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2070 Background: The leptomeninges are an increasingly frequent site of cancer relapse. The traditional gold-standard for diagnosis of LMD is CSF cytology, but MRI is now used routinely as a diagno...

Introduction The suprasellar location is the second common site for germ cell tumors during childhood consisting of 30 to 40% of cases. They are rare and present with diabetes insipidus (DI) and visual symptoms. We review our personal series of suprasellar malignant germ cell tumor (SMGCT) to define optimum therapy. Methods From 1994 to 2006, 27 children with SMGCT were diagnosed and treated at our institution. All patients had neuroimaging including CT and MRI. All had tumor marker, alpha-fetoprotein (AFP), and beta-HCG (b-HCG), in both serum and CSF. Results The common presenting symptoms were DI (25), headaches (11), and visual disturbances (7). Tumors were in suprasellar/intrasellar location (14), concurrent suprasellar and pineal location (11), and concurrent suprasellar and basal ganglia location (2). CSF disseminations were noted in the ventricle (4) and by positive lumbar CSF cytology (2). Tumor markers were negative for both in 12, positive for AFP in 6, positive for b-HCG in 8, and positive for ...

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.

Two series of newly diagnosed patients with medulloblastoma are compared in terms ofsurvival, relapse-free survival, and sites of relapse. Patients in series I were all diagnosed and treated prior to 1974 and did not have the benefit of myelography and CSF cytology for staging. All patients treated after 1974 had myelography and most had CSF cytology studies prior to radiotherapy. In addition, patients in the fatter series were all followed with CT scanning. Improved survival and relapse-free survival rates were seen in the series II patients. Approximately 30% of the staged patients have had abnormal myelograms. It is suggested that involved portions of the cord be treated with higher doses than the usual prophylactic doses. The better results seen in the series II patients are probably due in part to a combination of adequate staging with radiation doses to the neuraxis based on the staging, close followup with CT scanning, and aggressive re-treatment of relapses.

In two patients of meningeal leukemia, the changes of CSF cell pattern following intrathecal methotrexate (MTX) therapy were serially examined by light microscopy. The first case reacted well to cytostatic treatment. 72 h after the first intrathecal MTX injection, an alteration of the chromatin structure could be observed in the nucleus of CSF blast cells; there was a condensation of the heterochromatin, a fragmentation of the nucleus and a dispersal of the chromatin into the cytoplasm. With the therapy-resistant patient No. 2, 72 h after intrathecally administered MTX, the rate of blast cells did not change, and nuclear damage has manifested itself by a rarefaction and disappearance of the chromatin substance. There is strong evidence that these nuclear changes are due to intrathecal MTX treatment. Such changes, however, may not be considered to be specific.

Gadolinium-DTPA was used in MR imaging of the spine to determine the ability of a contrast agent to increase the detection and characterization of disease in the intradural extramedullary space. Although MR imaging, especially with recent technological improvements, has been shown to be at least competitive with, and often superior to, myelography and postmyelography CT in the study of intramedullary and extradural disease, its use in the assessment of intradural extramedullary disease has been questioned. We selected 12 patients with intradural extramedullary disease as demonstrated by positive CSF cytology and/or myelographic findings and performed MR examinations on them before and after administering gadolinium-DTPA (0.1 mmol/kg). Gadolinium-DTPA was extremely effective in depicting intradural extramedullary disease of the spine. Small nodules of 3 mm, virtually invisible on noncontrast MR scans, enhanced strongly and were easily detected. In addition, leptomeningeal spread of tumor along nerve roots was also visualized, sometimes more readily than by myelography and postmyelography CT. The remarkable sensitivity of gadolinium-DTPA to intradural extramedullary disease assures its role in future MR examinations of the spine.

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.

Effects of intrathecal cytostatic chemotherapy on the clinical symptoms and cerebrospinal fluid (CSF) findings are being demonstrated in a case of metastatic carcinoma of the breast with signs of meni

Clinical and radiological findings of 10 breast cancer patients with meningeal carcinomatosis were recorded. Special attention was drawn to CSF findings. Initial CSF cytology revealed malignant cells in all cases with a background of inflammatory cells in 7. Oligoclonal bands were found in the CSF of 3 out of 5 cases examined. Repeated CSF control under therapy showed elevation of lactate to be a better diagnostic parameter than lowered glucose. Six patients responded well to CNS radiation therapy and intrathecal chemotherapy. Median duration of survival was 6.4 months.

Trotz des Hinweises von Bailey, primare Melanome des ZNS konnten durch cytologische Liquoruntersuchung festgestellt werden, sind Berichte hieruber selten geblieben. Bei einem 35jahrigen Mann wurden Ruckenschmerzen zunachst als Ischias fehlgedeutet. Die Klarung der Diagnose gelang erst durch cytologische Liquoruntersuchung. Dabei fanden sich sowohl pigmentierte wie pigmentfreie Tumorzellen, ein Befund, der durch die Sektion bestatigt wurde. Gleichzeitig vorhandene Siderophagen als Ausdruck von Blutungen in solide Tumoren der Hirnoberflache wie aus den diffus infiltrierten Hirnhauten waren gut zu unterscheiden von Blastomzellen. Die Latenz zwischen Erstsymptom und Klarung der Diagnose von bisher 6–12 Monaten sollte durch cytologische Untersuchung des Liquors verkurzt werden konnen. Dies ist um so wichtiger, als chemotherapeutische wie chirurgische Behandlungsversuche, wenngleich mit bisher nur begrenztem Erfolg, unternommen wurden.

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.

Das Liquorzellbild bei einem 43 jahrigen Mann mit primarer diffuser Melanoblastose der Meningen wird beschrieben. Es wird versucht, pigmenthaltige Tumorzellen von melaninspeichernden Makrophagen (Melanophagen) morphologisch abzugrenzen; Melanophagen weisen wabig-vacuolisierte Plasmaanteile und klumpige Pigmentaggregate auf, wahrend Melanoblasten feinste Pigmentgranula neben groseren Pigmentkugeln sowie grose Nucleolen besitzen. Im Vergleich mit histologischen Autopsiepraparaten konnen gut erhaltene Liquorzellen feinere cytologische Details zeigen. Die Bedeutung des Liquorzellbefundes und der Thormalen-Reaktion auf freies Liquormelanin fur die Diagnostik primarer Pigmentgeschwulste des ZNS und seiner Hullen wird betont.

Oligodendrogliomas occur primarily in the cerebral hemispheres of adults. A rare case of an oligodendroglioma in the cerebellum of a child is presented. The tendency for oligodendroglioma to metastasize through the cerebrospinal fluid (CSF) is reviewed and emphasized. A recommendation for CSF cytology and possible spinal axis irradiation in the treatment of oligodendrogliomas is made.

Choroid plexus and ependymal cells were only demonstrated in 10 of a series of 2620 CSF cytograms. Choroid plexus cells sometimes stained positive for acid phosphatase while in ependymal cells this enzyme activity was not observed. Choroid plexus and ependymal cells in CSF were found to be associated with various neurological disorders involving mainly the brain stem and spinal cord. This is probably due to the higher chance of sedimentation of viable cells in the lumbar sac in these conditions. Loss of these cells might explain the incidental observation of granular ependymitis in post-mortem brains.

Central nervous system (CNS) involvement in Hodgkin's disease is rare, but when the tumor extends into the CNS the route of tumor spread is similar to that seen in non-Hodgkin's lymphoma. Reed-Sternberg cells were identified in the cerebrospinal fluid (CSF) of a patient with Hodgkin's disease involving the CNS. Sequential cytologic examination of the CSF proved valuable in evaluating the efficacy of therapy. The ability to identify Reed-Sternberg cells in the CSF makes CSF cytology a useful adjunct in the management of patients with established or suspected CNS involvement of Hodgkin's disease. Diagn Cytopathol 1987;3:323-5.

An assembly is described which substantially increases the in-vivo capture of cells and/or microbes when they are present in low concentrations in CSF.

The success in inducing hematologic remissions in leukemia has brought a marked increase in the incidence of CNS leukemia.

Examination of cerebrospinal fluid (CSF) for the presence of malignant cells is a time-honored and widely used technique. Since DuFour8 first identified malignant cells in CSF in 1904, a number of reports have attested to the usefulness of CSF cytology in assisting in the diagnosis of primary and metastatic central nervous system (CNS) tumors.

An improved cytocentrifuge method well suited for CSF cytology is described. By contrast with the old chamber, the newly developed sample chamber, which fits into the Cytospin centrifuge (Shandon Elliott, Great Britain) is placed horizontally. All cells are centrifuged in a straight line against the glass slide, and an air bubble between the fluid and the blotting paper prevents premature fluid loss. It is shown that these two variables play an important role in cell loss, and that the cell loss in the old chamber is of a selective nature. There are statistically significant differences in the nuclear and cytoplasmic size of the cell populations using the old and the new chamber.

The CSF of 12 patients with acute meningitis and meningoencephalitis of viral nature (proven in 10 and probably in 2) was investigated by light microscopy. In early CSF, 1--31% reactive lymphocytes and 1--6% plasma cells were found consistently. In addition, various lymphoid cell features of marked immune activation were disclosed in association: cell polymorphism, normal-appearing mitosis and binucleation, abnormal nuclear lobulation and even partition, as well as Russell bodies, morular appearance and clasmatosis in plasma cells. The CSF findings are discussed with respect to those described in tuberculous meningitis and multiple sclerosis and distinguishing features are suggested to occur in early CSF of viral meningitis.

✓ A method is described which has been found capable of detecting subarachnoid hemorrhage (SAH) up to 15 to 17 weeks after its occurrence. The episode of SAH was confirmed by bloody and/or xanthochromic cerebrospinal fluid (CSF) at the time of SAH onset. In this study, 47 samples of lumbar CSF from diagnostically confirmed SAH patients were used. The CSF cells were collected onto slides and stained with May-Gruenwald-Giemsa or Perl's reagent. Iron-positive cells were detected at 1 week, increased by 4 to 6 weeks to 8.5% of total nucleated cells, and decreased to 1% by 15 to 17 weeks. All 27 samples obtained at 2 to 9 weeks after SAH showed iron-positive cells. No iron-positive cells (false-negative samples) were noted in 25% (one of four) of samples obtained during the first week, and in 33% (one of three) of samples obtained 10 to 12 weeks and 15 to 17 weeks after SAH. Of the total samples (37) obtained within 17 weeks after SAH, 8.1% (three of 37) were false negative. No iron-positive cells were detected in samples obtained later than 21 weeks after the SAH episode (10 samples).

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.

It was established over ten years ago that children dying of acute lymphoblastic leukaemia (ALL) had a high incidence of CNS infiltration, especially of the leptomeninges (Hyman et al., 1965; Thomas, 1965). Increasingly effective chemotherapy protocols resulted in the majority of children achieving remission and an increased expectation of prolonged remission duration and survival, but with an apparent increase in the cumulative risk of developing CNS leukaemia (CNSL) (Evans et al., 1970; Hustu et al., 1973; Nies et al., 1965a; Pavlovsky et al., 1973; Pinkel et al., 1971; Rieselbach et al., 1963; West et al., 1972). A greater awareness of CNSL led to improved methods of processing cerebrospinal fluid (CSF), notably membrane filtration (Del Vecchio et al., 1959; Hutton, 1958), gravity sedimentation (Kolar and Zeman, 1968; Sayk, 1960; Somas, 1967) and cytocentrifugation (Watson, 1966). These techniques clearly showed that examination of CSF cytology was capable of detecting CNSL in the absence of symptoms, clinical signs, changes in biochemistry or increased CSF cell count (Drewinko et al., 1973; Evans, 1974; Hustu et al., 1973; Nies et al., 1965b).

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.

Among 162 children referred with head injury (in a 3-year period) a viral meningoencephalitis was proven to be present in seven cases. Only one patient showed symptoms of infection before the accident. On admission classical signs of viral meningoencephalitis were absent or mixed with the complications of head injury. A diagnosis of viral meningitis/meningoencephalitis was documented by immunofluorescent demonstration of viral antigens in CSF cells and/or pattern of CSF cytology and/or conventional serological methods. Whether the trauma and the infection are coincidental or causally related can not be decided definitively. A hypothesis is presented suggesting diminished alertness in subclinical viral meningoencephalitis, leading to accident proneness.

• We examined the CSF of 46 noninfected neonates with birth weights ranging from 650 to 4,000 g, using the new cytocentrifuge technique. The macrophage was the predominant cell in the CSF in most cases. (Am J Dis Child1982;136:297-298)

In a 57-year-old male patient meningitic symptoms occurred. CSF cytology exhibited carcinoma cells, thus establishing the diagnosis of carcinomatous meningeosis. The primary site of the tumor or metastases were not detected intra vitam. The autopsy revealed a malignant thymoma with an exclusive metastatic participation of the leptomeninges except for some few regional lymph nodes. Cerebral metastases of malignant thymoma is an extremely rare condition.

Sir .—The report "CSF Cytology in the Neonate" by Pappu et al (Journal1982;136:297-298) emphasizes the importance of cytologic evaluations of neonatal CSF using a slow-speed cytocentrifuge technique. The authors warn against one of the limits of the method, ie, blood contamination of samples. Delay in laboratory procedures, because of CSF hypo-osmolality, and the kind of sampling material, such as glass tubes, can also produce significant impairment of results. In our experience, 1,2 laboratory procedures were started within ten minutes after lumbar taps, and my colleagues and I think that it should never exceed a half hour. The predominant cells in nonbloody CSF collections of neonates are histiomonocytes. 1 However, the term "macrophage" should be used with caution and, according to Oehmichen, 3 should be restricted to monocytic cells in which the vacuolar content is precisely identified. Then, macrophages can be divided into a few subclasses: true lipophages, erythrophages, and

we studied a 3-month-old boy who had opsoclonus in association with acute bacterial meningitis. The CSF IgG and IgM were elevated acutely, gradually returning to normal with clinical improvement. Correspondingly, CSF cytomorphology showed excessive plasmocytosis and a higher proportion of reactive lymphocytes than expected in an acute bacterial meningitis. These abnormalities in CSF cytology are effects of an abnormal immune response in the CNS, and provide evidence to support an immunopathic basis to opsoclonus.

2072 Background: The diagnosis of LM remains challenging, as standard diagnostic tools such as CSF cytology and MRI have low sensitivity. We previously showed that detection of CSF CTC by rare cell...

e13061 Background: Currently, LM diagnosis is based on CSF cytology and findings on MRI, but sensitivity of these techniques is low, and diagnosis is usually confirmed late in the disease course. I...

In Reply.—We agree with Dr Dalens, and we reemphasize the importance of processing CSF samples quickly for several reasons. First, neutrophils degenerate rapidly, and they can alter the total and differential cell counts. Second, the delay in processing may result in degenerative, as well as artifactual, changes in monocytes. Third, the bacteria can be identified before disintegration. The definition of macrophages in CSF is not universal. A review of the literature shows that various investigators1-5have used different terms for the cells of the mononuclear phagocytic system. In our article, we followed the nomenclature in which a nonactivated monocyte in CSF was identified morphologically as a monocyte, whereas the activated monocyte and macrophage were considered identical, because we believe that except for minor variations they are similar cell types.6,7 Observations of a relationship between psychomotor handicaps and a greater percentage of histiomonocytic cells in CSF on serial