Smear preparation of intracranial lesions: A retrospective study of 306 cases

Abstract

A cytohistological correlation with determination of accuracy rate of smear preparation result was done in a retrospective study of 306 cases of intracranial tumors. Cytomorphology of few new entities of CNS tumors are described. The cytological features and WHO grading of the tumors were described on smear preparation. The cases with discrepancy in cytological and histological diagnosis were reviewed again and a final possible diagnosis on smear preparation which should have been given is discussed. The clinical details like the age, sex, and site of the tumors were analyzed. The age range of the patients was from 3 years to 63 years with male:female ratio of 1.5:1. Of the total 306 cases, a cytohistological correlation was seen in 93% cases. Twenty-two (7.3%) cases showed discrepancy between the crush preparation diagnosis and final histopathological diagnosis. Majority of the tumors were located in the cerebral hemisphere (56%) and the most frequently diagnosed tumor was astrocytoma, in particular, pilocytic astrocytoma (18.5%) followed by meningioma (11.9%), medulloblastoma (7.3%), anaplastic oligodendroglioma (5%), ependymoma (4.3%), pituitary adenoma (3.3%), schwannoma (3.3%), etc. A few rarer tumors, in central nervous system like differentiating neuroblastoma, pineocytoma, atypical choroid plexus papilloma, piloxmyxoid astrocytoma, rosette forming glioneuronal tumor, etc. are also described, Smear/crush preparation is a very effective, simple, rapid and reliable technique for the diagnosis and WHO grading of central nervous system tumors. Diagnostic accuracy of cytology with final histopathological report is established with accuracy rate of 93%.

Intraoperative Squash and Touch Preparation Cytology of Brain Lesions Stained with H+E and Diff-Quik™: A 20-Year Retrospective Analysis and Comparative Literature Review

“…In fact, this combined methodology greatly enhanced our cytodiagnostic acumen regarding brain lesions. Most previous investigations utilized H+E (69.2%) [3, 5-7, 9-12, 15, 16, 19-26] , Pap (38.5%) [2-5, 7, 11, 18, 19, 26] , or both (21.4%) [3,5,7,11,19,26] ( Table 3 ). The study authors declared these stains to be beneficial for evaluating subtle degrees of nuclear atypia, nuclear chromatin patterns, and cytoplasmic features such as glial projections [2,4] .…”

“…The study authors declared these stains to be beneficial for evaluating subtle degrees of nuclear atypia, nuclear chromatin patterns, and cytoplasmic features such as glial projections [2,4] . Eight studies (30.8%) employed TB [1, 8-11, 13, 17, 24] and 8 used MGG stains [2,4,14,19,20,23,24,26] . Krishnani et al [22] observed that lymphoglandular bodies, a useful aid in the identification of lymphoid tumors, were better appreciated with MGG than with H+E staining.…”

“…Among 9 reports, the age range of the patients was 15 days to 87 years [8,15,16,19,[21][22][23][24]26] . Ten studies reported a male-tofemale ratio of 1.1-2.5 (mean 1.6) [8,12,15,16,19,[21][22][23][24]26] . The types of neoplasms encountered ranged from 9 to 37, and averaged 18 per study [1-5, 7-10, 12, 15-24, 26] .…”

“…Far fewer studies have utilized the DQ stain [7,12] , despite its effectiveness in the diagnosis of hematopoietic lesions [7] . Although the MGG stain exhibits more intense staining color, it takes longer to execute than DQ staining [2,4,14,19,20,23,24,26] . TB is also a rapidly performed cytologic stain, but further processing of the slide is necessary and thus it requires a more laborious procedure than DQ [8,9] .…”

“…Various stains have been utilized for intraoperative brain cytology, such as hematoxylin and eosin (H+E) [3, 5-7, 9-12, 15, 16, 19-26] , Papanicolaou (Pap) [2-5, 7, 11, 18, 19, 26] , May-Grünwald-Giemsa (MGG) [2,4,14,19,20,23,24,26] , toluidine blue (TB) [1, 8-11, 13, 17, 24] , and Diff-Quik TM (DQ) [7,12] . Although not frequently employed to examine cytologic specimens, H+E is by far the most commonly used stain for SP/TP [3, 5-7, 9-12, 15, 16, 19-26] , as it is the most prevalent stain in FS consultations.…”