Kluge / Wieczorek / Linke Atlas of CSF Cytology

1. Auflage 2006
ISBN: 978-3-13-257844-9
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 152 Seiten, ePub

A complete, single-volume reference for the cytological examination of cerebrospinal fluid! This full-color atlas presents all the essential information needed for reaching an accurate cytological diagnosis of cerebrospinal fluid and its abnormalities. Designed as a clinical and laboratory reference, Atlas of CSF Cytology provides an overview of all the standard diagnostic techniques and offers insight into advanced methods such as flow cytometry and immunocytological phenotyping. Brief descriptions of the indications, advantages, and limitations are provided for each method. An extensive collection of more than 300 high-quality cytological pictures demonstrating normal cell structures, as well as pathological cells in acute and remission phases enables the reader to understand disease processes. Highlights: Guidelines for the proper handling of specimens, cell preparation, and staining techniques Review of the common sources of error in diagnosis Thorough coverage of the techniques for detecting and classifying inflammatory, infectious, neoplastic, and hemorrhagic conditions of the central nervous system Descriptions of the principle features of cells and the classification of tumor cell types according to current W.H.O. standards Full-color images depicting pathological alterations of CSF cells -- an indispensable visual aid to comprehension Atlas of CSF Cytology is ideal for specialists in neurology, neurosurgery, pathology/neuropathology, cytopathology, microbiology, and laboratory medicine, as well as for those internists, pediatricians, and psychiatrists who frequently request cytological examination of the CSF. Though it is written to meet the needs of specialists, the 'Atlas' will also be found accessible and enlightening by interested medical students, interns and residents.

Kluge

Zielgruppe

Ärzte

Autoren/Hrsg.

Kluge, Harald

Wieczorek, Valentin

Linke, Ernst

Zimmermann, Klaus

Isenmann, Stefan

Witte, Otto W.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Labormedizin
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Neurochirurgie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Pathologie, Cytopathologie, Histopathologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Neurologie, Klinische Neurowissenschaft

Inhaltsverzeichnis

1 Introduction
2 Cell Populations in the Normal Cerebrospinal Fluid
3 Pathological CSF Cell Findings in Infectious and Inflammatory Diseases of the Central Nervous System
4 Pathological CSF Cell Findings in Intracranial Hemorrhage and Traumatic and Hypoxic-Ischemic Brain Injury
5 Pathological CSF Cell Findings in Primary and Metastatic CNS Tumors, Malignant Lymphoma, and Leukemia
6 Pathological CSF Cell Findings in Cysts

Leseproben

2 Cell Populations in the Normal Cerebrospinal Fluid

H. Kluge, E. Linke, V. Wieczorek, K. Zimmermann, H.-J. Kuehn

The (CSF) obtained by an has a cell count of up to 5/µL, consisting exclusively of and in a ratio of approximately 70:30 (in sediment obtained by centrifugation) or 60:40 (after spontaneous sedimentation in a Sayk chamber, cf. Lymphocytes and Monocytes below). Rarely, normal CSF obtained in this way will contain cells or cell clusters belonging to the structures that enclose the CSF space. These cells, designated as in the consensus reporting form in Figure 1.1 (see also The CSF Cytology Report, Chapter 1 and Cells and Cell Clusters from the Structures Enclosing the CSF Space below), are more commonly seen after and in Their presence in lumbar CSF is to be considered a secondary effect of manipulation, i.e., as a CSF artifact. Further artifactual findings include obtained by unintended aspiration of the marrow space as well as (see Lumbar Puncture Artifacts below).

Possible secondary artifacts due to contamination of the specimen after lumbar puncture (bacteria, fungi, dust particles, etc.) are not discussed in this chapter. The possibly artifactual admixture of blood in the CSF is discussed in Chapter 4.

Lymphocytes and Monocytes

The in the cellular sediment of CSF stained with the May–Grünwald–Giemsa method are nonactivated, small isomorphic cells with a diameter of 5–8 µm. The round or mildly oval, turbid or coarsely granulated nucleus is surrounded by a very thin rim of cytoplasm, which is either practically indiscernible (such lymphocytes are said to have “naked nuclei”) or just wide enough to be visible. The cytoplasm is clear or, at most, mildly basophilic (Fig. 2.1).

methods of cell differentiation (flow cytometry) reveal that about 93% of lymphocytes in normal CSF are and about 1% are The distinction between these two types of cell is important in the differential diagnosis of inflammatory and infectious diseases. Venous blood, in contrast, contains 60–80% T lymphocytes and 10–30% B lymphocytes.

(activated B lymphocytes; many earlier authors classified these cells according to their cytoplasmic size and basophilia as a highly heterogeneous category of , see Chapter 3, Cytological Findings in Infectious and Inflammatory Diseases) are rarely present in normal CSF, and their final differentiated type—the —is never found in it. These cell types and the question of the origin of normal and activated lymphocytes in CSF are discussed in Chapter 3.

The in the cellular sediment of CSF stained with the May–Grünwald–Giemsa method are of Before passing into the CSF, however, they are present as “free” cells in the extracellular spaces of the meninges (including the stroma of the choroid plexus). Here, under pathological conditions, they may become transformed into activated monocytes and then into macrophages (see Chapter 4). As these monocytes are surrounded by a quite different milieu than blood, and because they have to migrate twice to find their way into the CSF (first across the vascular endothelium and then through the epithelial/ependymal cell layers), “normal” CSF monocytes have a highly varied morphology; at times, they almost resemble activated monocytes. With diameters of 15–20 µm, they are about four times as large as the normal CSF lymphocytes. The peripherally located nucleus is oval, or kidney- or horseshoe-shaped, or lobulated, and sometimes contains pale nucleoli. The cytoplasm is smoky gray or, at most, mildly basophilic near the cell membrane. Any basophilic coloring of the cytoplasm, or the occasional appearance of a few vesicular structures within it, indicates an incipient activated state. Figure 2.2 shows diverse structural variants of “normal” CSF monocytes surrounding five normal lymphocytes in the center of the figure.

Although this chapter is principally devoted to cell morphology, we have included some normal forms and contrasting of lymphocytes and monocytes in Figure 2.3 for didactic purposes. Note the differences between normal and activated types with respect to cell size and shape, nuclear size and shape, and above all, cytoplasmic structure and staining. Activated monocytes are sometimes considerably larger than the ones shown in Figure 2.3 (see the cytological illustrations in Chapters 3 and 4 for examples).

Fig. 2.1 Nonactivated lymphocytes in normal CSF. Left column: lymphocytes with “naked nuclei,” i.e., the cytoplasm is barely discernible as a clear or only slightly colored rim around the nucleus. Middle column: lymphocytes with a significantly larger amount of clear cytoplasm. Right column: lymphocytes with a thin, mildly basophilic rim of cytoplasm (incipient activation).

Fig. 2.2 Nonactivated monocytes in normal CSF (outer circle of cells), some of which show early signs of activation, and, for comparison, lymphocytes with a thin, mildly basophilic rim of cytoplasm (the five cells in the center).

Fig. 2.3 An illustration of different cell types to demonstrate the cytological differences between nonactivated and activated lymphocytes and monocytes in the CSF. First column from left: nonactivated or only mildly activated monocytes. Second column from left: monocytes in various stages of activation. First column from right: nonactivated or only mildly activated lymphocytes. Second column from right: activated lymphocytes, some of which are undergoing transformation to plasma cells (see Chapter 3, Cytological Findings in Infectious and Inflammatory Disease).

Cells and Cell Clusters From the Structures Enclosing the CSF Space

The cells described in this section, which are designated as “” in the consensus reporting form in Figure 1.1, mainly consist of and and (meningeal connective tissue cells). They can be found in normal CSF as an artifact of lumbar puncture, in CSF of hydrocephalic children, and in CSF altered by certain pathological conditions (e.g., infectious or other processes affecting the structures that enclose the CSF space).

When present as an cells of these types are derived from the injured meningeal layers and/or the other tissues along the trajectory of the lumbar puncture needle. If they are recognized as an artifact, they are to be interpreted as a normal finding. Epithelial and ependymal cells are more commonly seen in such cases than the other two cell types mentioned above. Cells of all four types can display the morphological features of their cell population of origin when seen on cytological examination of the CSF, as long as the time interval between the lumbar puncture and the cytological preparation is not prolonged (see Chapter 1, Proper Handling of CSF Specimens Before Cytological Examination).

are often seen in large clusters. The chromatin-rich nucleus is mostly isomorphic, round to lightly oval, and mainly peripherally located. The cytoplasm is acidophilic. The more fragile have similar-looking nuclei, which, however, are more often pyknotic in shape, and a paler cytoplasm, often with peripheral fraying. are more elongated and usually have an oblong, oval nucleus. from the connective tissue of the meningeal layers often display a fibrillary structure in their predominantly acidophilic cytoplasm.

Regardless of the length of the interval between the lumbar puncture and further processing of the CSF specimen, the local environment of these cells is altered when they are separated from their tissues of origin and set free in the CSF. They may thus undergo secondary changes that make them barely recognizable. An excessively long interval between the lumbar puncture and further processing will, of course, lead to yet more cell degeneration. As these complicating phenomena make these four cell types difficult to tell apart from each other, and because their presence in CSF is merely an artifact and thus of no diagnostic significance, CSF cytologists are agreed that they can be grouped together under the collective heading The final (descriptive, not merely numerical) cytology report should always state explicitly that the presence of these cells is an artifact, to distinguish this situation from the rarer finding of of these four types, which may possess (see Chapter 4). This will occur mainly under associated with...

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