CSF and Serous Fluids Flashcards
Production of CSF fluid
Made by Choroid Plexus cells that line the ventricular system of the brain
Normally have about 150mL, with <5 cells/mm3
Common CSF Cells
- Lymphocytes
- Monocytes
Uncommon CSF Cells:
Ependymal cells/choroid plexus cells
- 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
Uncommon CSF Cells:
Germinal matrix cells
- 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
Uncommon CSF Cells: Brain Tissue
- 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)
Uncommon CSF Cells: Bone Marrow
If the needle is inserted too far, it can hit the vertebrae and contaminate the sample with Bone Marrow
Degenerative/Hydropic Cells
- Displace but do not indent the nucleus (i.e., nucleus is not wrapping around vacuole, as in a true signet ring cell)
- Are “crystal clear” and contain no secretory material (typically pink)
- Keep your neighbors in mind!
Normal Serous Cells: Mesothelial cells (“serosa”)
- 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
“Potential” Spaces
- Contain a small amount of fluid, enough to lubricate surfaces for breathing, heartbeat, etc.
- In disease states, fliud can accumualte, causeing Effusion
Transudative
- Low LDH, low protein
- Due to imbalance between hydrostatic and oncotic pressures (e.g., CHF, cirrhosis, nephrotic syndrome)
Exudative
- High LDH, high protein
- Due to increased vascular permeability and/or disruption of mesothelial integrity (e.g., malignancy, pneumonia, infarction, trauma)
Normal Serous Cells: Histiocytes and Macrophages
- 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
Normal Serous Cells: Inflammatory Cells
- 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
General Features of Malignant Cells in CSF/Serous Fluids
- Atypical nuclear chromatin (hyperchromasia or immature/blast-like chromatin)
- Macronucleoli
- Nuclear pleomorphism/membrane irregularity
- High N/C ratio
- Clusters (especially of 12 or more cells)
Normal CSF Cell Count
- 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
Cytocentrifuge Slides
- 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
Telling a Traumatic Tap from an Intracranial Hemorrhage
- Erythrophagocytosis
- Hemosiderin pigment/hematoidin crystals (orange-yellow rectangular prisms)
- Xanthochromia
Uncommon Body Fluid Cells: Mast Cells
- Small numbers associated with inflammatory conditions, foreign body reactions, and parasitic infections
- Morphology: abundant cytoplasmic purple granules obscuring nucleus
Chondrocytes
- 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
Findings in a patient with recent ventriculo-peritoneal shunt or recent neurosurgery
- Ventricular lining cells (may have microvilli around cytoplasmic border)
- Neural tissue
- Capillaries
- Germinal matrix cells
Cytocentrifuge Artifacts
- Cell flattening
- Smooth Chromatin
- Accentuations of nucleoli
- Peripheral distribution of granulocytic nuclear lobes
Characteristics of Benign cell populations in CSF
- Cell type variation
- Spectrum of cellular maturation
- Low N:C ratio
- Regular nuclear borders
- Clumped nuclear chromatin
- Indistint nucleoli
Characteristics of Non-hematopoetic neoplastic cells in CSF
- 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
Characteristics of Hematopoetic Neoplasms in CSF
- Monotonic cell population
- Variation in cell size
- Irregular nuclear borders
- High N:C ratio
- Fine nuclear chromatin
- Prominent nucleoli
Malignent Effusions in Pleural Cavity
- Lung or breast cancer
- Gastrointestinal or ovarian carcinoma
- Lymphomas
- Melanomas
- Sarcomas
- Mesotheliomas
Choroidal cells
Ependymal cells
Macrophage with Hemosiderin and Hematoin Crystals
Macrophage with Hemosiderin Granules
Macrophage
Adenocarcinoma
Chondrocyte
Germinal Matrix cells
Mesothelial cells
Neuronal cell
Ventricular cells
