Cytomorphologic and Flow Cytometric Analysis of Cerebrospinal Fluid with T-Cell Lymphoma Involvement: A Retrospective Study of Rare Cases

Abstract

Objective: To compare the efficacy of conventional cytomorphologic analysis and flow cytometry (FC) in the diagnosis of T-cell lymphoma in the cerebrospinal fluid (CSF). Study Design: We performed a retrospective review of CSF samples from 2002 to 2012 that showed involvement of a T-cell lymphoma, either by cytomorphologic analysis and/or FC. Patients' demographics, clinical history and follow-up were assessed. Results: Thirty-nine CSF samples were identified from 9 patients. A definitive diagnosis of T-cell lymphoma involvement was made by cytomorphologic analysis and FC in 6 (15.4%) and 39 (100.0%) specimens, respectively. In specimens with definitive cytopathologic diagnoses, the cytomorphologic features included increased cellularity, a monotonous lymphoid population and large, atypical lymphoid cells. Considering cytomorphologic features only, 9 specimens demonstrated atypical lymphocytes not fulfilling the criteria for malignancy, and 24 specimens were negative for malignancy. Conclusions: CSF with T-cell lymphoma involvement may yield paucicellular or acellular specimens depending on the volume of the CSF, the time interval between specimen collection and specimen processing and the application of preservative to CSF. The rate of detection of T-cell lymphoma in the CSF by FC is unequivocally higher than by cytomorphologic analysis. Careful attention to clinical history is crucial, as FC testing may be tailored to evaluate for T-cell lymphoproliferative disorders in limited samples.

Accuracy of flow cytometry and cytomorphology for the diagnosis of meningeal involvement in lymphoid neoplasms: A systematic review

“…A total of 41 studies comparing flow cytometry and cytology in CSF samples from patients with lymphoid neoplasia were identified .…”

“…Regarding study populations, 17/27 include only proven hematological diagnoses with risk factors or signs/symptoms suggestive for CNS dissemination, whereas 2/27 comprise a mixture of proven and suspected hematological diagnoses. Moreover, 6/27 comprise only cases of acute lymphoblastic leukemia/lymphoma and 2/27 encompass only cases of T‐cell lymphoma …”

“…Moreover, 6/27 comprise only cases of acute lymphoblastic leukemia/lymphoma 8,17,25,[28][29][30] and 2/27 encompass only cases of T-cell lymphoma. 24,32 Analytical informations are summarized in Table III. Only 9/27 studies report technical specifications regarding centrifugation of samples over slides for cytomorphological analysis (time, centrifugal force); regarding the staining method used, May-Grunwald-Giemsa is the most widely employed (11/27).…”

“…However, the majority of the papers regard populations of proven lymphoma diagnoses studied for high risk CNS involvement or for staging purposes, but two studies regard a mixture of proven and suspected diagnoses: this factor can likely affect pre‐test probability and, hence, test results (Table ). Moreover, there is an extreme heterogeneity of lymphoproliferative diseases in these studies, with six of them pertaining only cases of acute lymphoblastic leukemia/lymphoma and two studies encompassing only T‐cell lymphomas: this factor certainly influences study results given different types of hematological malignancies show different tendencies to involve central nervous system . Furthermore, differences in timing of sample withdrawal during clinical course could likely influence pre‐test probability of finding malignant cells in CSF (e.g., at the time of diagnosis, during therapy, at relapse, etc.).…”

15-Year Retrospective Survey of the Cytopathologic Spectrum of Cerebrospinal Fluid Aspirate in a Teaching Hospital in Uyo, Southern Nigeria

“…Cerebrospinal fluid (CSF) analysis for cytopathological diagnosis plays a pivotal role in the diagnosis and management of a wide array of neurological disorders, including infections, [1][2][3][4][5][6] neoplasms, and inflammatory conditions. The cytopathologic examination of CSF specimens offers a minimally invasive means of obtaining valuable diagnostic information, aiding in the identification of abnormal cells, infectious agents, and other pathological processes within the central 1,3,4,[7][8][9][10][11][12][13][14][15] nervous system (CNS).…”