Cerebrospinal fluid cytomorphologic findings in 41 intracranial tumors: a retrospective review

Sá, Maria José; Vaz, Rui; Cruz, Celso

doi:10.1590/S0004-282X1995000200006

Abstracts

The main objective of this retrospective review of clinical and cerebrospinal fluid (CSF) data from 41 patients with intracranial tumors diagnosed between 1975 and 1989, is to report the role that the finding of neoplastic cells in CSF plays, specially when cerebral CT-scanning and MRI were not currently done. Another objective is to study the CSF proteic abnormalities in cerebral tumors. CSF cell count, cytomorphologic pictures obtained after sedimentation and protein findings are described. Tumor cells were seen in 12 cases (29%): medulloblastomas - 6, meningeal carcinomatosis - 3, multiforme glioblastoma - 1, ependymoma -1, cerebral metastasis -1; in two cases it was an unexpected finding. We noticed that tumoral localization next to the ventricles favoured cell exfoliation. Although pleocytosis was rare and uncorrelated with the presence of neoplastic cells, pathological cytomorphologic pictures appeared in most of the cases including all "positive" ones. Our results stress that the appearance of neoplastic cells in CSF remains helpful specially when it is an unexpected finding.

CSF cytology; CSF tumor cells; cerebral tumors

O objectivo fundamental desta revisão retrospectiva dos dados clínicos e do estudo do líquido céfalo-raquidiano (LCR) de 41 doentes com tumores intracranianos diagnosticados entre 197S e 1989 é analisar a importância do achado de células neoplásicas no LCR, principalmente quando o recurso à tomografia computorizada e ressonância magnética cerebrais era raro. Outro objectivo diz respeito ao estudo das alterações proteicas do LCR nos tumores cerebrais. A análise do LCR compreendeu a contagem celular, a observação dos quadros citomorfológicos obtidos após sedimentação, o doseamento das proteínas totais e a determinação dos perfis electroforéticos. Encontraram-se células tumorais em 12 doentes (29%): meduloblastomas - 6, meningites carcinomatosas - 3, glioblastoma multiforme - 1, ependimoma -1, metastases cerebrais -1; em 2 casos este achado foi inesperado. Na maior parte dos casos a localização do tumor perto do sistema ventricular favoreceu a exfoliação celular. Embora a pleocitose fosse rara e não se correlacionasse com a presença de células neoplásicas, verificámos que na maioria dos casos, incluindo todos aqueles com citologia "positiva", os quadros citomorfológicos eram patológicos. Os nossos resultados mostram que a pesquisa de células tumorais no LCR continua a ser util e o seu achado particularmente relevante quando inesperado.

citologia do LCR; células tumorais no LCR; tumores cerebrais

Cerebrospinal fluid cytomorphologic findings in 41 intracranial tumors: a retrospective review

Alterações citomorfológicas do líquido céfalo-raquidiano em 41 doentes com tumores intracranianos: estudo retrospectivo

Maria José Sá^I; Rui Vaz^II; Celso Cruz^III

^IM.D. - Assistente de Neurologia do Serviço de Neurologia e Neurocirurgia do Hospital de S.João (Porto, Portugal), Membro do "CSF Research Group" - World Federation of Neurology

^IIM.D.- Assistente de Neurocirurgia do Serviço de Neurologia e Neurocirurgia do Hospital de S.João (Porto, Portugal)

^IIIPh.D.-Professor Catedrático de Neurologia e Neurocirurgia da Faculdade de Medicina do Porto, Director do Serviço de Neurologia e Neurocirurgia do Hospital de S. João (Porto, Portugal)

SUMMARY

The main objective of this retrospective review of clinical and cerebrospinal fluid (CSF) data from 41 patients with intracranial tumors diagnosed between 1975 and 1989, is to report the role that the finding of neoplastic cells in CSF plays, specially when cerebral CT-scanning and MRI were not currently done. Another objective is to study the CSF proteic abnormalities in cerebral tumors. CSF cell count, cytomorphologic pictures obtained after sedimentation and protein findings are described. Tumor cells were seen in 12 cases (29%): medulloblastomas - 6, meningeal carcinomatosis - 3, multiforme glioblastoma - 1, ependymoma -1, cerebral metastasis -1; in two cases it was an unexpected finding. We noticed that tumoral localization next to the ventricles favoured cell exfoliation. Although pleocytosis was rare and uncorrelated with the presence of neoplastic cells, pathological cytomorphologic pictures appeared in most of the cases including all "positive" ones. Our results stress that the appearance of neoplastic cells in CSF remains helpful specially when it is an unexpected finding.

Key words:CSF cytology, CSF tumor cells, cerebral tumors.

RESUMO

O objectivo fundamental desta revisão retrospectiva dos dados clínicos e do estudo do líquido céfalo-raquidiano (LCR) de 41 doentes com tumores intracranianos diagnosticados entre 197S e 1989 é analisar a importância do achado de células neoplásicas no LCR, principalmente quando o recurso à tomografia computorizada e ressonância magnética cerebrais era raro. Outro objectivo diz respeito ao estudo das alterações proteicas do LCR nos tumores cerebrais. A análise do LCR compreendeu a contagem celular, a observação dos quadros citomorfológicos obtidos após sedimentação, o doseamento das proteínas totais e a determinação dos perfis electroforéticos. Encontraram-se células tumorais em 12 doentes (29%): meduloblastomas - 6, meningites carcinomatosas - 3, glioblastoma multiforme - 1, ependimoma -1, metastases cerebrais -1; em 2 casos este achado foi inesperado. Na maior parte dos casos a localização do tumor perto do sistema ventricular favoreceu a exfoliação celular. Embora a pleocitose fosse rara e não se correlacionasse com a presença de células neoplásicas, verificámos que na maioria dos casos, incluindo todos aqueles com citologia "positiva", os quadros citomorfológicos eram patológicos. Os nossos resultados mostram que a pesquisa de células tumorais no LCR continua a ser util e o seu achado particularmente relevante quando inesperado.

Palavras-chave: citologia do LCR, células tumorais no LCR, tumores cerebrais.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Acknowledgements

The authors are indebted to the medical staff of the Neurology and Neurosurgery Department of Hospital de S.João for making clinical data available. We are also grateful to Mr.Óscar Campos for technical assistance in the CSF studies.

Aceite: 5-novembro-1994.

Dra. Maria José Sá - Serviço de Neurologia e Neurocirurgia, Hospital de S. João - Al. Prof. Hernâni Monteiro -4200 Porto, Portugal Fax (3512) 598119.

1. Balhuizen JC, Bots GThAM, Schaberg A, Bosman F. Value of cerebrospinal fluid cytology for the diagnosis of malignancies in the central nervous system. J Neurosurg 1978, 481:747-753.
2. Bigner SH, Johnston WW. The cytopathology of cerebrospinal fluid: I.Nonneoplastic conditions, lymphoma and leukemia. Acta Cytol 1981, 25:335-353.
3. Bigner SH, Johnston WW. The cytopathology of cerebrospinal fluid: II.Metastatic cancer, meningeal carcinomatosis and primary central nervous system neoplasms. Acta Cytol 1981, 25:461-479.
4. Boogerd W, Vroom THM, Van Heerde P, Brutel de la Rivičre G, Peterse JL, Van der Sande JJ. CSF cytology versus immunocytochemistry in meningeal carcinomatosis. J Neurol Neurosurg Psychiatry 1988, 51:142-145.
5. Cutler RWP, Spertell RB. Cerebrospinal fluid:a selective review. Ann Neurol 1982, 11:1-10.
6. Den Hartog Jager WA. Color atlas of CSF cytopathology. Philadelphia: J B Lippincot 1980, p 11-12.
7. Dufresne JJ. Cytologic pratique du liquide céphalo-rachidiea. Balę: Ciba-Geigy 1972, p78-93.
8. Dyken PR. Cerebrospinal fluid cytology:practical clinical usefulness. Neurology 1975, 25:210-217.
9. Dyken PR, Shirley S, Trefz J, El Gammal T. Comparison of cytocentrifugation and sedimentation techniques for CSF cytomorphology. Acta Cytol 1980, 24:167470.
10. Glass JP, Melamed M, Chernik NL, Posner JB. Malignant cells in cerebrospinal fluid (CSF):the meaning of a positive CSF cytology. Neurology 1979, 29:1369-1375.
11. Gondos B, King EB. Cerebrospinal fluid cytology:diagnostic accuracy and comparison of different techniques. Acta Cytol 1976, 20:542-547.
12. Kajikawa H, Ohta T, Ohshiro H, Harada K, Ishikawa S, Uozumi T, Kodama M, Okada T. Cerebrospinal fluid cytology in patients with brain tumors: a simple method using the cell culture technique. Acta Cytol 1977, 1:162-167.
13. Kline TS. Cytological examination of the cerebrospinal fluid. Cancer 1962, 15:591-597.
14. Kline TS, Speigel IJ, Tinsley M. Tumor cells in the cerebrospinal fluid. Cancer 1962, 15:679-684.
15. Kolar O, Zeman W. Spinal fluid cytomorphology: description of apparatus, technique and findings. Arch Neurol 1968, 18:44-51.
16. Krentz MJ, Dyken PR. Cerebrospinal fluid cytomorphology: sedimentation vs filtration. Arch Neurol 1972, 26:253-257.
17. Laterre EC. Les proteines du liquide céphalo-rachidien ŕ 1'état normal et pathologique. Bruxelles: Arscia 1965, pp207; 230-244.
18. Mayer JR, Watson CW. Cytologic monitoring of cerebrospinal fluid in the treatment of histiocytic lymphoma involving the central nervous system. Acta Cytol 1980, 24:26-29.
19. McCormack LJ, Hazard JB, Belovichi D, Gardner WJ. Identification of neoplastic cells in cerebrospinal fluid by a wet-film method. Cancer 1957, 10:1293-1299.
20. Naylor B. The cytologic diagnosis of cerebrospinal fluid. Acta Cytol 1964, 8:141-149.
21. Oehmichen M. Cerebrospinal fluid cytology: an introduction and atlas. Philadelphia: Saunders 1976, p 148- 162.
22. Oehmichen M, Domasch D, Wietholter H. Origin, proliferation and fate of cerebrospinal fluid cells: a review on cerebrospinal fluid kinetics. J Neurol 1982, 227:145-150.
23. Papadopoulos NM, Hess WC, O'Doherty D, McLane DE. A procedure for the determination of cerebrospinal fluid total protein and gamma-globulin in neurologic disorders. Clin Chem 1959, 5:569-574.
24. Pereira S, Sá MJ, Vieira S, Silva CA. Cytoproteic CSF findings in 33 MS patients: usefulness for diagnosis. Acta Neurol Scand 1989, 79:170-172.
25. Pfister A, Vendrely E, Delezoide AL, Da Lage C, Dhont P. Detection et diagnostic des tumeurs du sistčrne nerveux central par I'étude cytologique du liquide céphalorachidien et des liquides de kystes tumoraux. Arch Anat Cytol Path 1981, 19:295-303.
26. Sá MJ, Silva CA, Cruz C. Clinical and CSF cyto-proteic findings in 23 patients with CSF eosinophilia. Acta Neurol Scand 1986, 73:279-282.
27. Schmidt RM. Cytological investigations of the cerebrospinal fluid in secondary brain tumours. Arch Suisses Neurol Neurochirurg Psychiat 1980, 127:233-236.
28. Shah NT. Cytology of cerebrospinal fluid. Am J Med Technol 1982, 48:829-831.
29. Silva CA, Sá MJ. Electrophoretic pattern of cerebrospinal fluid proteins in non-neoplastic infantile hydrocephalus. Acta Neurol Scand 1978, 57:317-328.
30. Silva CA, Rio ME, Cruz CA. Protein patterns of the cerebrospinal fluid of 30 patients with subacute sclerosing panencephalitis (SSPE). Acta Neurol Scand 1981, 63:255-266.
31. Somas R. A new method for the cytological examination of the cerebrospinal fluid. J Neurol Neurosurg Psychiatry 1967, 30:568-577.
32. Subero A, Foncin J-F, Le Beau J. Diagnostic cytologique du liquide céphalo-rachidien par la chambre de sedimentation de Suta. Neurochirurgie 1968, 14:627-634.
33. Van Zanten AP, Twijnstra A, Ongerboer de Visser BW. Routine investigations of the CSF with special reference to meningeal malignancy and infectious meningitis. Acta Neurol Scand 1988, 77:210-214.
34. Watson CW, Hajdu SI. Cytology of primary neoplasms of the central nervous system. Acta Cytol 1977, 21:40-47.

Publication Dates

Publication in this collection
20 Jan 2011
Date of issue
June 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Balhuizen JC, Bots GThAM, Schaberg A, Bosman F. Value of cerebrospinal fluid cytology for the diagnosis of malignancies in the central nervous system. J Neurosurg 1978, 481:747-753.

[2] 2. Bigner SH, Johnston WW. The cytopathology of cerebrospinal fluid: I.Nonneoplastic conditions, lymphoma and leukemia. Acta Cytol 1981, 25:335-353.

[3] 3. Bigner SH, Johnston WW. The cytopathology of cerebrospinal fluid: II.Metastatic cancer, meningeal carcinomatosis and primary central nervous system neoplasms. Acta Cytol 1981, 25:461-479.

[4] 4. Boogerd W, Vroom THM, Van Heerde P, Brutel de la Rivičre G, Peterse JL, Van der Sande JJ. CSF cytology versus immunocytochemistry in meningeal carcinomatosis. J Neurol Neurosurg Psychiatry 1988, 51:142-145.

[5] 5. Cutler RWP, Spertell RB. Cerebrospinal fluid:a selective review. Ann Neurol 1982, 11:1-10.

[6] 6. Den Hartog Jager WA. Color atlas of CSF cytopathology. Philadelphia: J B Lippincot 1980, p 11-12.

[7] 7. Dufresne JJ. Cytologic pratique du liquide céphalo-rachidiea. Balę: Ciba-Geigy 1972, p78-93.

[8] 8. Dyken PR. Cerebrospinal fluid cytology:practical clinical usefulness. Neurology 1975, 25:210-217.

[9] 9. Dyken PR, Shirley S, Trefz J, El Gammal T. Comparison of cytocentrifugation and sedimentation techniques for CSF cytomorphology. Acta Cytol 1980, 24:167470.

[10] 10. Glass JP, Melamed M, Chernik NL, Posner JB. Malignant cells in cerebrospinal fluid (CSF):the meaning of a positive CSF cytology. Neurology 1979, 29:1369-1375.

[11] 11. Gondos B, King EB. Cerebrospinal fluid cytology:diagnostic accuracy and comparison of different techniques. Acta Cytol 1976, 20:542-547.

[12] 12. Kajikawa H, Ohta T, Ohshiro H, Harada K, Ishikawa S, Uozumi T, Kodama M, Okada T. Cerebrospinal fluid cytology in patients with brain tumors: a simple method using the cell culture technique. Acta Cytol 1977, 1:162-167.

[13] 13. Kline TS. Cytological examination of the cerebrospinal fluid. Cancer 1962, 15:591-597.

[14] 14. Kline TS, Speigel IJ, Tinsley M. Tumor cells in the cerebrospinal fluid. Cancer 1962, 15:679-684.

[15] 15. Kolar O, Zeman W. Spinal fluid cytomorphology: description of apparatus, technique and findings. Arch Neurol 1968, 18:44-51.

[16] 16. Krentz MJ, Dyken PR. Cerebrospinal fluid cytomorphology: sedimentation vs filtration. Arch Neurol 1972, 26:253-257.

[17] 17. Laterre EC. Les proteines du liquide céphalo-rachidien ŕ 1'état normal et pathologique. Bruxelles: Arscia 1965, pp207; 230-244.

[18] 18. Mayer JR, Watson CW. Cytologic monitoring of cerebrospinal fluid in the treatment of histiocytic lymphoma involving the central nervous system. Acta Cytol 1980, 24:26-29.

[19] 19. McCormack LJ, Hazard JB, Belovichi D, Gardner WJ. Identification of neoplastic cells in cerebrospinal fluid by a wet-film method. Cancer 1957, 10:1293-1299.

[20] 20. Naylor B. The cytologic diagnosis of cerebrospinal fluid. Acta Cytol 1964, 8:141-149.

[21] 21. Oehmichen M. Cerebrospinal fluid cytology: an introduction and atlas. Philadelphia: Saunders 1976, p 148- 162.

[22] 22. Oehmichen M, Domasch D, Wietholter H. Origin, proliferation and fate of cerebrospinal fluid cells: a review on cerebrospinal fluid kinetics. J Neurol 1982, 227:145-150.

[23] 23. Papadopoulos NM, Hess WC, O'Doherty D, McLane DE. A procedure for the determination of cerebrospinal fluid total protein and gamma-globulin in neurologic disorders. Clin Chem 1959, 5:569-574.

[24] 24. Pereira S, Sá MJ, Vieira S, Silva CA. Cytoproteic CSF findings in 33 MS patients: usefulness for diagnosis. Acta Neurol Scand 1989, 79:170-172.

[25] 25. Pfister A, Vendrely E, Delezoide AL, Da Lage C, Dhont P. Detection et diagnostic des tumeurs du sistčrne nerveux central par I'étude cytologique du liquide céphalorachidien et des liquides de kystes tumoraux. Arch Anat Cytol Path 1981, 19:295-303.

[26] 26. Sá MJ, Silva CA, Cruz C. Clinical and CSF cyto-proteic findings in 23 patients with CSF eosinophilia. Acta Neurol Scand 1986, 73:279-282.

[27] 27. Schmidt RM. Cytological investigations of the cerebrospinal fluid in secondary brain tumours. Arch Suisses Neurol Neurochirurg Psychiat 1980, 127:233-236.

[28] 28. Shah NT. Cytology of cerebrospinal fluid. Am J Med Technol 1982, 48:829-831.

[29] 29. Silva CA, Sá MJ. Electrophoretic pattern of cerebrospinal fluid proteins in non-neoplastic infantile hydrocephalus. Acta Neurol Scand 1978, 57:317-328.

[30] 30. Silva CA, Rio ME, Cruz CA. Protein patterns of the cerebrospinal fluid of 30 patients with subacute sclerosing panencephalitis (SSPE). Acta Neurol Scand 1981, 63:255-266.

[31] 31. Somas R. A new method for the cytological examination of the cerebrospinal fluid. J Neurol Neurosurg Psychiatry 1967, 30:568-577.

[32] 32. Subero A, Foncin J-F, Le Beau J. Diagnostic cytologique du liquide céphalo-rachidien par la chambre de sedimentation de Suta. Neurochirurgie 1968, 14:627-634.

[33] 33. Van Zanten AP, Twijnstra A, Ongerboer de Visser BW. Routine investigations of the CSF with special reference to meningeal malignancy and infectious meningitis. Acta Neurol Scand 1988, 77:210-214.

[34] 34. Watson CW, Hajdu SI. Cytology of primary neoplasms of the central nervous system. Acta Cytol 1977, 21:40-47.

Brasil

Brasil

Cerebrospinal fluid cytomorphologic findings in 41 intracranial tumors: a retrospective review

Alterações citomorfológicas do líquido céfalo-raquidiano em 41 doentes com tumores intracranianos: estudo retrospectivo

Abstracts

Publication Dates