Cytologic Features of Ventricular Tumors of the Central Nervous System: A Review with Emphasis on Diff-Quik Stained Smears

Abstract

<b><i>Background:</i></b> Neoplasms from the ventricular system share a common location but have highly variable histogenesis. Many are slowly growing tumors that behave in a benign fashion. They can be classified as primary and secondary tumors. The most common primary tumors are ependymomas, subependymomas, subependymal giant cell astrocytomas, central neurocytomas, choroid plexus tumors, meningiomas, germinomas, pineal parenchymal tumors, papillary tumors of the pineal region, chordoid gliomas, rosette-forming glioneuronal tumors of the fourth ventricle, and craniopharyngiomas. Pilocytic astrocytomas, medulloblastomas, and atypical teratoid/rhabdoid tumors often show secondary involvement of the ventricular system. <b><i>Summary:</i></b> Advances in neurosurgery have facilitated access to the ventricular system increasing the number of cases in which such tumors can be biopsied. In this context, cytology has been proven to be an extremely useful diagnostic tool during intraoperative pathologic consultations. Many ventricular tumors are infrequent, and the cytologic information available is limited. In this review, we describe the cytologic features of the uncommon ventricular tumors and report on unusual findings of the more common ones. For the cytologic evaluation of brain tumors, many neuropathologists prefer formalin fixation and hematoxylin and eosin staining. In this review, we highlight the cytologic findings as seen with Diff-Quik, a very popular staining method among cytopathologists. In fact, when pathologists are unfamiliar with cytology, it is common to request the assistance of cytopathologists during the evaluation of intraoperative procedures. <b><i>Key Message:</i></b> Ventricular tumors of the central nervous system comprise a group of heterogeneous tumors with very different cytologic features. The cytomorphology of these tumors, including rare entities, is often very characteristic, allowing a precise recognition during intraoperative pathologic consultations. Diff-Quik is a valuable staining method that can be used alone or as a complement to hematoxylin and eosin staining. Diff-Quik allows for clear visualization of the overall architecture, cytoplasmic details, and extracellular material.

Cytological features of ependymal and choroid plexus tumours

“…• In some cases, microcystic transformation with prominent metachormatic myxoid material in Giemsa stained smears. 9 While tumours with subependymoma morphology occur in the supra-and infratentorial compartment as well as the spinal cord, they belong to different epigenetic types; the current WHO classification nevertheless considers them a single tumour type. In the infratentorial compartment, tumours with a hybrid ependymoma/ subependymoma morphology may occur that epigenetically cluster with subependymomas.…”

“…• Hyalinized vessels. 9 • Oval to round nuclei with a coarse chromatin (often resembling a 'pepper-and-salt' chromatin), usually with less nuclear pleomorphism than in diffuse astrocytomas.…”