title: CSF cytology--the ongoing dilemma to distinguish neoplastic and inflammatory lymphocytes.
abstract: To evaluate different morphological criteria for the distinction between inflammatory and neoplastic lymphocytes in the cerebrospinal fluid (CSF). Forty-two cytospin preparations of CSF from patients with confirmed CSF involvement by aggressive B-cell lymphoma or acute leukemia were compared with 26 samples of inflammatory diseases. CSF cytology was analyzed morphologically for preselected parameters of cell, cytoplasm and nucleic appearance, and the presence of mitoses or apoptoses. None of the evaluated parameters sharply discerns neoplastic and inflammatory changes. However, neoplastic cells were significantly larger. Moreover, irregular shape and pointed borders of the cytoplasm, and deep notches in the nucleus were significantly more frequent in neoplastic than in inflammatory lymphocytes. No single parameter is sufficient to detect neoplastic lymphocytes. Considering a combination of cell size and irregular shape of cell and nucleus, however, may improve the diagnostic accuracy of CSF dissemination by aggressive hematological malignancies.
authors.affiliation: Department of Pathology, University of Göttingen, Göttingen, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Perske
authors.forename: Ingelore
authors.initials: I
authors.lastname: Nagel
authors.forename: Holger
authors.initials: H
authors.lastname: Nagel
authors.forename: Herwig
authors.initials: H
authors.lastname: Strik
mesh_terms: D001402:B-Lymphocytes / Q000473:pathology*; D053144:Cell Nucleus Shape; D053145:Cell Nucleus Size; D048430:Cell Shape; D048429:Cell Size; D002494:Central Nervous System Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000473:pathology; D002843:Chromatin / Q000378:metabolism; D003453:Cryptococcosis / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D007249:Inflammation / Q000134:cerebrospinal fluid* / Q000175:diagnosis* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000134:cerebrospinal fluid* / Q000175:diagnosis* / Q000473:pathology; D008938:Mitosis; D009103:Multiple Sclerosis / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000473:pathology; D008061:Whipple Disease / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000473:pathology
chemical_list: D002843:Chromatin