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Di WY, Chen YN, Cai Y, Geng Q, Tan YL, Li CH, Wang YN, Shang YH, Fang C, Cheng SJ. The diagnostic significance of cerebrospinal fluid cytology and circulating tumor DNA in meningeal carcinomatosis. Front Neurol 2023; 14:1076310. [PMID: 36937524 PMCID: PMC10022429 DOI: 10.3389/fneur.2023.1076310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/08/2023] [Indexed: 03/06/2023] Open
Abstract
Objective The objective of this research is to investigate the clinical application value of cerebrospinal fluid (CSF) cytology and circulating tumor DNA (ctDNA) in lung adenocarcinoma (LUAD) meningeal metastasis-meningeal carcinomatosis (MC), and to further explore the possible molecular mechanisms and drug treatment targets of LUAD meningeal metastasis by next-generation sequencing (NGS). Methods We retrospectively analyzed LUAD with MC in 52 patients. CSF cytology was carried out using the slide centrifugation precipitation method and May-Grüwald-Giemsa (MGG) staining. Tumor tissue, plasma and CSF ctDNA of some MC patients were detected by NGS. Results Of the 52 MC patients, 46 (88.46%) were positive for CSF cytology and 34 (65.38%) were positive for imaging, with statistically significant differences in diagnostic positivity (P < 0.05). In 32 of these patients, CSF cytology, cerebrospinal fluid ctDNA, plasma ctDNA and MRI examination were performed simultaneously, and the positive rates were 84.38, 100, 56.25, and 62.50% respectively, the difference was statistically significant (P < 0.001). Analysis of the NGS profiles of tumor tissues, plasma and CSF of 12 MC patients: the mutated gene with the highest detection rate was epidermal growth factor receptor (EGFR) and the detection rate were 100, 58.33, and 100% respectively in tumor tissues, plasma and CSF, and there were 6 cases of concordance between plasma and tissue EGFR mutation sites, with a concordance rate of 50.00%, and 12 cases of concordance between CSF and tissue EGFR mutation sites, with a concordance rate of 100%. In addition, mutations not found in tissue or plasma were detected in CSF: FH mutation, SETD2 mutation, WT1 mutation, CDKN2A mutation, CDKN2B mutation, and multiple copy number variants (CNV), with the most detected being CDKN2A mutation and MET amplification. Conclusion CSF cytology is more sensitive than traditional imaging in the diagnosis of meningeal carcinomatosis and has significant advantages in the early screening and diagnosis of MC patients. CSF ctDNA can be used as a complementary diagnostic method to negative results of CSF cytology and MRI, and CSF ctDNA can be used as an important method for liquid biopsy of patients with MC, which has important clinical significance in revealing the possible molecular mechanisms and drug treatment targets of meningeal metastasis of LUAD.
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Affiliation(s)
- Wei-Ying Di
- Clinical Medical College, Hebei University, Baoding, China
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Ya-Nan Chen
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Yun Cai
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Qiang Geng
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Yan-Li Tan
- Department of Pathology, Affiliated Hospital of Hebei University, Baoding, China
| | - Chun-Hui Li
- Department of Neurosurgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Ya-Nan Wang
- Department of Pathology, Affiliated Hospital of Hebei University, Baoding, China
| | - Yan-Hong Shang
- Department of Oncology, Affiliated Hospital of Hebei University, Baoding, China
| | - Chuan Fang
- Department of Neurosurgery, Affiliated Hospital of Hebei University, Baoding, China
- Hebei Key Laboratory of Precise Diagnosis and Treatment of Glioma, Baoding, China
- *Correspondence: Chuan Fang
| | - Shu-Jie Cheng
- Clinical Medical College, Hebei University, Baoding, China
- Department of Hepatobiliary Surgery, Affiliated Hospital of Hebei University, Baoding, China
- Shu-Jie Cheng
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Straccia P, Fadda G, Pierconti F. Comparison between cytospin and liquid-based cytology in cerebrospinal fluid diagnosis of neoplastic diseases: A single institution experience. Cytopathology 2018; 30:236-240. [PMID: 30468697 DOI: 10.1111/cyt.12659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/15/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The current tools available for detecting malignant neoplasms in the cerebrospinal fluid (CSF) are neurological examination, followed by neuroimaging, cytology and molecular techniques. To highlight the role of cytology the diagnosis of metastatic tumours in CSF samples, we present our experience using cytospin and ThinPrep liquid-based cytology. METHODS A retrospective analysis was conducted using the pathological records of 8181 cytological specimens of CSF, which were diagnosed over a 17-year period. Between 2000 and 2014, a total of 6994 CSF samples were processed using cytospin method and 1187 specimens were examined using ThinPrep method in the period between 2015 and 2017. RESULTS The most frequent metastatic neoplasm of the first period was non-Hodgkin lymphoma; in the second period the commonest malignancy found was brain tumour (glioblastoma and medulloblastoma). The samples processed by cytospin revealed cytolysis and haemorrhage, while the cases processed by ThinPrep had a clear background. Ten false-positive cases belonging to the suspicious category were processed by cytospin, while there was only one false positive case in the group processed by ThinPrep. The positive predictive value was 95% in cytospin and 100% in Thin Prep with comparable sensitivity, specificity, diagnostic accuracy and negative predictive values. CONCLUSIONS CSF cytology is a reliable technique for identifying malignancy in CSF. ThinPrep technology can be applied with good results in terms of clear background, cell enrichment, better nuclear details and high cellularity per slide.
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Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pierconti
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
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Doval DC, Azam S, Sinha R, Batra U, Mehta A, Rao A. A Report of Two Cases of Leptomeningeal Carcinomatosis Arising from Gallbladder Carcinoma. J Gastrointest Cancer 2015; 46:417-20. [PMID: 25863810 DOI: 10.1007/s12029-015-9719-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Sector-5, Rohini, Delhi, India. .,Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India.
| | - Saud Azam
- Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Rupal Sinha
- Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Sector-5, Rohini, Delhi, India
| | - Anurag Mehta
- Department of Laboratory Services, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Avinash Rao
- Department of Radiology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
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Wauters CAP, Poelen J, Mulder I, Venderink D, Strobbe LJA, Wesseling P. Contribution of CSF cytology in the diagnostic work-up of breast cancer patients with neurological symptoms: a retrospective analysis over two decades. J Neurooncol 2012; 107:581-9. [PMID: 22215233 DOI: 10.1007/s11060-011-0782-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 12/19/2011] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the contribution of cytological analysis of cerebrospinal fluid (CSF) in the diagnostic work-up of breast cancer patients who present with neurological symptoms suspected for central nervous system (CNS) metastases. In the period 1989-2009, a total of 81 patients with breast cancer underwent CSF cytological examination. Relevant tumour characteristics, clinical presentation and radiological findings were scored. The CSF cytological diagnosis was classified according to the 1996 NCI-sponsored conference approach as malignant, suspicious for malignancy, atypical, benign or inadequate. During the course of 20 years, 145 CSF cytological examinations were performed. Relatively common neurological symptoms resulting in cytological CSF examination were headache (n = 25), nausea and vomiting (n = 19), sensory disturbances (n = 16), and cranial nerve dysfunction (n = 16). Of these, headache and nausea/vomiting were most often associated with malignant cells in the CSF (CSF(+)) (in 48 and 53% of the cases, respectively). The 4 patients with both headache and confusion/altered mental status all had CSF(+). In 10 patients, CSF(+) was found despite the absence of radiological evidence for metastasis in/around the CNS. In our series, repeated CSF analysis appeared to have limited additional value, and CSF(+) was strongly correlated with shorter survival. A substantial number of patients with neurological symptoms but without radiological abnormalities can have CSF(+). In our series, the additional value of repeated cytological examination of CSF was limited. Our study underscores the value of CSF cytology as a tool for the unequivocal diagnosis of metastatic spread of breast cancer to the CNS, and confirms that CSF(+) is a strong predictor of poor survival.
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Affiliation(s)
- C A P Wauters
- Department of Pathology, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands.
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Grewal J, Saria MG, Kesari S. Novel approaches to treating leptomeningeal metastases. J Neurooncol 2011; 106:225-34. [PMID: 21874597 DOI: 10.1007/s11060-011-0686-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 08/03/2011] [Indexed: 12/27/2022]
Abstract
Leptomeningeal metastasis is a devastating complication of the central nervous system in patients with late-stage solid or hematological cancers. Leptomeningeal metastasis results from the multifocal seeding of the leptomeninges by malignant cancer cells. Although central nervous system metastasis usually presents in patients with widely disseminated and progressive late-stage cancer, malignant cells may spread to the cerebrospinal fluid during earlier disease stages in particularly aggressive cancers. Treatment of leptomeningeal metastasis is largely palliative but will often provide stabilization and protection from further neurological deterioration and improve quality of life. There is a need to raise awareness of the impact of leptomeningeal metastases on cancer patients and its known and putative biological basis. Novel diagnostic approaches include identification of biomarkers that may stratify the risk for developing leptomeningeal metastasis. Current therapies can be used more effectively while waiting for advanced treatments to be developed.
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Affiliation(s)
- Jai Grewal
- Long Island Brain Tumor Center, NSPC, 600 Northern Blvd, Suite 113, Great Neck, NY 11577, USA
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Butchart C, Dahle-Smith A, Bissett D, Mackenzie JM, Williams DJP. Isolated Meningeal Recurrence of Transitional Cell Carcinoma of the Bladder. Case Rep Oncol 2010; 3:171-175. [PMID: 20740192 PMCID: PMC2919995 DOI: 10.1159/000315473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Meningeal carcinomatosis occurs in 1–18% of patients with solid tumours, most commonly carcinomas of the breast and lung or melanomas. There are relatively few reports of meningeal carcinomatosis in transitional cell carcinoma of the bladder. Isolated meningeal recurrence is particularly uncommon, and we present an unusual case of this in a 58-year-old man. The case was further complicated by the somewhat atypical presentation with a confirmed ischaemic stroke. The patient died one month after presentation.
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Abstract
This chapter discusses the anatomy, functions, and biochemistry of cerebrospinal fluid (CSF). CSF has four major functions: physical support of neural structures, excretion and “sink” action, intracerebral transport, and control of the chemical environment of the central nervous system. CSF provides a “water jacket” of physical support and buoyancy. The CSF is protective because its volume changes reciprocally with changes in the volume of intracranial contents, particularly blood. Thus, the CSF protects the brain from changes in arterial and central venous pressure associated with posture, respiration, and exertion. Acute or chronic pathological changes in intracranial contents can be accommodated, to a point, by changes in the CSF volume. The direct transfer of brain metabolites into the CSF provides excretory function. This capacity is important because the brain lacks a lymphatic system. The lymphatic function of the CSF is also manifested in the removal of large proteins and cells, such as bacteria or blood cells, by bulk CSF absorption. The “sink” action of the CSF arises from the restricted access of water-soluble substances to the CSF and the low concentration of these solutes in the CSF.
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Lee O, Cromwell LD, Weider DJ. Carcinomatous meningitis arising from primary nasopharyngeal carcinoma. Am J Otolaryngol 2005; 26:193-7. [PMID: 15858776 DOI: 10.1016/j.amjoto.2004.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Carcinomatous meningitis, also known as leptomeningeal metastasis and meningeal carcinomatosis, is the invasion of neoplastic cells into the leptomeninges. Head and neck cancers, especially nasopharyngeal carcinoma, give rise to carcinomatous meningitis very infrequently. In this case report, we present a rare case of carcinomatous meningitis with nasopharyngeal carcinoma as the primary source. In 1987, a 45-year-old white female presented with a few year history of chronic bilateral serous otitis media. She also complained of intermittent diplopia, right facial pain, right-sided headache, and, finally, right facial palsy. The patient was subsequently diagnosed with nasopharyngeal carcinoma by biopsy and treated with radiation as well as chemotherapy. Her neurological symptoms improved, and she did fairly well for several years. However, various neurologic symptoms started to recur, including right facial weakness, right facial numbness in the distribution of all 3 divisions of cranial nerve (CN) V, loss of taste as well as smell, and diplopia. In 1993, magnetic resonance imaging scan of the head revealed recurrence of nasopharyngeal carcinoma with involvement of the ethmoid sinuses as well as extension of the tumor into the frontotemporal leptomeninges. Over the course of the next 3 years, the patient experienced a very gradual decline with involvement of almost all of the CNs (CN I, II, III, V, VI, VII, VIII, IX, X, XII). This case report of carcinomatous meningitis from primary nasopharyngeal carcinoma is one of the few reported in the literature. Although very rare, nasopharyngeal carcinoma can give rise to carcinomatous meningitis, probably by direct invasion of malignant cells. We also review the literature with respect to the diagnosis and treatment of carcinomatosis meningitis.
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Affiliation(s)
- Oneil Lee
- Department of Radiology, University of Chicago Hospitals, IL, USA
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Enting RH. Leptomeningeal neoplasia: epidemiology, clinical presentation, CSF analysis and diagnostic imaging. Cancer Treat Res 2005; 125:17-30. [PMID: 16211881 DOI: 10.1007/0-387-24199-x_2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The incidence of leptomeningeal metastasis over the past several decades has increased among solid tumor patients and decerased in patients with hematologic malignancies. Improvements in systemic therapies are likely responsible for both changes; solid tumor patients are living longer and, threfore, are at higher risk to develop leptomeningeal tumors while patients with hematologic malignancy have benefitted from more aggressive central nervous system prophylaxis. Regardless, both types of patients present with symptoms referrable to multiple levels of the central nervous system and a careful dignostic approach incorporating cerebrospinal fluid studies and appropriate neuroimaging is critical.
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Miyagui T, Luchemback L, Teixeira GHMDC, de Azevedo KML. Meningeal carcinomatosis as the initial manifestation of a gallbladder adenocarcinoma associated with a Krukenberg tumor. REVISTA DO HOSPITAL DAS CLINICAS 2003; 58:169-72. [PMID: 12894314 DOI: 10.1590/s0041-87812003000300007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A case of malignant neoplasm is described in which the initial manifestations were mental dysfunction and meningeal irritation, mimicking chronic or subacute meningitis. Physical examination showed cranial nerve involvement and a pelvic tumor. There was progressive deterioration, and death occurred in 2 weeks. The autopsy revealed a gallbladder adenocarcinoma, meningeal carcinomatosis, and ovarian metastasis presenting as a Krukenberg tumor. The authors emphasize the importance of including meningeal carcinomatosis as a possibility in the differential diagnosis of non-characteristic clinical pictures, as well as the importance of the cerebrospinal fluid cytologic examination, repeated as needed, in order to confirm this diagnosis.
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Affiliation(s)
- Tizuko Miyagui
- Departments of Pathology and Clinical Medicine, Infectious and Parasitic Disease Service, Antonio Pedro University Hospital, Faculty of Medicine, Fluminense Federal University, Rio de Janeiro, RJ, Brazil
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Yu H, Mitsumori M, Nagata Y, Katakura Y, Kokubo M, Oya N, Fujishiro S, Sasai K, Hiraoka M, Kan N. Meningeal carcinomatosis in patients with breast cancer: report of 8 patients. Breast Cancer 2001; 8:74-8. [PMID: 11180770 DOI: 10.1007/bf02967482] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Meningeal carcinomatosis (MC) is an uncommon but aggressive complication of advanced breast cancer with a recently increasing incidence. Although the prognosis is extremely poor for MC patients, early diagnosis and appropriate treatment are important. SUBJECTS AND METHODS We reviewed 8 cases of MC from breast cancer at Kyoto University Hospital from 1990 to 1999. The median age was 51.5 years. All patients had widespread systemic metastases when diagnosed with MC. clinical symptoms were categorized into 3 groups: cranial nerve symptoms, spinal nerve symptoms, and other symptoms. Imaging studies were positive for MC in only 4 patients. Initial CSF cytology studies were positive in 4 patients, and repeated CSF cytology yielded positive results in the remaining 4 patients. Thus the median interval between the onset of any clinical symptom of MC and the initiation of treatment was 22.5 days (range 7 to 120 days ). All patients received whole brain radiotherapy (WBRT). Four patients were given intrathecal chemotherapy and/or intrathecal immunotherapy in addition to WBRT. RESULTS Improvement of cranial nerve symptoms, spinal nerve symptoms, and other symptoms were observed in 3/5, 1/3, and 5/7 patients, respectively. Patients with cranial nerve symptoms who started WBRT within 29 days of the onset of the symptoms showed at least partial recovery whereas patients who started WBRT later showed no recovery. The median survival was 123 days (53 to 310 days). MC was the direct cause of death in 1 of 8 patients. CONCLUSION When MC is clinically suspected, neither a negative imaging study nor a single negative CSF cytology can rule out MC. Prompt initiation of WBRT with or without intrathecal chemotherapy may be important for recovery from cranial nerve symptoms.
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Affiliation(s)
- H Yu
- Department of Therapeutic Radiology and Oncology, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Hoon DS, Kuo CT, Wascher RA, Fournier P, Wang HJ, O'Day SJ. Molecular detection of metastatic melanoma cells in cerebrospinal fluid in melanoma patients. J Invest Dermatol 2001; 117:375-8. [PMID: 11511319 DOI: 10.1046/j.0022-202x.2001.01417.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Melanoma frequently metastasizes to the central nervous system (CNS). The diagnosis of CNS metastases typically is made following the onset of clinical symptoms. Thus, more sensitive diagnostic approaches are needed to identify subclinical CNS metastases. Currently, standard cytologic analysis of the cerebrospinal fluid (CSF) is limited by its poor sensitivity. A more sensitive assay was therefore developed using multiple reverse transcriptase-polymerase chain reaction (RT-PCR) markers. CSF was collected and assessed by RT-PCR for three known melanoma-associated markers (MAGE-3, MART-1, and tyrosinase) to detect occult metastatic melanoma cells in the CSF of 37 American Joint Committee on Cancer (AJCC) stage IV melanoma patients. Cytologic analysis of CSF was performed on all patients, and immunohistochemistry (IHC) analysis was performed on 33 CSF samples using anti-S100 and anti-HMB-45 antibodies. Only one patient (3%) had tumor-positive CSF cytology and IHC upon entry into the study, whereas 12 patients (32%) were positive for at least one RT-PCR marker. The correlation between CSF RT-PCR positivity of MART-1 and/or MAGE-3 and the development of CNS metastases at 3 mo was significant (p = 0.04). Fifteen of 37 patients (41%) had either positive MRI and/or positive RT-PCR results. Multimarker RT-PCR is more informative and sensitive than cytology/IHC in assessing the CSF of melanoma patients.
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Affiliation(s)
- D S Hoon
- Department of Molecular Oncology, Division Medical Oncology, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, California 90404, USA.
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Abstract
Nervous system metastases occur in about 25% of patients with systemic cancer (Table 1) and usually involve the brain parenchyma, leptomeninges, and spinal epidural space. Although they are ominous, they can be effectively treated in many patients, reducing disability and prolonging life. Treatment may include surgery, and radiation therapy and chemotherapy are often necessary. The choice of agents is often made on the basis of the primary tumor. Even when sustained remission cannot be achieved, effective palliation can be accomplished in most patients.
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