title: Diagnostic value of immunocytochemistry in leptomeningeal tumor dissemination.
abstract: Differentiating chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis can be difficult, particularly when the differentiation is based solely on routine cytologic examination. The diagnosis of cerebrospinal fluid tumor dissemination in at-risk patients requires cytologic examination of cerebrospinal fluid and radiography of the leptomeninges. Routine cytologic examination alone has proven less than desirable, in most instances providing confirmation in as little as 50% of cases in the first lumbar puncture. This percentage increases to 85% to 90% after multiple lumbar punctures. We retrospectively reviewed 2 cases of leptomeningeal dissemination (one gliomatosis, the other carcinomatosis) with initial false-negative test results. However, after further examination of the cerebrospinal fluid by selected battery of immunocytochemical stains, both cases were identified as positive for malignancy (ie, false negatives). Immunocytochemistry can be useful in distinguishing chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis in patients at risk or when abnormal cells are seen on routine cerebrospinal fluid cytologic examination.
authors.affiliation: Department of Pathology, Medical College of Ohio Hospitals, Toledo, OH 43614-2598, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Thomas
authors.forename: E
authors.initials: E
authors.lastname: Falls
authors.forename: M E
authors.initials: ME
authors.lastname: Velasco
authors.forename: A
authors.initials: A
authors.lastname: Zaher
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D001929:Brain Edema / Q000175:diagnosis; D002114:Calcinosis / Q000175:diagnosis; D002555:Cerebrospinal Fluid / Q000166:cytology*; D018281:Cholangiocarcinoma / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000556:secondary; D002908:Chronic Disease; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D008297:Male; D008577:Meningeal Neoplasms / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000556:secondary; D008582:Meningitis, Aseptic / Q000175:diagnosis; D018396:Mucin-1 / Q000032:analysis; D018302:Neoplasms, Neuroepithelial / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D012189:Retrospective Studies
chemical_list: D005904:Glial Fibrillary Acidic Protein; D018396:Mucin-1; D007633:Keratins