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Body Fluids > CSF and Serous Fluids > Flashcards

CSF and Serous Fluids Flashcards

1
Q

Production of CSF fluid

A

Made by Choroid Plexus cells that line the ventricular system of the brain

Normally have about 150mL, with <5 cells/mm3

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2
Q

Common CSF Cells

A
  1. Lymphocytes
  2. Monocytes
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3
Q

Uncommon CSF Cells:
Ependymal cells/choroid plexus cells

A
  • Ventricular lining cells
  • Round to slightly oval, paracentral to eccentric nuclei
  • Dispersed chromatin texture
  • Moderately abundant cytoplasm
  • May be seen singly or in small clusters
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4
Q

Uncommon CSF Cells:
Germinal matrix cells

A
  • Underneath ependymal cells
  • Exfoliate during (so-called “germinal matrix hemorrhage”)
  • More common in neonates (especially preterm infants), with hydrocephalus, intraventricular hemorrhage, ventriculostomy, or placement of ventricular-peritoneal (VP) shunt
  • Small cells with fine chromatin, scant cytoplasm, and high nucleus-to-cytoplasm ratio
  • Often clustered with nuclear molding, blast-like cells with fine chromatin, may have a nucleolus
  • May mimic a small cell malignancy
  • Typically accompanied by hemosiderin-laden macrophages
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5
Q

Uncommon CSF Cells: Brain Tissue

A
  • Seen only in samples taken directly from the ventricles
  • Fragments of brain tissue have a fibrillary texture and may contain glial cells, neurons, and/or capillaries
  • Rarely, isolated neurons are present (large, angular cells with round to ovoid nucleus and prominent central nucleolus)
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6
Q

Uncommon CSF Cells: Bone Marrow

A

If the needle is inserted too far, it can hit the vertebrae and contaminate the sample with Bone Marrow

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7
Q

Degenerative/Hydropic Cells

A
  1. Displace but do not indent the nucleus (i.e., nucleus is not wrapping around vacuole, as in a true signet ring cell)
  2. Are “crystal clear” and contain no secretory material (typically pink)
  3. Keep your neighbors in mind!
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8
Q

Normal Serous Cells: Mesothelial cells (“serosa”)

A
  • Single layer lines Pleural, pericardial, and peritoneal cavities
  • Round cells with dense, two-toned cytoplasm with outer “lacy skirt” (May have “blebbing” and vaculation)
  • Round, central to paracentral nucleus (may be binucleated, multinucleated, or vacuolated) with (typically) single nucleolus
  • Generally isolated, although occasional clusters (more than 12 is unusual)
  • Spectrum = reassuring, two separate populations = suspicious
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9
Q

“Potential” Spaces

A
  • Contain a small amount of fluid, enough to lubricate surfaces for breathing, heartbeat, etc.
  • In disease states, fliud can accumualte, causeing Effusion
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10
Q

Transudative

A
  • Low LDH, low protein
  • Due to imbalance between hydrostatic and oncotic pressures (e.g., CHF, cirrhosis, nephrotic syndrome)
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11
Q

Exudative

A
  • High LDH, high protein
  • Due to increased vascular permeability and/or disruption of mesothelial integrity (e.g., malignancy, pneumonia, infarction, trauma)
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12
Q

Normal Serous Cells: Histiocytes and Macrophages

A
  • Nucleus (smaller than mesothelial cells) oval to reniform (bean-like, folded or clefted)
  • Fine chromatin, inconspicuous nucleoli (basically absent)
  • Pale, ill-defined, vacuolated cytoplasm
  • May contain phagocytized debris (phagocytized RBCs and/or hemosiderin is a sign of recent and/or remote hemorrhage, respectively)
  • No intercellular windows
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13
Q

Normal Serous Cells: Inflammatory Cells

A
  • Lymphocytes, Neutrophils, Eosinophils
  • Neutrophils considered significant at ≥25%
  • Eosinophilic effusions (≥10% eosinophils) may be associated with allergic, parasitic, neoplastic, or medication-related processes, among others
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14
Q

General Features of Malignant Cells in CSF/Serous Fluids

A
  1. Atypical nuclear chromatin (hyperchromasia or immature/blast-like chromatin)
  2. Macronucleoli
  3. Nuclear pleomorphism/membrane irregularity
  4. High N/C ratio
  5. Clusters (especially of 12 or more cells)
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15
Q

Normal CSF Cell Count

A
  • Neonates: 0-30 cells/mcL, mostly Monocytes
  • Adults: 0-5 leukocytes/mcL (10e6/L), mostly Lymphocytes
  • Pediatrics: 0-10 cells/mcL Higher counts are reported, mostly Monocytes
  • RBCs are not found in normal CSF, rarely Neutrophils can be found without disease
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16
Q

Cytocentrifuge Slides

A
  • A drop of albumin added to the cytocup preserves fragile cells and helps the cells stick to the slide, then stained with Wright-Geimsa
  • Recovered cells by cytocentrifugation is approximately 15-30 cells for each nucleated cell
  • Cytocentrifugation can result in cellular artifacts which in come cases may make it difficult to tell normal from malignant. Higher speeds result in more artifact
17
Q

Telling a Traumatic Tap from an Intracranial Hemorrhage

A
  • Erythrophagocytosis
  • Hemosiderin pigment/hematoidin crystals (orange-yellow rectangular prisms)
  • Xanthochromia
18
Q

Uncommon Body Fluid Cells: Mast Cells

A
  • Small numbers associated with inflammatory conditions, foreign body reactions, and parasitic infections
  • Morphology: abundant cytoplasmic purple granules obscuring nucleus
19
Q

Chondrocytes

A
  • Cartilage cell
  • A rare finding, more common in infants. Due to the needle nicks the vertebral cartilage (cartilage fragments can be seen along with the cells) “traumatic tap”
  • Round oval nucleus, clear zone around the nucleus, dense purple/red cytoplasm
20
Q

Findings in a patient with recent ventriculo-peritoneal shunt or recent neurosurgery

A
  • Ventricular lining cells (may have microvilli around cytoplasmic border)
  • Neural tissue
  • Capillaries
  • Germinal matrix cells
21
Q

Cytocentrifuge Artifacts

A
  • Cell flattening
  • Smooth Chromatin
  • Accentuations of nucleoli
  • Peripheral distribution of granulocytic nuclear lobes
22
Q

Characteristics of Benign cell populations in CSF

A
  • Cell type variation
  • Spectrum of cellular maturation
  • Low N:C ratio
  • Regular nuclear borders
  • Clumped nuclear chromatin
  • Indistint nucleoli
23
Q

Characteristics of Non-hematopoetic neoplastic cells in CSF

A
  • Tendency to form syncytial cell clusters
  • Large nuclei with irregular borders
  • Nuclear molding
  • Prominent, large nucleoli
  • High N:C ratio
  • Fine nuclear chromatin
  • Marked variation in cell and nucleus size
24
Q

Characteristics of Hematopoetic Neoplasms in CSF

A
  • Monotonic cell population
  • Variation in cell size
  • Irregular nuclear borders
  • High N:C ratio
  • Fine nuclear chromatin
  • Prominent nucleoli
25
Q

Malignent Effusions in Pleural Cavity

A
  • Lung or breast cancer
  • Gastrointestinal or ovarian carcinoma
  • Lymphomas
  • Melanomas
  • Sarcomas
  • Mesotheliomas
26
Q
A

Choroidal cells

27
Q
A

Ependymal cells

28
Q
A

Macrophage with Hemosiderin and Hematoin Crystals

29
Q
A

Macrophage with Hemosiderin Granules

30
Q
A

Macrophage

31
Q
A

Adenocarcinoma

32
Q
A

Chondrocyte

33
Q
A

Germinal Matrix cells

34
Q
A

Mesothelial cells

35
Q
A

Neuronal cell

36
Q
A

Ventricular cells

Body Fluids (17 decks)

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