-237)

Background: Histopathologic changes of lung described in COVID-19 autopsy cases have been reported.However, due to the highly contagious spread and invasiveness of the procedure bronchoalveolar lavage (BAL), rare reports exist regarding BAL findings. Design:We reviewed 90 bronchoalveolar lavage (BAL) samples collected from 82 patients who presented to our hospital in the period of March to October 2020.There were 49 males (60%) and 33 females (40%) with an age range of 27-83 years old.68 (82%) patients received RT-PCR COVID-19 test as send-out testing initially and later in house.The specimen collected for test was nasopharyngeal swab.The majority of the patients had COVID-19 test performed multiple times, ranging from 1-9 times.Clinical history and imaging findings were reviewed.The BAL samples were processed by ThinPrep method.Results: There were 7 out of 68 tested patients positive for COVID-19.Three of these patients were positive for human immunodeficiency virus (HIV) with chest X-ray and/or CT showing bilateral infiltrates/haziness and nodules predominantly in the lower lobes.The other 4 patients presented with acute respiratory distress syndrome with imaging showing bilateral interstitial infiltrates with alveolar or hilar opacities.One positive patient (patient #7 in the Table 1) had the first BAL in January and COVID-19 test in March.The first BAL was also included in our study.M 33 HIV, DLBCL High/Present Present Absent Neutrophils Present 9 mon Moderate/Absent Present Absent Lymphocytes & Neutrophils PresentConclusions: There is no definite viral cytopathic effect identified in our BAL specimens from patients with COVID 19 disease.Features indicating pulmonary injury such as bi-or multinucleated giant cells and hemosiderin ladenmacrophages are very frequently seen, which may be a hint of COVID -19 disease.The presence of cellular atypia and apoptosis of pneumocytes in BAL may mimic a neoplastic process.Further more extensive study is necessary to reveal other cytological findings in BAL in patients with COVID-19 disease.