Pulmonary alveolar proteinosis consists of eosinophilic exudates that appear denser rather than frothy when compared to P. Aspiration pneumonia has more distinctive lipid vacuoles present on standard pap stains and can be diagnosed with use of Oil red O special stain. The differential diagnosis includes disease states associated with pulmonary macrophages. Key cytomorphologic features include a frothy background containing the cyst-like organisms which are cup or crescent-shaped, and have been described by some appearing as “crushed ping-pong balls.” These cysts may also have tiny basophilic dots noted on pap stain. jiroveci is officially classified as a fungus, however infection usually responds to antibiotics rather than antifungals. BAL is a relatively common specimen received from these patients and sensitivity has been reported as high as 90-98% (1). Pneumocystis jiroveci (carinii) pneumonia (PJP) is a common cause of pneumonia in immunosuppressed patients.
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