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]]''.
+==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==
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 {{familytree | C01 | | | | C02 | | C03 | | | | C04 | |C01=Glial|C02=Non-glial|C03=Infectious|C04=Non-infectious }}
 {{familytree/end}}
+{| class="wikitable"
+|
+| Glial
+| Non-glial
+|-
+| Stranding <br>(cytoplasmic)
+| thin - cannot be seen at low <br>power (2.5x obj.), true cytoplasmic <br>processes
+| thick - can be seen at low <br>power (2.5x obj.), artifact of smearing
+|-
+| Edge of cluster
+| smooth/non-distinct
+| sharp
+|}
 Glial vs non-glial:
-*Glial has glial strands (stringy processes) ~ 1-2 micrometers thick.
+*Glial has cytoplasmic processes/cytoplasmic strands (stringy processes) ~ 1 micrometer thick.
+**They cannot be seen well at low power.
+**Cotton candy-like appearance.
 **Images:
 *** [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>
+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:
+*Crush artifact (in smear preparation) can mimic glial processes.
+**Crush artifact vs. real glial processes:
+***No glial processes run perpendicular to the direction of smear.
+***Glial processes may branch.
+***Crushed/elongated nuclei are present in artifactual processes.
+<!-- *** something i forgot -->
+===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)
+<gallery>
+File:Meningioma cytologie.jpg | HE smear of a meningioma displaying typical whorl formations (WC/jensflorian)
+</gallery>
+===Metastatic carcinoma===
+Typically has a 'cannonball' appearance -- with small, highly cohesive clusters of epithelioid cells.
+{{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/Images/SampleQ50.gif Adenocarcinoma (ouhsc.edu)].
+*[http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Images/SampleQ59.gif Small cell carcinoma (ouhsc.edu)].
+===Metastatic melanoma===
+*Occasionally large bi- or multinucleated cells
+*Discohesive cells
+*Large nucleoli
+*Pigmented tumor cells
+*Accompanied by tumor infiltrating lymphocytes
+<gallery>
+File:Melanoma_CNS_met_smear_HE.jpg | Melanoma smear prep (H&E)
+File:Melanoma - cytology field stain.jpg
+</gallery>
+===Metastatic lymphoma===
+*Small round and blue cells
+===Glial tumors===
+* Elongated cell processes
+* Cohesive growth
+* Often attached to vasculature
+<gallery>
+File:Pilocytic astrocytoma - smear - very high mag.jpg | Pilocytic astrocytoma smear preparation (H&E)
+</gallery>
 ==Things that don't smear well==
-*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>
+Cohesive tumours:
-*Neurofibroma.<ref name=pmid7962615/>
+*[[Neurofibroma]].
+*[[Schwannoma]].<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
+*Subependymoma
+*Abscess (because of fibrous capsule)
+*Metastasis.<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
+===Things that smear well===
+Dyscohesive tumours:
+*[[Lymphoma]].<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
+*[[Pituitary adenoma]].<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
+*Oligodendroglioma.<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
+*[[Astrocytoma]].
+*Normal brain.
 ==See also==

Difference between revisions of "CNS cytopathology"

CNS cytopathology (view source)

Revision as of 14:59, 21 December 2016

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