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#REDIRECT [[CSF cytopathology]]
''CNS cytopathology'' is a subset of [[neuropathology]] and [[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==
{{familytree/start}}
{{familytree | | | | | | | | | A01 | | | | |A01=CNS cytology}}
{{familytree | | | | |,|-|-|-|-|^|-|-|-|-|.|}}
{{familytree | | | | B01 | | | | | | | | B02|B01=Tumour|B02=Non-tumour }}
{{familytree | |,|-|-|^|-|-|.| | | |,|-|-|^|-|-|.| | |}}
{{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 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==
Cohesive tumours:
*[[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==
*[[Neuropathology]].
*[[Neurohistology]].
*[[CNS tumours]].
 
==References==
{{Reflist|1}}
 
==External links==
*[http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html Diagnostic neuropathology smears (msdlatinamerica.com)].
 
[[Category:Cytopathology]]
[[Category:Neuropathology]]
Retrieved from "https://librepathology.org/wiki/CNS_cytopathology"