W4L5 - Malignant CSF Cytology Flashcards
Leptomeningeal Carcinomas
Brain tumours
Presence of malignant cells on CSF cytology is the gold standard for diagnosing leptomeningeal carcinomatosis
Malignant cells into the CSF gain access via haematogenous spread or by lesions tracking along the spinal or cranial nerves
Leptomeningeal Carcinomas - Symptoms
Headaches Mental change Gait difficulty Diplopia Back pain Lower extremity weakness Peripheral neuropathy
Primary Tumours of the CNS
Low grade astrocytomas High grade astrocytomas Oligodendroglioma Ependymomas Medulloblastomas Primary malignant lymphomas Multiple myeloma of the brain
Low Grade Astrocytomas
Tumours of glial cells, rare in CSF
Tumour cells are spindly with stellate cytoplasm
Nuclei are pale, not enlarged and cannot be recognised as malignant
High grade Astrocytomas and Glioblastoma Multiforme
CSF may contain a few abnormal cells showing nuclear enlargement and hyperchromasia
Sheds moderate to large abnormal cells some with eosinophilic/transparent cytoplasm
Large single nuclei and prominent nucleoli
The appearance is suggestive of a metastatic epithelial tumour
Oligodendroglioma
These are uniformly round cells with eccentric nuclei and prominent nucleoli
May be benign or malignant
They respond to treatment better than other gliomas
The benign variant shows sheets of monotonous small cells with scanty clear cytoplasm, surrounding the nucleus with a halo-like effect in a fibrillary background
The malignant variant is characterised by hyperchromasia and evidence of mitotic activity
Ependymomas
Derived from the ependymal lining of the cerebral ventricles occurring mainly in the 4th ventricle resulting in hydrocephalus
Tumours may be benign or malignant
On histology these tumour are characterised by perivascular arrangement of large, uniform columnar cells in pseudorosette formation
The malignant phenotype shows obvious nuclear hyperchromasia and abnormalities of the nuclear size and contour
Cytologically see columnar or cuboidal cells with rosettes
Occasionally cohesive sheets of uniform columnar cells (benign)
Malignant variant shows less cohesive clusters with hyperchromatic nuclei
DDx metastatic carcinoma
Medulloblastomas
Account for 10% of all childhood brain tumours
Most common malignant brain tumour in kids
Often occur in the posterior fossa and have potential for leptomeningeal spread
Tx is combination surgery, radiation therapy (> 3yrs)
Outcomes are poor in infants and children < 3yrs
Tx is assoc with significant morbidity, esp in younger patients
Symptoms occur over a period of weeks to months, rapid growing
Primary Malignant Lymphomas
Non-Hodgkins lymphoma may occur as a primary lesion in the brain, particularly in AIDS patients
The unique histological feature of lymphoma of the brain is the accumulation of malignant lymphocytes in perivascular spaces.
The cytological appearance is similar to Non-Hodgkins lymphoma in other organs
Multiple Myelomas that Involve the Brain
Tumour cells resemble plasma cells with abundant cytoplasm with an eccentrically located nucleus
Distinguishable ‘hoff’ zone within the cytoplasm
Nuclei are usually round, with coarse chromatin pattern (clockface), nuclei may be cleaved
Prion
Acronym for proteinaceous infectious particles
The normal prion protein, which is designated as PrPc , is a 35kD membrane glycoprotein, which is water-soluble and proteinase-sensitive
Abnormal prions, designated as PrPSc or PrPTSE, result from a change in the folding pattern of PrPc, which makes it resistant to the action of proteases and causes it to precipitate as insoluble amyloid
- conversion results in neuronal degeneration and loss by an unknown mechanism
Self propagating and transmissible
CSF Marker for CJD
Elevation of protein 14-3-3
30kD protein -> cell proliferation, differentiation, signal transduction and regulates neurotransmitter synthesis
It is non-specific: protein 14-3-3 is also elevated in patients with encephalitis, cerebral infarction and other conditions
