Cytomorphologic characteristics, differential diagnosis and utility during intraoperative consultation for medulloblastoma.
OBJECTIVE
To study the cytologic findings that differentiate LC/A and non-LC/A (NLCA) types.


METHODS
Cytologic smears, prepared during intraoperative consultation (IOC) of 43 cases of pure histologic type, defined as > 80% of the tumor being composed of 1 of 3 major histologic types--classic, nodular and LC/A--were reviewed and graded semiquantitatively (0-3+) for 14 cytologic features: cellularity, nuclear streaming, endothelial proliferation, necrosis, lymphoglandular bodies, rosette formation, apoptosis, nuclear cannibalism, pleomorphism, macronucleoli, paranuclear inclusions, cytoplasmic vacuoles, mitoses and multinucleation. The grades were compared between the 2 histologic groups, LC/A vs. NLCA, as well as between the preparation methods, squash vs. touch (TP). Values of p < 0.05 were accepted as statistically significant.


RESULTS
"Cell wrapping" (cannibalism), pleomorphism, macronucleoli, apoptosis, mitoses and cytoplasmic vacuoles were more significantly observed in LC/A than in NLCA.


CONCLUSIONS
Intraoperative cytologic evaluation of these cytologic parameters allows distinction between LC/A and NLCA, which can be prognostically useful during IOC. Rosette formation, the histologic hallmark of classic medulloblastoma, is not a discriminator. Given the fewer artifacts and sufficient cellularity, TP is the preferred method of cytologic preparation.
Takei
Hidehiro
H
Department of Pathology, The Methodist Hospital, TX, USA. takei327@aol.com
Dauser
Robert C
RC
Adesina
Adekunle M
AM
D000293:Adolescent; D001706:Biopsy / Q000379:methods / Q000592:standards; D002467:Cell Nucleus / Q000473:pathology; D049109:Cell Proliferation; D002528:Cerebellar Neoplasms / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D002531:Cerebellum / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003593:Cytoplasm / Q000473:pathology; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D042783:Endothelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D008297:Male; D008527:Medulloblastoma / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies