脑脊液细胞学检查的特异性发现

Specific findings in cerebrospinal fluid cytology

目的 回顾本实验室 392 2例脑脊液 (CSF)细胞学检查的特异性发现 ,探讨其临床意义。方法 1984年 4月至 2 0 0 3年 4月CSF细胞学检查 392 2例 ,CSF标本经自然沉淀法或玻片离心法制片 ,常规采用迈 格 姬染色 ,部分标本行PAS染色或免疫细胞化学染色后观察。结果 CSF细胞学特异性发现包括感染性病原体与恶性肿瘤 ,共 5 5例 ,占全部CSF细胞学检查的 1 4 0 %。其中感染性病原体包括新型隐球菌 5例 ,镰刀菌 1例。恶性肿瘤 4 9例 ,包括转移性癌 2 6例 ,转移性淋巴瘤 /白血病 7例 ,脑生殖细胞瘤 4例 ,原发性中枢神经系统恶性淋巴瘤 (PCNSL) 4例 ,胶质母细胞瘤 2例 ,来源未明的肿瘤 6例。PAS染色对新型隐球菌的形态显示良好。转移癌细胞的免疫细胞化学染色上皮膜抗原 (EMA)和 (或 )细胞角蛋白 (CK)阳性 ,淋巴瘤细胞可见LCA ,CD2 0或CD34等标记物阳性。结论 CSF细胞学对临床有重要意义 ,其特异性发现所见的肿瘤细胞以转移癌多见 ,病原体以新型隐球菌多见。CNS镰刀菌病是罕见的霉菌感染 ,CSF细胞学可检出镰刀菌。CSF免疫细胞学方法有助于鉴别肿瘤细胞的来源。

Objective To analysis one institution’s cerebrospinal fluid (CSF) cytology results from 3 922 specimens. Methods A retrospective study of 3 922 CSF cytology specimens generated between 1984 and 2003. The May-Grunwald- Giemsa’s stain was applied to routine cytology, while PAS or immunno-cytochemical stain for tumor markers were used in some specimens. Results A total of 3 922 CSF specimens were interpreted. Specific findings were identified in 55 specimen. Specific infectious organisms were identified in specimens: cryptococcus was the most common infectious agent observed ( n =5), and Fusarium was identified in a female with breast cancer. 49 cases were positive for malignant cells. Diagnosis included the metastatic carcinomas ( n =26), metastatic lymphoma/leukemia ( n =7), primary central nervous system neoplasms ( n =10), including primary CNS malignant lymphoma ( n =4), Germinoma ( n =4) and glioblastoma ( n =2) and also the malignant unclassified neoplasms ( n =6). Carcinoma cells showed positive staining for epithelial membrane antigen and /or cytokeratin immunostain. Lymphoma cells showed positive staining for CD34, LCA and (or) CD20. Conclusion Although specific findings in CSF cytology account for a small percent of the total specimens, they are of great significance in reaching final diagnoses. The most commonly identified infectious organisms were Cryptococcus. The most commonly identified malignancy was metastatic neoplasms. CNS fusarosis might be identified by CSF cytology.