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We present a rare case of recurrent carcinoma of gallbladder with leptomeningeal carcinomatosis. Cerebrospinal fluid (CSF) cytology showed atypical cells, which were suspicious for malignancy on initial reporting. Diagnosis of malignancy and primary from hepatobiliary source was confirmed by doing immunohistochemistry on CSF cell block.

Background Primary central nervous system lymphoma (PCNSL) is the most prevalent brain, spinal cord, eyes, and leptomeningeal lymphoma. It is often misdiagnosed due to an unspecific presentation or unavailable biopsy and results in a poor prognosis. Although the craniocerebral imaging examination of PCNSL has some characteristics, it is limited, and atypical cases are especially difficult to identify with intracranial tumours and other diseases. The biopsy, as the gold standard for PCNSL diagnosis, is not eligible for all patients suspected of having PCNSL. Case presentation This report documents a woman who presented with a three-month history of numbness and weakness in the right leg. She was treated with drugs at a local hospital for one month. She developed demyelination lesions and her symptoms were aggravated. The patient was admitted to the Department of Nerve Infection and Immunology at Tiantan Hospital. Head magnetic resonance imaging (MRI) enhanced scanning indicated significant inflammatory demyelinating disease, and lymphoma was not excluded. CSF revealed a high protein level and CSF cytology detected abnormal cells, PCNSL was eventually presumed according to positive CSF cytology and cytological detection of the cerebrospinal fluid flow. Conclusions PCNSL is a highly invasive tumour. With the development of technologies such as cerebrospinal fluid cytology and flow cytology, CSF analysis has become one of the definite diagnosis methods, and the tumour cell finding in CSF is the only reliable basis for diagnosis. Flow cytometric analysis and gene rearrangement testing also provide objective evidence.

Leptomeningeal carcinomatosis (LC) is a rare leptomeningeal spread of diffusely metastatic tumors. It occurs more commonly with hematologic tumors, less commonly with solid tumors, and is exceedingly rare in prostate cancer. Due to its scarcity, it has traditionally been difficult to diagnose LC but advancement of MRI has helped considerably. However, even with technological improvements, pre-mortem diagnosis of LC remains difficult and controversial. Our case is a 71-year-old male with prostate cancer with bone metastases who presented to our facility with altered mental status (AMS), lower extremity weakness, and worsening diarrhea. The diarrhea was responsive to antibiotic therapy, but his AMS did not resolve. A head CT without contrast was negative but follow-up brain MRI revealed leptomeningeal enhancement highly suggestive of LC. Cerebrospinal fluid (CSF) cytology results were negative and other CSF studies were inconclusive. Although further studies were planned, the patient continued to deteriorate, and the family elected to withdraw care. He passed away without beginning treatment for the LC. Despite advances in cancer therapies, LC remains difficult to diagnose and treat. Imaging may be suggestive of the condition but the confirmatory tests such as repeated CSF cytology or meningeal biopsy are not only invasive but also usually occur postmortem. Additional methods of CSF testing have been studied to evaluate their role in accurately diagnosing LC but low specificity for LC has somewhat limited their use. Although treatment options are mainly palliative in nature, prompt recognition and early treatment could grant valuable time for patients and families.

Ependymomas are glial neoplasms of central nervous system originated from the ependymal lining of the brain ventricles and spinal cord central canal, and rarely exfoliated into cerebrospinal fluid (CSF). In this case we report the cytomorphological and immunocytomorphological features of ependymoma in CSF and intraoperative squash preparations, confirmed by histology. Case report. The patient was a nineteen months old female presented at the University hospital of Heraklion, Crete, in a hemicoma, and was intubated. Computed tomography, scanning and magnetic resonance imaging (MRI), were performed and a mass in the posterior fossa was found. A sample of cerebrospinal fluid (CSF) was sent for cytologic evaluation. A diagnosis of ependymoma was rendered, followed by tumor resection, during which intraoperative squash smears for cytologic interpretation were obtained. Cytological consultation disclosed a grade II ependymoma (WHO grade II), with focally anaplastic features (WHO grade III).

Background Cerebrospinal fluid (CSF) analysis is a crucial method in the diagnostic process for suspected subarachnoid hemorrhage (SAH), especially when cerebral imaging is negative or inconclusive. CSF cytology (detection of erythrophages or siderophages) is used to determine whether a bloodstained CSF resembles a genuine SAH. Whether erythrophages may develop in vitro after a traumatic puncture in case of delayed CSF analysis is unclear. An in vitro development of erythrophages after traumatic puncture would diminish the diagnostic properties of CSF analysis. We assessed whether erythrophagocytosis is detectable in CSF after an imitated traumatic lumbar puncture. Methods We mimicked a traumatic lumbar puncture by mixing surplus CSF with whole blood from the same patient. From this mixture, cytological specimens were obtained immediately and repeatedly at time intervals of 1 h, until 7 h after mixing, or until the mixture was exhausted. Each cytological specimen was microscopically examined independently by four experienced CSF cytologists for the presence of erythrophages. Results We studied 401 CSF cytological specimens of 96 punctures in 90 patients. We could not identify any erythrophages in all cytological specimens. Fleiss’ Kappa for interrater-reliability was 1.0. Conclusions We did not find evidence for an in vitro erythrophagocytosis after a mimicked traumatic lumbar puncture. Therefore, the occurrence of erythrophages in CSF cytology can be regarded as a reliable sign of an autochthonous bleeding in the subarachnoid space. Our results support the crucial role of CSF analysis in clinical practice in case of a suspected SAH but negative cerebral imaging. Electronic supplementary material The online version of this article (10.1186/s12987-018-0116-3) contains supplementary material, which is available to authorized users.

Objective: To investigate the effects of linezolid and moxifloxacin combined with quadruple antituberculosis drugs on CSF cytology, NSE (neuronal specific enolase), NGF(nerve growth facor) and its receptors, endothelin and its receptors and CRP (C reaction protein) in patients with refractory tuberculous meningitis. Method: A total of 56 patients were selected with tuberculous meningitis in our hospital from February 2014 to December 2017,randomly divided them into 2 groups, each group was 28 cases, set as the observation group and the control group, both groups were treated with quadruple antituberculosis drugs, the observation group was given ilinezolid on this basis, and the control group was combined with moxifloxacin, The course of treatment was 4 weeks, compared the levels of CSF cytology, NSE, NGF and NGF receptors, endothelin and endothelin receptors, and CRP after treatment in the two groups. Result： The CSF cytology, NSE, NGF and NGF receptors, endothelin and endothelin receptor, and CRP levels remained unchanged before treatment, the difference was not statistically significant. After treatment, the chloride and glucose levels in the observation group were higher than those before treatment and that of the control group, the protein, white blood cell count, and cerebrospinal fluid pressure levels were lower than before treatment and that of the control group, the difference was statistically significant; The NSE level in the observation group after treatment was lower than before treatment and that of the control group, the difference was statistically significant; After treatment, the levels of NGF and its receptors in the observation group were higher than those before treatment and that of the control group, and the levels of endothelin, and its receptor, CRP were lower than those before treatment and that of the control group, the difference was statistically significant. Conclusion: The use of linezolid in combination with quadruple antituberculosis drugs to treat refractory tuberculous meningitis has better clinical effect, effectively improve cerebrospinal fluid cytology, regulate cerebrospinal fluid NSE levels, restore NGF, endothelin and its receptor function, reduce inflammatory response, recommended for clinical promotion and application.

Leptomeningeal carcinomatosis (LC) diagnosis is based on cerebrospinal fluid (CSF) cytological analysis and contrast-enhanced magnetic resonance imaging (MRI); however, low sensitivity was evidenced in some cases delaying prompt and adequate treatments. Brain 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) was also employed in doubtful cases. We retrospectively described 4 suspected LC cases with uncertain or undetectable MRI and initially negative CSF cytology. Whole-body (WB) and brain 18F-FDG PET/computed tomography (CT) were used, the latter showing intracranial tracer uptakes suspected for LC in 3/4 cases. In 2 of these 3 cases, WB scan also evidenced spinal cord lesion and pulmonary tumor, respectively, while both procedures were true negative in the fourth case. CSF cytology became positive after repeated exams in the 3 PET/CT-positive cases. In 1 of these 3 patients, it was also confirmed at MRI, while it stayed negative in the remaining PET/CT-negative case with uncertain MRI. 18F-FDG PET/CT could be a useful supportive diagnostic tool in doubtful intracranial and spinal LC.

The incidence of leptomeningeal dissemination (LMD) of anaplastic glioma has been increasing. LMD can be observed at the time of initial presentation or the time of recurrence. As a result of both rarity and unusual presentation, a standard therapy has not yet been suggested. In contrast to leptomeningeal carcinomatosis for systemic solid cancers, a relatively prolonged survival is observed in some patients with LMD of anaplastic gliomas. Treatment modalities include whole craniospinal irradiation, intra-cerebrospinal fluid (CSF) chemotherapy, and systemic chemotherapy. In some cases, response to temozolomide (TMZ), with or without combined radiation has been reported. Here, we report two cases of LMD of an anaplastic glioma. In one case LMD presented at the time of diagnosis, and in the other at the time of recurrence after radiation. CSF cytology was positive in both cases, and persisted in spite of intrathecal methotrexate chemotherapy. Later, TMZ was prescribed for progressing brain parenchymal lesions, and both radiological and cytological responses were obtained after oral TMZ treatment.

// Jae-Won Hyun 1, 6 , Ji Hyun Park 2 , Boo Gil Kang 3 , Eun Young Park 4 , Boram Park 4 , Jungnam Joo 4 , Jong Kuk Kim 5 , Su-Hyun Kim 1 , Jee Hyang Jeong 6 , Hyang Woon Lee 6 , Kee Duk Park 6 , Kyung Gyu Choi 6 , Sang-Hyun Hwang 3, 7 , Ho-Shin Gwak 7 and Ho Jin Kim 1, 7 1 Department of Neurology, National Cancer Center, Goyang, Korea 2 Department of Oncology, Konkuk University of Medical College, Seoul, Korea 3 Department of Laboratory Medicine, National Cancer Center, Goyang, Korea 4 Biometric Research Branch, National Cancer Center, Goyang, Korea 5 Department of Neurology, Dong-A University College of Medicine, Busan, Korea 6 Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea 7 Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea Correspondence to: Ho Jin Kim, email: hojinkim@ncc.re.kr Keywords: leptomeningeal carcinomatosis, diagnosis, prognosis, CSF, CYFRA 21-1 Received: November 30, 2016 Accepted: May 18, 2017 Published: June 08, 2017 ABSTRACT Objectives: To investigate the diagnostic and prognostic values of cerebrospinal fluid (CSF) CYFRA 21-1 in patients with leptomeningeal carcinomatosis (LMC). Methods: Concentration of CSF CYFRA 21-1 was detected using electro-chemiluminescent immunoassay. The difference in level of CYFRA 21-1 between 61 patients with LMC and 200 patients with other neurological disease was evaluated, and diagnostic performance of CSF CYFRA 21-1 was investigated. In LMC patients treated with ventriculo-lumbar perfusion (VLP) chemotherapy, prognostic performance of CSF CYFRA 21-1 was evaluated. Results: The CSF CYFRA 21-1 was significantly higher in LMC patients than that in patients with other neurological diseases (p

Objective: The history of Sayk's cell sedimentation chamber is examined and reviewed in the context of clinically utilizable cerebrospinal fluid (CSF) cytology. Methods: A review of the literature was undertaken in PubMed and Google Scholar to search for primary and secondary sources on the history of CSF diagnosis. Moreover, documents in the archives of the Universities of Rostock and Jena, the Brain Research Institute of Cécile and Oskar Vogt in Düsseldorf and the Centre for Neurology at Rostock University were used. Results: The cell sedimentation chamber, developed by Johannes Sayk (1923-2005) at the beginning of the 1950s, enabled, for the first time, CSF cells to be presented with a quality comparable to the blood profile, with a low technological expenditure and using all staining methods suitable for haematological cells. The procedure could be performed quickly and cost efficiently, and therefore, it was easy to integrate it into clinical routine and it quickly became a widely used procedure. In Europe, it was considered the standard method for cytodiagnosis of CSF until the 1990s. Conclusions: The procedure revolutionised CSF diagnostics and paved the way for modern qualitative CSF cytology. In course of time, the cell sedimentation chamber was superseded by the cytocentrifuge.

Background. Although CSF cytology and MRI are standard methods to diagnose neoplastic meningitis (NM), this complication of neoplastic disease remains difficult to detect. We therefore reevaluated the sensitivity of gadolinium (GD)-enhanced MRI and cerebrospinal-fluid (CSF)-cytology and the relevance of tumor type and CSF cell count.Methods. We retrospectively identified 111 cases of NM diagnosed in our CSF laboratory since 1990 with complete documentation of both MRI and CSF cytology. 37 had haematological and 74 solid neoplasms. CSF cell counts were increased in 74 and normal in 37 patients.Results. In hematological neoplasms, MRI was positive in 49% and CSF cytology in 97%. In solid tumors, the sensitivity of MRI was 80% and of cytology 78%. With normal CSF cell counts, MRI was positive in 59% (50% hematological, 72% solid malignancies) and CSF cytology in 76% (92% in hematological, 68% in solid neoplasms). In cases of elevated cell counts, the sensitivity of MRI was 72% (50% for hematological, 83% for solid malignancies) and of CSF cytology 91% (100% for haematological and 85% for solid neoplasms). 91% of cytologically positive cases were diagnosed at first and another 7% at second lumbar puncture. Routine protein analyses had a low sensitivity in detecting NM.Conclusions. The high overall sensitivity of MRI was only confirmed for NM from solid tumors and for elevated CSF cell counts. With normal cell counts and haematological neoplasms, CSF-cytology was superior to MRI. None of the analysed routine CSF proteins had an acceptable sensitivity and specificity in detecting leptomeningeal disease.

The pediatric oncologists in Germany are running multicenter treatment optimization studies for all kinds of tumors including CNS tumors. They have instituted reference centers for neuropathology, CSF cytology, radiotherapy, and neuroradiology for these studies in order to harmonize the individual results of histological diagnosis, staging, treatment, and response evaluation of their patients who are diagnosed and treated in many different hospitals all over the country [6, 7] rather than in few specialized centers. It has been recognized in several German and European studies that the event-free survival (EFS) of the study patients has been improved by a central review process [8]. The author has been working as the leader of the reference center for neuroradiology for more than 20 years. The aim of this publication is to present on one hand an easy way to approximately predict or sometimes diagnose the histology of many pediatric brain tumors from the aspect on imaging examinations, and on the other hand to guide into the different aspects of trial requirements, frequent diagnostic quality problems, and questions from the oncologists that have to be answered by the radiologist and are influencing the planning of imaging procedures.

Background Pathological examination combined with tumor markers has become a standard for the diagnosis of intracranial germ cell tumors (ICGCTs), but the current concept of ‘secreting germ cell tumors’ and three empirically highly specific diagnostic criteria (β-hCG ≥ 50 IU/L or αFP ≥ 10 ng/mL; β-hCG ≥ 100 IU/L or αFP ≥ 50 ng/mL; β-hCG > 50 IU/L or αFP > 25 ng/mL) are not based upon pathology examination or CSF cytology. Further investigation is needed to re-evaluate their value. Methods A multidisciplinary diagnostic team was created. Valid β-hCG/αFP data were collected from cases of ICGCTs confirmed by pathology and CSF cytology (n = 58) between 1991 and 2012, and from suspected ICGCTs cases (n = 17) between 2011 and 2012 as controls [Langerhans cell histiocytosis (LCH), n = 12; and other intracranial tumor (ICT), n = 5]. The cut-off points for β-hCG and αFP were calculated using receiver operating characteristic (ROC) curves. Results This study clarifies the relative rationality of one criteria (β-hCG > 50 IU/L and αFP > 25 ng/mL); confirms new β-hCG diagnostic cut-off points: CSF β-hCG ≥ 8.2 IU/L and serum β-hCG ≥ 2.5 IU/L (sensitivity of 47 and 34 %, respectively, specificity of 100 %, both; P

Neurolymphomatosis (NL) is a rare condition associated with lymphomas in which various structures of the nervous system are infiltrated by malignant lymphocytes. Rarely, it may be the presenting feature of recurrence of lymphoma otherwise deemed to be in remission. It is crucial, as is the case with all types of nodal or visceral involvement of lymphoma, to identify the disease early and initiate treatment with chemotherapy and/or radiation therapy. Positron emission tomography-computed tomography (PET-CT) has been shown to be a sensitive modality for staging, restaging, biopsy guidance, therapy response assessment, and surveillance for recurrence of lymphoma. Magnetic resonance imaging (MRI) is another useful imaging modality, which, along with PET/CT, compliment cerebrospinal spinal fluid (CSF) cytology and electromyography (EMG) in the diagnosis of NL. Performing nerve biopsies to confirm neurolymphomatosis can be challenging and with associated morbidity. The case presented herein illustrates the practical usefulness of these tests in detecting NL as a heralding feature of lymphoma recurrence, especially in the absence of histopathologic correlation.

脳脊髄液細胞診にみられたLarge granular lymphocytic leukemia (LGL白血病) の1例を報告する.腫瘍細胞は弱塩基性で広い細胞質を有し, 一部に明瞭なアズール穎粒がみられた. 核は比較的小型で核形不整もほとんどみられなかった.また出現細胞数の増加も認められなかったため, 反応性リンパ球との鑑別に苦慮した.本症例は肝生検におけるEpstein-Barr virus encoded small RNA (EBER/1, 2) のin situhybridization (ISH) が陽性であったことから, 脳脊髄液のパパニコロウ脱色標本を用いてEBER-1, 2のISHを行ったところ, 異常リンパ球がすべて陽性を示し, 腫瘍細胞の脳脊髄膜への浸潤と考えられた.

The main objective of this retrospective review of clinical and cerebrospinal fluid (CSF) data from 41 patients with intracranial tumors diagnosed between 1975 and 1989, is to report the role that the finding of neoplastic cells in CSF plays, specially when cerebral CT-scanning and MRI were not currently done. Another objective is to study the CSF proteic abnormalities in cerebral tumors. CSF cell count, cytomorphologic pictures obtained after sedimentation and protein findings are described. Tumor cells were seen in 12 cases (29%): medulloblastomas - 6, meningeal carcinomatosis - 3, multiforme glioblastoma - 1, ependymoma -1, cerebral metastasis -1; in two cases it was an unexpected finding. We noticed that tumoral localization next to the ventricles favoured cell exfoliation. Although pleocytosis was rare and uncorrelated with the presence of neoplastic cells, pathological cytomorphologic pictures appeared in most of the cases including all "positive" ones. Our results stress that the appearance of neoplastic cells in CSF remains helpful specially when it is an unexpected finding. O objectivo fundamental desta revisão retrospectiva dos dados clínicos e do estudo do líquido céfalo-raquidiano (LCR) de 41 doentes com tumores intracranianos diagnosticados entre 197S e 1989 é analisar a importância do achado de células neoplásicas no LCR, principalmente quando o recurso à tomografia computorizada e ressonância magnética cerebrais era raro. Outro objectivo diz respeito ao estudo das alterações proteicas do LCR nos tumores cerebrais. A análise do LCR compreendeu a contagem celular, a observação dos quadros citomorfológicos obtidos após sedimentação, o doseamento das proteínas totais e a determinação dos perfis electroforéticos. Encontraram-se células tumorais em 12 doentes (29%): meduloblastomas - 6, meningites carcinomatosas - 3, glioblastoma multiforme - 1, ependimoma -1, metastases cerebrais -1; em 2 casos este achado foi inesperado. Na maior parte dos casos a localização do tumor perto do sistema ventricular favoreceu a exfoliação celular. Embora a pleocitose fosse rara e não se correlacionasse com a presença de células neoplásicas, verificámos que na maioria dos casos, incluindo todos aqueles com citologia "positiva", os quadros citomorfológicos eram patológicos. Os nossos resultados mostram que a pesquisa de células tumorais no LCR continua a ser util e o seu achado particularmente relevante quando inesperado.

Background The diagnosis of leptomeningeal metastasis (LM) in patients with solid tumors remains difficult. The usual diagnostic methods of cytomorphological assessment of cerebro-spinal fluid (CSF) and gadolinium enhanced MRI of the entire neuraxis lack both specificity and sensitivity. The Veridex CellSearch® technology has been designed for the detection of circulating tumor cells (CTC) in blood from cancer patients and validated for the follow-up and prognosis of breast, prostate, colorectal, and lung cancer. Our aim was to adapt this technology for the detection and the enumeration of tumor cells in the CSF of breast cancer patients presenting with LM. Methods On the occasion of a randomized phase III study evaluating the role of the intrathecal treatment in LM from breast cancer (DEPOSEIN, EudraCT N°: 2010-023134-23), the CellSearch® technology was adapted to direct enrichment, enumeration and visualization of tumor cells in 5 mL CSF samples, collected on CellSave® Preservative Tubes and analyzed within 3 days after CSF sampling. Results Sixteen CSF of 8 patients with primary breast cancer presenting with LM were studied. EpCAM+/cytokeratin + cells with typical morphology could be observed and enumerated sequentially with reproducible results in low or elevated numbers in 8 patients. Conclusion This methodology, established on a limited volume of sample and allowing delayed processing, could prove of great interest in the diagnosis and follow-up of cancer patients with LM, especially to appreciate the efficacy of chemotherapy.

A 38-year-old Japanese man presented with a 2-year history of cerebellar ataxia, fever, and headaches. MRI revealed migration of the lesion (figure, A–C). CSF cytology showed eosinophilic meningitis (figure, D); serum and CSF ELISA were positive for Spirometra erinaceieuropaei . Human sparganosis is a rare parasitic …

Central nervous system (CNS) lymphoma can present a diagnostic challenge. Currently, there is no consensus regarding what presurgical evaluation is warranted or how to proceed when lesions are not surgically accessible. We conducted a review of the literature on CNS lymphoma diagnosis (1966 to October 2011) to determine whether a common diagnostic algorithm can be generated. We extracted data regarding the usefulness of brain and body imaging, serum and cerebrospinal fluid (CSF) studies, ophthalmologic examination, and tissue biopsy in the diagnosis of CNS lymphoma. Contrast enhancement on imaging is highly sensitive at the time of diagnosis: 98.9% in immunocompetent lymphoma and 96.1% in human immunodeficiency virus-related CNS lymphoma. The sensitivity of CSF cytology is low (2%-32%) but increases when combined with flow cytometry. Cerebrospinal fluid lactate dehydrogenase isozyme 5, β2-microglobulin, and immunoglobulin heavy chain rearrangement studies have improved sensitivity over CSF cytology (58%-85%) but have only moderate specificity (85%). New techniques of proteomics and microRNA analysis have more than 95% specificity in the diagnosis of CNS lymphoma. Positive CSF cytology, vitreous biopsy, or brain/leptomeningeal biopsy remain the current standard for diagnosis. A combined stepwise systematic approach outlined here may facilitate an expeditious, comprehensive presurgical evaluation for cases of suspected CNS lymphoma.

Background Cerebrospinal fluid (CSF) examination can be used to verify the presence of primary malignancies as well as cases of central nervous system (CNS) metastasis. Because of its importance, there have been several studies concerning the sensitivity of CSF cytology. To determine the practical use and reproducibility of diagnoses based on CSF cytology, we evaluated this test by analyzing cytology results from consecutive CSF samples. Methods Between July 2010 and June 2013, 385 CSF cytology samples from 42 patients were collected. The samples were gathered using a ventricular catheter and reservoir. CSF cytology of all patients was examined more than two times with immunocytochemistry for cytokeratin. Results Primary neoplastic sites and histologic types of patients' metastatic cancer were diverse. The overall sensitivity for detecting malignancy was 41.3%. Even within short-term intervals, diagnoses frequently changed. Conclusions Our results were inconsistent, with low sensitivity, when compared to the results of previous studies. However, CSF evaluation can still provide valuable diagnostic and prognostic information because adjuvant treatments are now routinely performed in patients with CNS metastasis. Negative CSF cytology results should not be ignored, and continuous CSF follow-up is essential for following the clinical course of patients with metastatic cancer involving the CNS.

Practical CSF Cytology (CD-ROM) By Harald Von Kluge, Stefan Isenmann, Hans J. Kuehn, Martin M. Kluska, Valentin Wieczorek, Otto W. Witte New York: Thieme Publishers [CD-ROM] 2008. $49.95 USD This interactive CD-ROM is intended for neurologists, neuropathologists, cytopathologists, and other laboratory practitioners. There is a single-screen introduction text with a list of cell types and descriptions, and a brief (18 figures with short explanatory legends) example section, but the majority of the images are found in the exercises, a 140-question interactive self-examination with …

Cerebrospinal fluid (CSF) cytology is based on the cytopathologic findings of other body fluids. However, CSF's cytologic features are less familiar to physicians than are those of the other body fluid's cytology because of the small number of cases. The low overall diagnostic accuracy and the presence of false positivity still remain as problems. The incidence of lymphoreticular malignancies and metastatic carcinomas are rather higher than that of primary brain tumors. In this review, the characteristic cytologic findings of conventional CSF cytology are reviewed along with a brief note on the technical preparation and diagnostic pitfalls.

Neoplastic meningitis is seen in five to ten percent of patients with solid tumors and is characterized by multifocal neurological signs and symptoms. The diagnosis is established by imaging, cerebrospinal fluid (CSF) cytology, and radioisotope CSF flow studies. Gastric adenocarcinoma is a rare cause of neoplastic meningitis. We review here CSF cytology results from our Oncology center obtained over two years and report three cases of gastric adenocarcinoma with cytologically positive CSF.

Fifteen pediatric (age under 16) cases of oligodendroglioma (ODG) were surgically proven from January 1985 to April 1992 at the Division of Pediatric Neurosurgery, Seoul National University Children's Hospital. To observe the proportion of ODG's in primary intracranial tumors, the location of ODG's and the prognostic significance of the histological grading of ODG's in childhood, the 15 cases of pediatric ODG's were retrospectively analyzed. ODG's accounted for 5.6% of pediatric primary intracranial tumors operated on during the same period. Nine tumors were located in the cerebral hemisphere (3 cases each in the frontal, temporal and parietooccipital lobes), 1 in the thalamus, 2 in the pons-medulla, 2 in the cerebellum and 1 in the thoracolumbar spinal cord. Four tumors were anaplastic and an additional case showed positive cerebrospinal fluid (CSF) cytology for tumor cells. All the cases of anaplasia or positive CSF cytology had a poor outcome. All the seven cases of benign ODG's in cerebral hemispheres presented with seizures which were controlled with or without medication after tumor removal.

We reviewed the correlation between malignant cells in cerebrospinal fluid (CSF) (positive cytology) and pathologic findings at autopsy. The purpose was to discover: (1) the incidence of negative CSF cytology in patients with CNS malignancy, (2) the incidence of false-positive cytology, and (3) the relationship between a true-positive cytology and the distribution of malignant tumor at autopsy. Of 117 patients with CNS tumor and premortem cytologic examination of the CSF, 31 (26 percent) were positive and 86 (74 percent) were negative. Only 1 of 66 patients with tumor that did not reach the leptomeninges had a positive cytology. Of 51 patients with leptomeningeal tumor at autopsy, cytology was positive in 30 (59 percent) and negative in 21 (41 percent). Five potentially "false-positive" cytologies were encountered: three patients were treated, and tumor may have been eradicated; in two patients with lymphoma, inflammatory cells associated with infection were apparently mistaken for malignant cells. These data indicate that a positive CSF cytology is a reliable indicator of CNS malignancy and almost always reflects leptomeningeal tumor.

Para mostrar a utilidade da técnica de Suta no estudo da citologia do LCR são apresentados 4 casos nos quais foi demonstrada a presença de células de natureza neoplásicas. Os achados são analisados frente à citologia normal do LCR e classificados segundo variante da classificação de Papanicolaou aplicável à citologia do LCR.

Bu çalışma, 6-11 Ekim 1980 tarihlerinde Antalya[Türkiye]’da düzenlenen XVI. Ulusal Psikiyatri ve Nörolojik Bilimler Kongresi‘nde bildiri olarak sunulmuştur. Bu çalışmada, beyin tümörü tespit edilen 29 vak'ada B. O.S. (Beyin-Omurilik-Sıvısı) sitolojisi bulguları ile histopatolojik bulgular arasındaki korrelasyon araştırılarak sito-diagnozun değeri tartışılmıştır. 29 vak'anın 18'inde (% 62) sitolajik olarak doğru tanı konduğu, genellikle malign patolojilerde sito-diagnoz ihtimalinin daha yüksek olduğu saptanmıştır. ln this study, correlation of CSF cytology and histopathological findings in 29 Brain Tumours was investigated and value of cyto-diagnosis was discussed. In 18 (62 %) cases cyto-diagnosis was made correctly. In malignant processes, high probability of correct cyto-diagnosis was found.

In nine out of 11 patients with herpes zoster and neurological symptoms varicella-zoster antigen was demonstrated in CSF cells by indirect immunofluorescent staining. Cerebrospinal fluid cytology was in most cases highly suggestive of viral infection. This study demonstrates the value of both immunofluorescent staining on CSF cells and CSF cytology, as corroboration of an otherwise exclusively serologically based virological diagnosis.