Difference between revisions of "CNS cytopathology"

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An introduction to cytopathology is in the ''[[cytopathology]]'' article.  Cerebrospinal (CSF) specimens are dealt with in a separate article called ''[[CSF cytopathology]]''.
An introduction to cytopathology is in the ''[[cytopathology]]'' article.  Cerebrospinal (CSF) specimens are dealt with in a separate article called ''[[CSF cytopathology]]''.
==Technique==
Smears (really squash preps) are common in neuropathology. Here are some tips for getting a good smear:
# Sampling is key -- choose 3-4 small pieces of tissue from different areas of the tissue (if there are different colours, get some of each).
# Keep pieces small (easier to smear).
# Avoid air drying (place into formal alcohol immediately upon smearing).


==Basic approach==
==Basic approach==
Line 27: Line 32:


Glial vs non-glial:
Glial vs non-glial:
*Glial has ctyoplasmic processes/cytoplasmic strands (stringy processes) ~ 1 micrometer thick.
*Glial has cytoplasmic processes/cytoplasmic strands (stringy processes) ~ 1 micrometer thick.
**They cannot be seen well at low power.  
**They cannot be seen well at low power.  
**Cotton candy-like appearance.
**Cotton candy-like appearance.
Line 33: Line 38:
*** [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/files/cf76aad0d9dab70c99b93186ca8b3ad4.gif Stringy processes - glial tumour (msdlatinamerica.com)].<ref name=latinam>URL: [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html]. Accessed on: 2 November 2010.</ref>
*** [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/files/cf76aad0d9dab70c99b93186ca8b3ad4.gif Stringy processes - glial tumour (msdlatinamerica.com)].<ref name=latinam>URL: [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html]. Accessed on: 2 November 2010.</ref>
*** [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/files/59f74df1106573dcdea73be7febff2aa.gif Glial tumour mimicing a carcinoma (msdlatinamerica.com)].<ref name=latinam>URL: [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html]. Accessed on: 2 November 2010.</ref>
*** [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/files/59f74df1106573dcdea73be7febff2aa.gif Glial tumour mimicing a carcinoma (msdlatinamerica.com)].<ref name=latinam>URL: [http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html]. Accessed on: 2 November 2010.</ref>
Gliosis vs. neoplasm:
*Gliosis - uniform, pink
*Astrocytoma - irregular, coarse clumps of pink fibrillary material
High grade vs. low-grade:
*Markers of high grade glioma:
# Mitoses (can see these in smear)
# Necrosis (can also see in smears)


Notes:
Notes:
Line 41: Line 55:
***Crushed/elongated nuclei are present in artifactual processes.  
***Crushed/elongated nuclei are present in artifactual processes.  
<!-- *** something i forgot -->
<!-- *** something i forgot -->
===Meningioma===
Most meningiomas smear rather well, the only exception being ones that are densely fibrous.
*Key features of meningioma smears:
# Single cells or small groups of epithelioid cells with distinct cytoplasmic 'flags' (cytoplasm usually abundant)
# Round nuclei with vesicular chromatin and unapparent or small nucleoli
# Visible actin striations / stress filaments in cells (seen as pink straight lines)
<gallery>
File:Meningioma cytologie.jpg | HE smear of a meningioma displaying typical whorl formations (WC/jensflorian)
</gallery>


===Metastatic carcinoma===
===Metastatic carcinoma===
Typically has a 'cannonball' appearance -- with small, highly cohesive clusters of epithelioid cells.
{{Main|Metastasis}}
*[http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/_derived/Q92-Ans.htm_txt_SampleQ92.gif Squamous cell carcinoma (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Q92-Ans.htm http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Q92-Ans.htm]. Accessed on: 3 November 2010.</ref>
*[http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/_derived/Q92-Ans.htm_txt_SampleQ92.gif Squamous cell carcinoma (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Q92-Ans.htm http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Q92-Ans.htm]. Accessed on: 3 November 2010.</ref>
*[http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Images/SampleQ50.gif Adenocarcioma (ouhsc.edu)].
*[http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Images/SampleQ50.gif Adenocarcinoma (ouhsc.edu)].
*[http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Images/SampleQ59.gif Small cell carcinoma (ouhsc.edu)].
*[http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Images/SampleQ59.gif Small cell carcinoma (ouhsc.edu)].
===Metastatic melanoma===
*Occasionally large bi- or multinucleated cells
*Discohesive cells
*Large nucleoli
*Pigmented tumor cells
*Accompanied by tumor infiltrating lymphocytes
<gallery>
File:Melanoma_CNS_met_smear_HE.jpg | Melanoma smear prep (H&E)
File:Melanoma - cytology field stain.jpg
</gallery>
===Metastatic lymphoma===
*Small round and blue cells
===Glial tumors===
* Elongated cell processes
* Cohesive growth
* Often attached to vasculature
<gallery>
File:Pilocytic astrocytoma - smear - very high mag.jpg | Pilocytic astrocytoma smear preparation (H&E)
</gallery>


==Things that don't smear well==
==Things that don't smear well==
Cohesive tumours:
Cohesive tumours:
*Meningioma.<ref name=pmid7962615>{{cite journal |author=Ironside JW |title=Update on central nervous system cytopathology. II. Brain smear technique |journal=J. Clin. Pathol. |volume=47 |issue=8 |pages=683–8 |year=1994 |month=August |pmid=7962615 |pmc=502135 |doi= |url=}}</ref><ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*[[Neurofibroma]].
*Neurofibroma.<ref name=pmid7962615/>
*[[Schwannoma]].<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*[[Schwannoma]].<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*Subependymoma
*Abscess (because of fibrous capsule)
*Metastasis.<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*Metastasis.<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>


===Things that smear well===
===Things that smear well===
Dyscohesive tumours:
Dyscohesive tumours:
*Lymphoma.<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*[[Lymphoma]].<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*Pituitary adenoma.<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*[[Pituitary adenoma]].<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*Oligodendroglioma.<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*Oligodendroglioma.<ref name=Ref_TPoSP|252>{{Ref TPoSP|252}}</ref>
*[[Astrocytoma]].
*[[Astrocytoma]].

Latest revision as of 14:59, 21 December 2016

CNS cytopathology is a subset of neuropathology and cytopathology.

An introduction to cytopathology is in the cytopathology article. Cerebrospinal (CSF) specimens are dealt with in a separate article called CSF cytopathology.

Technique

Smears (really squash preps) are common in neuropathology. Here are some tips for getting a good smear:

  1. Sampling is key -- choose 3-4 small pieces of tissue from different areas of the tissue (if there are different colours, get some of each).
  2. Keep pieces small (easier to smear).
  3. Avoid air drying (place into formal alcohol immediately upon smearing).

Basic approach

 
 
 
 
 
 
 
 
CNS cytology
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Tumour
 
 
 
 
 
 
 
Non-tumour
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Glial
 
 
 
Non-glial
 
Infectious
 
 
 
Non-infectious
 
Glial Non-glial
Stranding
(cytoplasmic) 		thin - cannot be seen at low
power (2.5x obj.), true cytoplasmic
processes 		thick - can be seen at low
power (2.5x obj.), artifact of smearing
Edge of cluster smooth/non-distinct sharp

Glial vs non-glial:

Gliosis vs. neoplasm:

  • Gliosis - uniform, pink
  • Astrocytoma - irregular, coarse clumps of pink fibrillary material

High grade vs. low-grade:

  • Markers of high grade glioma:
  1. Mitoses (can see these in smear)
  2. Necrosis (can also see in smears)

Notes:

  • Crush artifact (in smear preparation) can mimic glial processes.
    • Crush artifact vs. real glial processes:
      • No glial processes run perpendicular to the direction of smear.
      • Glial processes may branch.
      • Crushed/elongated nuclei are present in artifactual processes.

Meningioma

Most meningiomas smear rather well, the only exception being ones that are densely fibrous.

  • Key features of meningioma smears:
  1. Single cells or small groups of epithelioid cells with distinct cytoplasmic 'flags' (cytoplasm usually abundant)
  2. Round nuclei with vesicular chromatin and unapparent or small nucleoli
  3. Visible actin striations / stress filaments in cells (seen as pink straight lines)

  • HE smear of a meningioma displaying typical whorl formations (WC/jensflorian)

Metastatic carcinoma

Typically has a 'cannonball' appearance -- with small, highly cohesive clusters of epithelioid cells.

Main article: Metastasis

Metastatic melanoma

  • Occasionally large bi- or multinucleated cells
  • Discohesive cells
  • Large nucleoli
  • Pigmented tumor cells
  • Accompanied by tumor infiltrating lymphocytes

  • Melanoma smear prep (H&E)

  • Melanoma - cytology field stain.jpg

Metastatic lymphoma

  • Small round and blue cells

Glial tumors

  • Elongated cell processes
  • Cohesive growth
  • Often attached to vasculature

  • Pilocytic astrocytoma smear preparation (H&E)

Things that don't smear well

Cohesive tumours:

Things that smear well

Dyscohesive tumours:

See also

References

  1. ↑ 1.0 1.1 URL: http://www.msdlatinamerica.com/ebooks/DiagnosticNeuropathologySmears/sid117213.html. Accessed on: 2 November 2010.
  2. ↑ URL: http://moon.ouhsc.edu/kfung/JTY1/NeuroTest/Q92-Ans.htm. Accessed on: 3 November 2010.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Weedman Molavi, Diana (2008). The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process (1st ed.). Springer. pp. 252. ISBN 978-0387744858.

External links

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