Cytology of Cerebrospinal Fluid

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The first step in all hemato-oncological and neurological diagnostic assessments of cerebrospinal fluid is the quantitative and qualitative analysis of the cell composition (Table 32).

Table 32 Emergency diagnostics of the liquor (according to Felgenhauer in Thomas 1998)

> Pandy's reaction v Cell count (Fuchs-Rosenthal chamber) v Smear (or cytocentrifuge preparation)

- to analyze the cell differentiation and

- to search for bacteria and roughly determine their types and prevalence

> Gram stain

> An additional determination of bacterial antigens may be done

Using advanced cell diagnostic methods, lymphocyte subpopulations can be identified by immunocytology and marker analysis and cyto-genetic tests carried out on tumor cells.

Prevalence of neutrophilic granulocytes with strong pleocytosis suggests bacterial meningitis; often the bacteria can be directly characterized.

Prevalence of lymphatic cells with moderate pleocytosis suggests viral meningitis. (If clinical and serological findings leave doubts, the differential diagnosis must rule out lymphoma using immunocytological methods.)

Strong eosinophilia suggests parasite infection (e.g., cysticercosis).

A complete mixture of cells with granulocytes, lymphocytes, and mono-cytes in equal proportion is found in tuberculous meningitis.

Variable blasts, usually with significant pleocytosis, predominate in leukemic or lymphomatous meningitis.

Undefinable cells with large nuclei suggest tumor cells in general, e.g., meningeal involvement in breast cancer or bronchial carcinoma, etc. The cell types are determined on the basis of knowledge of the primary tumor and/or by marker analysis. Among primary brain tumors, the most likely cells to be found in cerebrospinal fluid are those from ependymoma, pinealoma, and medulloblastoma.

Erythrophages and siderophages (siderophores) are monocytes/macro-phages, which take up erythrocytes and iron-containing pigment during subarachnoid hemorrhage.

^ The cytological analysis of the cerebrospinal fluid offers important clues to the character of meningeal inflammation, the presence of a malignancy, or hemorrhage.

Viral, bacterial, and malignant meningitis can be distinguished by means of cerebrospinal fluid cytology a c e

Cerebrospinal Fluid Analysis Imagines

Fig. 68 Cerebrospinal fluid cytology. a Cerebrospinal fluid cytology in bacterial meningitis: granulocytes with phagocytosed diplococci (in this case, pneumococ-ci, arrow). b Cerebrospinal fluid cytology in viral meningitis: variable lymphoid cells. c Cerebrospinal fluid cytology in non-Hodgkin lymphoma: here, mantle cell lymphoma. d Cerebrospinal fluid cytology after subarachnoid hemorrhage: macrophages with phagocytosed erythrocytes. e-h Cerebrospinal fluid cytology in meningeal involvement in malignancy: the origin of the cells cannot be deduced with certainty from the spinal fluid cytology alone: (e) breast cancer, (f) bronchial carcinoma, (g) medulloblastoma, and (h) acute leukemia. -jgg

Fig. 68 Cerebrospinal fluid cytology. a Cerebrospinal fluid cytology in bacterial meningitis: granulocytes with phagocytosed diplococci (in this case, pneumococ-ci, arrow). b Cerebrospinal fluid cytology in viral meningitis: variable lymphoid cells. c Cerebrospinal fluid cytology in non-Hodgkin lymphoma: here, mantle cell lymphoma. d Cerebrospinal fluid cytology after subarachnoid hemorrhage: macrophages with phagocytosed erythrocytes. e-h Cerebrospinal fluid cytology in meningeal involvement in malignancy: the origin of the cells cannot be deduced with certainty from the spinal fluid cytology alone: (e) breast cancer, (f) bronchial carcinoma, (g) medulloblastoma, and (h) acute leukemia. -jgg b a d c f e h g

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