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Lamellar bodies 2

Lamellar bodies 2
#00064558
Author: Najmaldin Saki Ph.D; Mohammad Amin Vahid M.Sc; Bita Bandar M.Sc; Inas Afzali Nezhad B.Sc
Category: Laboratory Hematology > Body fluids:  abnormal cells and microorganisms with cross-references to specific diagnoses when appropriate > Miscellaneous findings in body fluids
Published Date: 09/08/2023

A 37/yo male patient with pervious history of multiple sclerosis(MS) presented with shortness of breath and dry cough. Bronchoalveolar lavage(BAL) specimen was negative for TB, RSV, fungal elements, Covid-19 and pneumocystis jiroverci pneumunia(PJP).
Macroscopic appearance of BAL fluid was milky with foamy pellicle on surface suggestive of high surfactant levels(image1).
In May Grunwald-Giemsa(MGG) smear, numerous amorphous proteinous eosinophilic materials were observed either in histocytes or extracellularly which resemble lamellar bodies(image2).
Lamellar bodies are surfactant rich particles that play a key role in respiration physiology and their clearance by pulmunary histocytes is necessary to maintain homeostasis of respiratory system. Pulmunary alveolar proteinosis(PAP) is a pathophysiologic condition refers to the ability of lung histocytes to clear excess surfactant commonly via autoimmune dependent inhibition of GM-CSF signaling in these histocytes.