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Difference between revisions of "CSF cytopathology"
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#Lymphoma is a common malignancy of malignancies found in the CSF. | #Lymphoma is a common malignancy of malignancies found in the CSF. | ||
In many institutions, all CSF specimens are ''stat''. | In many institutions, all CSF specimens are ''stat''. ''Lumbar puncture'' redirects here. | ||
==Cerebrospinal fluid== | ==Cerebrospinal fluid== | ||
==Normal== | ==Normal== | ||
*Paucicellular. | *Paucicellular. | ||
*< | **Acellular specimens common and considered adequate.<ref>{{cite book |author=Mody, Dina R. |title= [https://www.amazon.ca/Diagnostic-Pathology-Cytopathology-Dina-Mody/dp/1931884552/ Diagnostic Cytopathology] |publisher=Elsevier Canada |location= |year=2018 |pages= {{{1|II-3 2}}} |edition=1st |isbn=978-1931884556 |oclc= |doi= |accessdate=}}</ref> | ||
*protein is around 15-40 mg/dl. | |||
Gobs of anuclear material: | Gobs of anuclear material: | ||
*Protein vs. white | *Protein vs. white matter. | ||
*Ocassionally arachnoid cap cell- | |||
Bark-like flaky material: | Bark-like flaky material: | ||
| Line 35: | Line 37: | ||
==Hemorrhage== | ==Hemorrhage== | ||
*Xanthochromatous specimen | *Xanthochromatous specimen | ||
**Can be artificial -> due punctuation. | **Can be artificial -> due punctuation injuries or rifampin medication.<ref name="pmid7125611">{{Cite journal | last1 = Liggett | first1 = SB. | last2 = Berger | first2 = JR. | last3 = Hush | first3 = J. | title = Cerebrospinal fluid xanthochromia with rifampin. | journal = Ann Neurol | volume = 12 | issue = 2 | pages = 228-9 | month = Aug | year = 1982 | doi = 10.1002/ana.410120240 | PMID = 7125611 }}</ref> | ||
**Can be seen in newborn -> due to increased bilirubin levels. | |||
**Best seen when looking from top through the tube. <ref name="pmid3981778">{{Cite journal | last1 = Bremer | first1 = HL. | title = Identification of xanthochromia. | journal = JAMA | volume = 253 | issue = 17 | pages = 2496 | month = May | year = 1985 | doi = | PMID = 3981778 }}</ref> | |||
**pink (free hemoglobin directly after bleeding) to yellow (bilirubin after one day). | |||
===Cytology=== | ===Cytology=== | ||
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<gallery> | <gallery> | ||
File:XanthochromeCSF.jpg | Xanthochromatous CSF (WC/Dschafar) | File:XanthochromeCSF.jpg | Xanthochromatous CSF (WC/Dschafar) | ||
File:Siderophage_CSF_cytology.jpg | A siderophage (WC/jensflorian) | |||
</gallery> | </gallery> | ||
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<gallery> | <gallery> | ||
File:CSF_pleocytosis_neutrophils.jpg | CSF (Pappenheim stain) with numerous neutrophils indicating a purulent meningitis (WC/jensflorian) | File:CSF_pleocytosis_neutrophils.jpg | CSF (Pappenheim stain) with numerous neutrophils indicating a purulent meningitis (WC/jensflorian) | ||
File:CSF S capitis 2013-11-08.JPG | Streoptococcal meningitis in a neonate with ventriculoperitoneal shunt (WC/Paulo Henrique Orlandi Mourao) | |||
File:Gram Stain Anthrax.jpg | Gram-positive Anthrax bacteria in a CSF specimen (WC/TenOfAllTrades). | |||
</gallery> | </gallery> | ||
DDx: | |||
*[[TBC]] | |||
*Fungal meningitis | |||
==Viral meningitis== | ==Viral meningitis== | ||
| Line 62: | Line 75: | ||
===General=== | ===General=== | ||
*Positive viral culture. | *Positive viral culture. | ||
**HSV | |||
**CMV | |||
**Enterovirus | |||
**HIV | |||
===Cytology=== | ===Cytology=== | ||
*Pleocytosis (usu. 10-1000 cells/µl). | |||
*Polymorphous population of lymphocytes.<ref name=Ref_APBR681/> | *Polymorphous population of lymphocytes.<ref name=Ref_APBR681/> | ||
* Activated lymphocytes. | |||
* Plasma cells (sometimes bi- and multinuclear). | |||
* Occ. mitoses. | |||
* Activated (vacuolated) monocytes. | |||
<gallery> | |||
File:Hiv_meningeoencephalitis_csf_pleocytosis.jpg | Lymphocytic plecoytosis in HIV meningeoencephalitis | |||
File:HSV1_encephalitis_CSF_specimen.jpg | Activated lymphocytes in HSV1 encephalitis | |||
</gallery> | |||
==Mollaret's meningitis== | ==Mollaret's meningitis== | ||
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</gallery> | </gallery> | ||
===Meningeosis carcinomatosa=== | ===Meningeal carcinomatosis (Meningeosis carcinomatosa)=== | ||
Histology: | Histology: | ||
*abnormal cell size / giant multinuclear cells. | *abnormal cell size / giant multinuclear cells. | ||
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File:Meningeosis carcinomatosa.jpg | Lung adenocarcinoma cells in CSF (WC/Marvin101). | File:Meningeosis carcinomatosa.jpg | Lung adenocarcinoma cells in CSF (WC/Marvin101). | ||
File:Leptomeningeal metastasis.jpg | Atypical mitosis in epithelial cells in CSF (WC/jensflorian). | File:Leptomeningeal metastasis.jpg | Atypical mitosis in epithelial cells in CSF (WC/jensflorian). | ||
File:Meningiosis carcinomatosa.jpg | Leptomeningeal carinomatois (WC/jensflorian). | |||
</gallery> | </gallery> | ||