Difference between revisions of "CSF cytopathology"

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==Acute bacterial meningitis==
==Acute bacterial meningitis==
*Neutrophils.<ref name=APBR681>APBR P.681 (Q25).</ref>
*Neutrophils.<ref name=Ref_APBR681>{{Ref APBR|681 (Q25)}}</ref>


==Viral meningitis==
==Viral meningitis==
*Polymorphous population of lymphocytes.<ref name=APBR681/>
*Polymorphous population of lymphocytes.<ref name=Ref_APBR681/>


==Mollaret's meningitis==
==Mollaret's meningitis==
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Histology:
Histology:
*Mollaret cells - described as ''monocytoid cells''<ref name=APBR681/> (look like monocytes<ref>[http://www.mondofacto.com/facts/dictionary?monocytoid+cell http://www.mondofacto.com/facts/dictionary?monocytoid+cell]</ref> - but do not phagocytose), and ''large endothelial cells''.<ref name=emed1169489/>  
*Mollaret cells - described as ''monocytoid cells''<ref name=Ref_APBR681/> (look like monocytes<ref>[http://www.mondofacto.com/facts/dictionary?monocytoid+cell http://www.mondofacto.com/facts/dictionary?monocytoid+cell]</ref> - but do not phagocytose), and ''large endothelial cells''.<ref name=emed1169489/>  
**Features - large cells with: abundant cytoplasm, footprint-shaped" nucleus.
**Features - large cells with: abundant cytoplasm, footprint-shaped" nucleus.
**Mollaret cells ''not'' pathognomonic.<ref name=emed1169489/>
**Mollaret cells ''not'' pathognomonic.<ref name=emed1169489/>
*Mixed population of inflammatory cells<ref name=APBR681/> (PMNs, monocytes, plasma cells, lymphocytes); usually lymphocyte predominant.<ref name=emed1169489/>
*Mixed population of inflammatory cells<ref name=Ref_APBR681/> (PMNs, monocytes, plasma cells, lymphocytes); usually lymphocyte predominant.<ref name=emed1169489/>


Image:
Image:
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==CNS lymphoma==
==CNS lymphoma==
Histology:<ref name=APBR681>APBR P.681 (Q25).</ref>
Histology:<ref name=Ref_APBR681>{{Ref APBR|681 (Q25)}}</ref>
*Too many cells - ''key feature''.
*Too many cells - ''key feature''.
**Not diagnostic... but should raise suspicion.
**Not diagnostic... but should raise suspicion.
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Notes:
Notes:
*Massive karyorrhexis (nuclear fragmentation) is suggestive of lymphoma<ref name=APBR681>APBR P.681 (Q25).</ref> - not common.
*Massive karyorrhexis (nuclear fragmentation) is suggestive of lymphoma<ref name=Ref_APBR681>{{Ref APBR|681 (Q25)}}</ref> - not common.


==CNS fungal infections==
==CNS fungal infections==
*Cryptococcus is the most common.<ref>APBR P.682.</ref>
*Cryptococcus is the most common.<ref name=Ref_APBR682>{{Ref APBR|682}}</ref>


==Cryptococcus infection==
==Cryptococcus infection==
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Microscopic appearance:
Microscopic appearance:
*Yeast:<ref>APBR P.682.</ref>
*Yeast:<ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
**Round/ovoid 5-15 micrometres.
**Round/ovoid 5-15 micrometres.
**Thick mucopolysacchardie capsule + refractile centre.
**Thick mucopolysacchardie capsule + refractile centre.

Revision as of 04:28, 2 November 2010

CNS cytopathology is a subset of cytopathology.

This article deal only with central nervous system (CNS) cytopathology. An introduction to cytopathology is in the cytopathology article.

All CSF specimens get triaged at UHN as:

  1. They are small specimens ~ usually 1-10 ml.
  2. The procedure to obtain them is non-trivial, i.e. not pleasant for the patient and not risk free.
  3. Lymphoma is a common malignancy of malignancies found in the CSF.

All CSF specimens are stat.

Cerebrospinal fluid (CSF)

Normal

  • Paucicellular.

Gobs of anuclear material:

  • Protein vs. white mater.

Bark-like flaky material:

  • Contaminant.

Fluffy/smudged large cells (~2-3x RBC dia.) with an indistinct nucleus:

  • Degenerated white cells.
    • Should prompt a comment about "degeneration", if the population is dominant.

Routine processing

  • Cytospin - if no abnormality at triage.
    • The cellularity of the cytospin will appear to be increased (artifact).

Acute bacterial meningitis

  • Neutrophils.[1]

Viral meningitis

  • Polymorphous population of lymphocytes.[1]

Mollaret's meningitis

General:

  • Rare aseptic meningitis.
  • Suspected to be caused by HSV1 and HSV2.[2]

Clinical:

  • Recurrent meningismus, headache, +/-fever.[2]

Histology:

  • Mollaret cells - described as monocytoid cells[1] (look like monocytes[3] - but do not phagocytose), and large endothelial cells.[2]
    • Features - large cells with: abundant cytoplasm, footprint-shaped" nucleus.
    • Mollaret cells not pathognomonic.[2]
  • Mixed population of inflammatory cells[1] (PMNs, monocytes, plasma cells, lymphocytes); usually lymphocyte predominant.[2]

Image:

CNS lymphoma

Histology:[1]

  • Too many cells - key feature.
    • Not diagnostic... but should raise suspicion.
  • Single cells (as typical of lymphoma/leukemia).
  • Large lymphocytes - >2x RBC diameter.
  • +/-Nuclear atypia.
    • Radial segmentation - a completely cleaved nucleus/quasi-binucleation.

Notes:

  • Massive karyorrhexis (nuclear fragmentation) is suggestive of lymphoma[1] - not common.

CNS fungal infections

  • Cryptococcus is the most common.[4]

Cryptococcus infection

  • Immunocompromised host.

Microscopic appearance:

  • Yeast:[4]
    • Round/ovoid 5-15 micrometres.
    • Thick mucopolysacchardie capsule + refractile centre.
      • "Target-like" shape/"bull's eye" appearance.
    • "Tear drop-shapped" budding pattern (useful to differentiate from Blastomyces, Histoplasma).

Images:

Main article: Microorganisms

Non-lymphoid neoplasm

  • Non-lymphoid neoplasms are rarely found in the CSF.

Astrocytoma:

  • May vaguely resemble a neuroendocrine tumour:
    • Small cell clusters.
    • Nuclear moulding.
    • Cells somewhat larger than small cell carcinoma.
    • Scant cytoplasm.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 681 (Q25). ISBN 978-1416025887.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 http://emedicine.medscape.com/article/1169489-overview
  3. ↑ http://www.mondofacto.com/facts/dictionary?monocytoid+cell
  4. ↑ 4.0 4.1 Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 682. ISBN 978-1416025887.
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