Cell borders were distinct. Nucleoli were only rarely seen. The morphology of these cells corresponded closely to the descriptions of Cahan et al. of post-tracheostomy atypia. None of the specimens showed atypical columnar cells. In our experience, the greatest difficulty in interpreting sputum specimens is the paucity of well-preserved atypical cells upon which a positive diagnosis can be made.
Tumors arise as focal lesions in the lung.
There is no biologic reason to scrape the same atypical cell population in ten segmental bronchi when their origin is a tumor. Furthermore, in the case described, there was no focal lung density to suggest that the patient had carcinoma. The patient did have a 30 year old tracheal stoma, and the atypical cells encountered were similar to those described in peri-stomal mucosa of tracheostomy patients. The distinguishing feature in this case is that atypical cells were not confined to the trachea but presented in segmental bronchi. The presence of atypical cells in bronchi throughout the lungs in tracheostomy patients is a previously unreported finding and would indicate that the toxic effect of dried air on respiratory mucosa is a diffuse pulmonary process.