Atypical lymphoid cells in cerebrospinal fluid in acute Epstein Barr virus infection: a case report demonstrating a pitfall in cerebrospinal fluid cytology.
BACKGROUND
Cytologic examination of cerebrospinal fluid (CSF) continues to be important in the diagnosis of malignancies involving the leptomeninges. A well-recognized pitfall is overinterpretation of the presence of atypical lymphocytes that resemble malignant lymphoid cells in the CSF. A definite diagnosis is often difficult because of limited viability of cells and small sample size of CSF.


METHODS
A 25-year-old patient with a past history of treated large granular lymphocytic leukemia and presence of a predominant population of large, atypical lymphoid cells in the CSF, giving us the impression of involvement with large cell lymphoma. However, a timely call to the hematologist revealed that the serology was positive for acute Epstein-Barr virus infection. Flow cytometry of CSF confirmed polyclonal population of B-cells and T-cells.


CONCLUSIONS
The presence of atypical cells in the CSF certainly warrants a detailed look at the patient's laboratory investigations and communication with the hematologist, because it may be the only specimen available for diagnosis on which therapy and prognosis is based.
Department of Pathology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, Maryland 21201, USA. varshamanucha@yahoo.com
Varsha
V
Manucha
Frank
F
Zhao
William
W
Rodgers
D000328:Adult; D002555:Cerebrospinal Fluid / Q000166:cytology*; D003584:Cytological Techniques / Q000379:methods*; D004279:DNA, Viral / Q000032:analysis / Q000097:blood; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000134:cerebrospinal fluid* / Q000235:genetics / Q000473:pathology*; D006529:Hepatomegaly / Q000000981:diagnostic imaging; D006801:Humans; D054066:Leukemia, Large Granular Lymphocytic / Q000188:drug therapy; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D011859:Radiography; D013156:Splenectomy; D014463:Ultrasonography
D004279:DNA, Viral