Difference between revisions of "CNS cytopathology"

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CNS cytopathology (view source)

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An introduction to cytopathology is in the ''[[cytopathology]]'' article.  Cerebrospinal (CSF) specimens are dealt with in a separate article called ''[[CSF cytopathology]]''.
An introduction to cytopathology is in the ''[[cytopathology]]'' article.  Cerebrospinal (CSF) specimens are dealt with in a separate article called ''[[CSF cytopathology]]''.
==Technique==
Smears (really squash preps) are common in neuropathology. Here are some tips for getting a good smear:
# Sampling is key -- choose 3-4 small pieces of tissue from different areas of the tissue (if there are different colours, get some of each)
# Keep pieces small (easier to smear)
# Avoid air drying (place into formal alcohol immediately upon smearing)


==Basic approach==
==Basic approach==
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Glial vs non-glial:
Glial vs non-glial:
*Glial has ctyoplasmic processes/cytoplasmic strands (stringy processes) ~ 1 micrometer thick.
*Glial has cytoplasmic processes/cytoplasmic strands (stringy processes) ~ 1 micrometer thick.
**They cannot be seen well at low power.  
**They cannot be seen well at low power.  
**Cotton candy-like appearance.
**Cotton candy-like appearance.
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*** [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/files/cf76aad0d9dab70c99b93186ca8b3ad4.gif Stringy processes - glial tumour (msdlatinamerica.com)].<ref name=latinam>URL: [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html]. Accessed on: 2 November 2010.</ref>
*** [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/files/cf76aad0d9dab70c99b93186ca8b3ad4.gif Stringy processes - glial tumour (msdlatinamerica.com)].<ref name=latinam>URL: [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html]. Accessed on: 2 November 2010.</ref>
*** [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/files/59f74df1106573dcdea73be7febff2aa.gif Glial tumour mimicing a carcinoma (msdlatinamerica.com)].<ref name=latinam>URL: [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html]. Accessed on: 2 November 2010.</ref>
*** [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/files/59f74df1106573dcdea73be7febff2aa.gif Glial tumour mimicing a carcinoma (msdlatinamerica.com)].<ref name=latinam>URL: [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html]. Accessed on: 2 November 2010.</ref>
Gliosis vs. neoplasm:
*Gliosis - uniform, pink
*Astrocytoma - irregular, coarse clumps of pink fibrillary material
High grade vs. low-grade:
*Markers of high grade glioma:
# Mitoses (can see these in smear)
# Necrosis (can also see in smears)


Notes:
Notes:
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***Crushed/elongated nuclei are present in artifactual processes.  
***Crushed/elongated nuclei are present in artifactual processes.  
<!-- *** something i forgot -->
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===Meningioma===
Most meningiomas smear rather well, the only exception being ones that are densely fibrous.
*Key features of meningioma smears:
# Single cells or small groups of epithelioid cells with distinct cytoplasmic 'flags' (cytoplasm usually abundant)
# Round nuclei with vesicular chromatin and unapparent or small nucleoli
# Visible actin striations / stress filaments in cells (seen as pink straight lines)


===Metastatic carcinoma===
===Metastatic carcinoma===
Typically has a 'cannonball' appearance -- with small, highly cohesive clusters of epithelioid cells.
{{Main|Metastasis}}
{{Main|Metastasis}}
*[http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/_derived/Q92-Ans.htm_txt_SampleQ92.gif Squamous cell carcinoma (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Q92-Ans.htm http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Q92-Ans.htm]. Accessed on: 3 November 2010.</ref>
*[http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/_derived/Q92-Ans.htm_txt_SampleQ92.gif Squamous cell carcinoma (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Q92-Ans.htm http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Q92-Ans.htm]. Accessed on: 3 November 2010.</ref>
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==Things that don't smear well==
==Things that don't smear well==
Cohesive tumours:
Cohesive tumours:
*[[Meningioma]].<ref name=pmid7962615>{{cite journal |author=Ironside JW |title=Update on central nervous system cytopathology. II. Brain smear technique |journal=J. Clin. Pathol. |volume=47 |issue=8 |pages=683–8 |year=1994 |month=August |pmid=7962615 |pmc=502135 |doi= |url=}}</ref><ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*[[Neurofibroma]].
*[[Neurofibroma]].<ref name=pmid7962615/>
*[[Schwannoma]].<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*[[Schwannoma]].<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*Subependymoma
*Subependymoma
Ana
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