2 results
METASTATIC NEOPLASMS OF THE CENTRAL NERVOUS SYSTEM
- from 3 - Brain Tumors
-
- By Gregory Moes
- Hannes Vogel, Stanford University School of Medicine, California
-
- Book:
- Nervous System
- Published online:
- 04 August 2010
- Print publication:
- 27 April 2009, pp 309-318
-
- Chapter
- Export citation
-
Summary
Neuropathologists as well as surgical pathologists routinely evaluate CNS lesions from patients undergoing resection of a known metastasis for therapeutic reasons or from a patient with no known prior history of malignancy. The most common intracranial and intraspinal tumors are metastases (about 20%) and the incidence increases with age (Klos and O'Neill, 2004). The frequency of metastatic disease depends on the primary site, with lung, breast, skin (malignant melanoma), renal cell carcinoma, carcinoma of the gastrointestinal (GI) tract, particularly colon, and choriocarcinoma being the more common malignancies to involve the CNS in order of decreasing frequency. Four of these, lung, melanoma, renal cell and choriocarcinoma, are malignancies that tend to produce “hemorrhagic” foci (Mandybur, 1977). Hemorrhagic lesions should not automatically be considered more likely to be a metastasis, since some primary glial neoplasms can be abundantly hemorrhagic (Ragland et al., 1990).
In accordance with the most common types of systemic neoplasms in adults, the most common type of metastatic brain tumors are those that arise from lung cancers, the most common CNS metastases in men, and breast carcinoma, the most common metastases in women (Evans et al., 2004). Breast carcinomas, and others such as lung carcinoma inmen, are particularly prone tometastasize to the sella turcica and thereby become symptomatic by causing diabetes insipidus (Bobilev et al., 2005; Teears and Silverman, 1975; Yap et al., 1979).
8 - Cytopathology of Cerebrospinal Fluid
-
- By Gregory Moes
- Hannes Vogel, Stanford University School of Medicine, California
-
- Book:
- Nervous System
- Published online:
- 04 August 2010
- Print publication:
- 27 April 2009, pp 477-492
-
- Chapter
- Export citation
-
Summary
CLINICAL INDICATIONS
Examination of cerebrospinal fluid (CSF) specimens is a routine component of most neurological evaluations and includes cell count, biochemical analysis, and cytological examination. Samples may be obtained by lumbar puncture or from the lateral ventricles or cisterna magna either at the time of surgery or from indwelling ventricular shunts. CSF analysis is not only useful for diagnosis of new neoplastic processes, but is routinely used for monitoring the efficacy of central nervous system (CNS) chemotherapy such as recurrence of lymphoma or leukemia and or in the evaluation of infections in immunocompromised patients. As with other aspects of cytology, the cytological findings must be correlated with the clinical, biochemical, and radiographic findings to ensure diagnostic accuracy.
SPECIMEN PREPARATION (CYTOPREPARATION)
CSF specimens are unique in cytology with respect to the small sample size, lack of cellular abundance, and susceptibility of the sample to undergo rapid degeneration. With this in mind, processing of CSF specimens for cell count, biochemical analysis, cytological preparation, and additional tests such as flow cytometric analysis in cases of suspected hematopoietic malignancies should be done as soon as possible. The specimen is collected in plastic tubes and divided among several divisions within the laboratory for specific testing Cytological diagnosis should be performed from the third or last tube since it will have less blood contamination in cases of traumatic tap.
The most common stain employed in CSF cytology is the Wright–Giemsa preparation, which is most useful for classification of hematopoietic cells and cytoplasmic detail while the Papanicolaou stain, best for nuclear detail, is the standard used for filter and cytocentrifugation preparations.