Metastatic Breast Carcinoma in Cerebrospinal Fluid: A Cytopathological Review of 15 Cases

Abstract

The incidence of metastatic carcinoma to the meninges ("meningeal carcinomatosis" [MC]) is increasing due to longer survival of patients and improved imaging techniques. Currently, MC is best diagnosed by cytopathological evaluation of cerebrospinal fluid (CSF). Breast primaries are the commonest cause of MC; although cytopathological features thereof have not been, as yet, fully characterized. In this study of meningeal mammary carcinomatosis, relevant clinicopathological data and archived cytopathological preparations of all "suspicious" and "positive" CSF specimens (1992-2015), from patients with a history of breast carcinoma, were retrieved and reviewed. Twenty-three "positive" CSF specimens, derived from 15 patients formed the basis of this study. All specimens were processed as Cytospin preparations, and stained by Papanicolaou and Diff-Quik techniques. All patients were female, with a mean age of 57 (range: 32-85) years. Mean interval between initial diagnosis of breast carcinoma and "positive" CSF was 32 (range 6-84) months. All 23 specimens (100%) were "cellular" (>10 carcinoma cells). Eighteen (78%) specimens showed only isolated nonclustered cells, and 5 (22%) specimens showed both cell clusters and isolated cells. In most "positive" cases, metastatic breast carcinoma cells showed variation in cell size, with hyperchromatic nuclei, irregular nuclear membranes, prominent nucleoli and cytoplasmic vacuolization. The background in some CSF samples showed red blood cells and fibrin admixed with rare lymphocytes and histiocytes. One specimen showed necrotic debris. Papanicolaou and Diff-Quik-stained Cytospin preparations were equally diagnostic, as the aforementioned findings were present in both types of preparation.

Meningeal Carcinomatosis in Advanced Extramammary Paget’s Disease: A Case Report

“…In breast carcinoma, there are several routes that carcinoma cells can potentially take to involve the meninges. Such involvement can follow metastasis to: (i) the meninges, (ii) brain parenchyma, (iii) axial bones, (iv) choroid plexus, or (v) cranial nerves (8). Most cases of EMPD brain metastasis show disseminated lesions, resulting mainly from intraspinal axial bone metastasis.…”

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).…”

“…CSF cytopathological evaluation is compulsory in suspected inflammatory, neoplastic, or hemorrhagic conditions and needs to be interpreted in the clinical [3][4][5][7][8][9][10][11][12][13][14][15][16] context.…”

Macrophages in Giemsa-stained cerebrospinal fluid specimens predict carcinomatous meningitis

“…Ho et al ( 11 ) summarized cytomorphological characteristics of primary CNS tumors in the CSF. Rao et al ( 12 ) reported cytopathological characteristics of CSF for 15 patients with breast cancer. Bell ( 13 ) reported the pitfalls which could interfere with the diagnostic accuracy in CSF cytology Bigner ( 14 ) comprehensively summarized CSF cytology from the preparation method to the cytological findings of non-infectious condition, infectious conditions, hematopoietic tumors, metastatic carcinomas and primary CNS tumors.…”

“…In terms of characteristics of leukocytes, the findings have been evaluated manually in cytological specimens. For example, lymphocytes and monocytes mixed with erythrocytes and fibrin are observed in the background of metastatic breast cancer specimens ( 12 ), neutrophils are identified in malignant specimens of the central nervous system and eosinophils have been reported in patients with Hodgkin's lymphoma ( 5 ). Moreover, reactive and inflammatory infiltrates have been reported in the background when only a few metastatic cancer cells are detected in CSF ( 14 ).…”