Cerebrospinal fluid cytology in nonmalignant aseptic meningeal disorders

Martínez‐Girón, Rafael; Pantanowitz, Liron

doi:10.1002/dc.23797

Cited by 8 publications

(6 citation statements)

References 88 publications

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“…For example, contamination of the CSF sample with peripheral blood lymphocytes from an active systemic lymphoma patient could give a false-positive cytology [ 76 ]. Additionally, the high number of mitotic B cells (CSF pleocytosis) noticed in patients with multiple sclerosis or other immune-related inflammatory diseases could also give a false-positive cytology [ 77 , 78 , 79 , 80 ].…”

Section: Lmd Diagnosismentioning

confidence: 99%

Leptomeningeal Disease (LMD) in Patients with Melanoma Metastases

Khaled

Tarhini

Smalley

et al. 2023

Cancers

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Leptomeningeal disease (LMD) is a devastating complication caused by seeding malignant cells to the cerebrospinal fluid (CSF) and the leptomeningeal membrane. LMD is diagnosed in 5–15% of patients with systemic malignancy. Management of LMD is challenging due to the biological and metabolic tumor microenvironment of LMD being largely unknown. Patients with LMD can present with a wide variety of signs and/or symptoms that could be multifocal and include headache, nausea, vomiting, diplopia, and weakness, among others. The median survival time for patients with LMD is measured in weeks and up to 3–6 months with aggressive management, and death usually occurs due to progressive neurologic dysfunction. In melanoma, LMD is associated with a suppressive immune microenvironment characterized by a high number of apoptotic and exhausted CD4+ T-cells, myeloid-derived suppressor cells, and a low number of CD8+ T-cells. Proteomics analysis revealed enrichment of complement cascade, which may disrupt the blood–CSF barrier. Clinical management of melanoma LMD consists primarily of radiation therapy, BRAF/MEK inhibitors as targeted therapy, and immunotherapy with anti-PD-1, anti-CTLA-4, and anti-LAG-3 immune checkpoint inhibitors. This review summarizes the biology and anatomic features of melanoma LMD, as well as the current therapeutic approaches.

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Section: Lmd Diagnosismentioning

confidence: 99%

Leptomeningeal Disease (LMD) in Patients with Melanoma Metastases

Khaled

Tarhini

Smalley

et al. 2023

Cancers

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“…One close differential is a transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome, which is characterized by migraine-like attacks with neurological deficits, papilloedema, CSF pleocytosis, and raised CSF pressure [9-10]. Other possible differentials include Mollaret meningitis, which is recurrent meningitis characterized by headache and CSF lymphocytosis but the disease course seen here was not recurrent; rather, it was one continuous process [11-12].…”

Section: Discussionmentioning

confidence: 99%

Persistent Cerebrospinal Fluid Leukocytosis: Could this be Idiopathic Intracranial Hypertension?

Malik

Ali

Shah

2019

Cureus

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A 37-year-old female, a known epileptic, presented to the neurology clinic with a seven-day history of persistent bilateral headache not improving with analgesics. Her neurological and systemic examinations were unremarkable except for right optic disc edema. Magnetic resonance imaging (MRI) brain and magnetic resonance venography (MRV) were normal but her cerebrospinal fluid (CSF) opening pressure was 280 mm of water with a CSF white cell count of 214. The patient showed improvement following treatment with intravenous antibiotics and acyclovir. She returned a week later with double vision and blurring in both eyes. Examination showed bilateral sixth nerve palsies and bilateral optic disc edema with left fundal hemorrhages. The spinal tap was repeated again, which showed a CSF opening pressure of 500 mm of water and the white cell count was 48. Extensive investigations for etiologies were mostly unrevealing. The patient was started on acetazolamide and topiramate combined with a large-volume therapeutic CSF tap. She continued to improve subsequently and was at the baseline functional state at three months, with complete resolution of hemorrhages and optic disc edema. Idiopathic intracranial hypertension (IIH) may present with persistent abnormal CSF with a high white cell count. Therefore, this must be diagnosed with caution, as it may be misdiagnosed and wrongly treated for other causes.

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“…In addition, if elevated, they are highly informative via the degree of elevation. However, only combined interpretation with cytomorphology allows accurate diagnostic clues about the underlying pathology [ 34 ]. For instance, in the case of suspected leptomeningeal neoplastic spread or subarachnoid haemorrhage (SAH), the detection of neoplastic cells or, respectively, erythro- and/or siderophages on cytoslides confirms the diagnosis irrespective of a normal or elevated CSF cell count ( Figure 2 ).…”

Section: Conventional Csf Cell Diagnosticsmentioning

confidence: 99%

Role and Relevance of Cerebrospinal Fluid Cells in Diagnostics and Research: State-of-the-Art and Underutilized Opportunities

et al. 2021

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Cerebrospinal fluid (CSF) has recently experienced a revival in diagnostics and research. However, little progress has been made regarding CSF cell analysis. For almost a century, CSF cell count and cytomorphological examination have been central diagnostic parameters, with CSF pleocytosis as a hallmark finding of neuroinflammation and cytology offering valuable clues regarding infectious, autoimmune, and malignant aetiologies. A great deal of information, however, remains unattended as modern immune phenotyping technologies have not yet been broadly incorporated into routine CSF analysis. This is a serious deficit considering the central role of CSF cells as effectors in central nervous system (CNS) immune defence and autoimmune CNS processes, and the diagnostic challenges posed by clinically overlapping infectious and immune-mediated CNS diseases. Here, we summarize historical, specimen-intrinsic, methodological, and technical issues determining the state-of-the-art diagnostics of CSF cells and outline future perspectives for this underutilized window into meningeal and CNS immunity.

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Cerebrospinal fluid cytology in nonmalignant aseptic meningeal disorders

Cited by 8 publications

References 88 publications

Leptomeningeal Disease (LMD) in Patients with Melanoma Metastases

Leptomeningeal Disease (LMD) in Patients with Melanoma Metastases

Persistent Cerebrospinal Fluid Leukocytosis: Could this be Idiopathic Intracranial Hypertension?

Role and Relevance of Cerebrospinal Fluid Cells in Diagnostics and Research: State-of-the-Art and Underutilized Opportunities

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