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Greer HR, Miller K, Samay S, Nellan A, Green AL. Investigation of white blood cell characteristics in cerebrospinal fluid samples at pediatric brain tumor diagnosis. J Neurooncol 2022; 159:301-308. [PMID: 35731362 PMCID: PMC10642713 DOI: 10.1007/s11060-022-04065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The role of white blood cells (WBC) in the pediatric central nervous system (CNS) tumor microenvironment is incompletely defined. We hypothesized that the WBC profile in cerebrospinal fluid (CSF) correlates with the presence of tumor cells and prognosis in pediatric CNS tumors, as well as other patient and disease characteristics, and differs by tumor type, thus giving insight into the tumor immune response. METHODS We conducted a retrospective analysis of CSF WBC profiles at CNS tumor diagnosis in 269 patients at our institution. We examined total nucleated cell count, absolute counts, and percentages by WBC subtype. We compared CSF WBC values by tumor cell presence, patient vital status, tumor location, and the most common tumor types. RESULTS Patients who died of their tumor had a lower CSF lymphocyte percentage and a higher absolute monocyte count in CSF at diagnosis. The presence of tumor cells in CSF was associated with fewer lymphocytes and monocytes. Ventricular tumors had higher CSF lymphocyte, monocyte, macrophage, and total nucleated cell counts than extraventricular tumors. Germ cell tumors, low-grade glioma, high-grade glioma, and ependymoma had lower macrophage counts or percentages compared to other tumor types. CONCLUSIONS WBC profile in CSF at pediatric CNS tumor diagnosis correlates with patient prognosis and presence of metastatic cells, along with tumor type and other tumor characteristics like relationship to the ventricles. Prospective CSF profiling and study may be useful to future immunotherapy and other pediatric CNS tumor clinical trials.
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Affiliation(s)
- Hunter R Greer
- University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Kristen Miller
- University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Sadaf Samay
- Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA
| | - Anandani Nellan
- Pediatric Oncology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | - Adam L Green
- Children's Hospital Colorado, University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA.
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Jakkani R, Ramineni K, Krishna Reddy GV, Rao GD, Ingle A. Zuckerguss sign: Sugar-coated cerebellum in a case of gastric adenocarcinoma. Ann Indian Acad Neurol 2022; 25:263-264. [PMID: 35693672 PMCID: PMC9175414 DOI: 10.4103/aian.aian_535_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/01/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022] Open
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Kobayashi S, Saio M, Fujimori M, Hirato J, Oyama T, Fukuda T. Macrophages in Giemsa-stained cerebrospinal fluid specimens predict carcinomatous meningitis. Oncol Lett 2020; 20:352. [PMID: 33123263 PMCID: PMC7586284 DOI: 10.3892/ol.2020.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/15/2020] [Indexed: 12/02/2022] Open
Abstract
Carcinomatous meningitis is a condition in which tumor cells spread to the subarachnoid space. Leukocyte counting and typing of cerebrospinal fluid (CSF) cell components are performed manually or using flow cytometry. However, a detailed analysis of these variables using cytological specimens has not yet been reported. The present study analyzed cytological specimens using Giemsa staining and whole slide imaging with computer-assisted image analysis (CAIA) to clarify the characteristics of the leukocyte population in CSF, especially in carcinomatous meningitis. Manual evaluation was performed using 280 Giemsa-stained cytological CSF specimens. For 49 samples, CAIA was used for the whole area of Papanicolaou (Pap) staining, and Giemsa-stained specimens of the same samples were imaged using a virtual slide scanner. The nuclear morphology of the leukocytes was assessed, and the total leukocyte and leukocyte subset (lymphocytes, neutrophils and macrophages) counts were evaluated. Then, the number and percentage of each leukocyte subset population were evaluated. The total leukocyte count was significantly higher in Giemsa-stained specimens compared with in Pap-stained specimens. The percentage of macrophages was significantly higher in samples from patients with non-hematological tumors compared with in samples from patients without tumors, which was confirmed by manual evaluation of the specimens. In addition, the cut-off value of the percentage of macrophages that could discriminate between the tumor history negative cases and cytologically tumor positive cases was determined, revealing that a higher proportion of macrophages reflected the existence of atypical/malignant epithelial tumor cells in CSF samples. Thus, atypical cell screening and analysis of the background characteristics of the leukocyte population should be the focus of cytological specimen screening, especially not to miss carcinomatous meningitis.
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Affiliation(s)
- Sayaka Kobayashi
- Laboratory of Histopathology and Cytopathology, Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma 371-8514, Japan
| | - Masanao Saio
- Laboratory of Histopathology and Cytopathology, Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma 371-8514, Japan
| | - Misa Fujimori
- Laboratory of Histopathology and Cytopathology, Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma 371-8514, Japan
| | - Junko Hirato
- Clinical Department of Pathology, Gunma University Hospital, Maebashi, Gunma 371-8511, Japan
- Department of Pathology, Public Tomioka General Hospital, Tomioka, Gunma, 370-2316, Japan
| | - Tetsunari Oyama
- Clinical Department of Pathology, Gunma University Hospital, Maebashi, Gunma 371-8511, Japan
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan
| | - Toshio Fukuda
- Laboratory of Histopathology and Cytopathology, Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma 371-8514, Japan
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Ma Y, Xing X, Li Y, Ao R, He M, Lan X, Zhao Y, Zhang J, Yu S. Brain Atrophy Associated with Primary Diffuse Meningeal Melanomatosis. World Neurosurg 2020; 136:311-314. [PMID: 32004738 DOI: 10.1016/j.wneu.2020.01.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Primary meningeal melanomatosis is a rare leptomeningeal tumor, and the diagnosis is challenging due to nonspecific clinical symptoms and radiologic findings. CASE DESCRIPTION A 21-year-old man presented with recurrent seizure and impaired memory. Cranial magnetic resonance imaging showed obvious brain atrophy with bilateral extensive meningeal enhancement in the supratentorial region. Diffusion-weighted imaging and fluid-attenuated inversion recovery showed slightly hyperintensive signals in the cortex. Microscopic examination revealed invasion of pigment into the Virchow-Robin space and cortex. Immunohistochemical examination of biopsy samples showed that cells were immunopositive for HMB45 and S-100 and immunonegative for melan-A with a Ki-67-positive percentage of 3%. No obvious atypia or nuclear mitosis was observed. Pathohistologic results of biopsied meninges confirmed the diagnosis of diffuse meningeal melanomatosis. The disease was aggravated with the occurrence of brain atrophy, recurrent seizure, and declined higher cortical function. CONCLUSIONS This case report illustrates that brain atrophy in meningeal melanomatosis is associated with a progressive decline of higher cortical function.
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Affiliation(s)
- Yubao Ma
- The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaowei Xing
- The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yang Li
- The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ran Ao
- The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Mianwang He
- The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaoyang Lan
- The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yan Zhao
- The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jiatang Zhang
- The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Shengyuan Yu
- The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
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Abstract
Cell-in-cell structures are reported in numerous cancers, and their presence is an indicator for poor prognosis. Mechanistic studies have identified how cancer cells manage to ingest whole neighbouring cells to form such structures, and the consequences of cell-in-cell formation on cancer progression have been elucidated. In this Opinion article, we discuss how two related cell-in-cell processes, cell cannibalism and entosis, are regulated and how these mechanisms promote cancer progression. We propose that cannibalistic activity is a hallmark of cancer that results in part from selection by metabolic stress and serves to feed aggressive cancer cells.
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Affiliation(s)
- Stefano Fais
- Department of Oncology and Molecular Medicine, National Institute of Health, Rome, Italy.
| | - Michael Overholtzer
- Cell Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Suresh PK, Kini JR, Basavaiah SH, Kini H, Khadilkar UN, Chakraborti S. Neoplastic Meningitis: A Study from a Tertiary Care Hospital from Coastal India. J Cytol 2018; 35:255-259. [PMID: 30498301 PMCID: PMC6210820 DOI: 10.4103/joc.joc_167_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Neoplastic involvement of cerebrospinal fluid (CSF) secondary to known or unknown primaries elsewhere is a poor prognostic factor and is equivalent to stage IV disease. Aim: The aim of the study is to analyse the cytological features of neoplastic meningitis in a tertiary care center. Materials and Methods: A retrospective study of 400 consecutive CSF samples was done in the cytology laboratory of our hospital. The fluid obtained by spinal tap was sent for microbiological, biochemical and cytological evaluation. Smears that showed the presence of malignant cells were included in this study. Results: Out of 400 cases, 36 (9%) showed neoplastic meningitis. Of which, 13 cases (36%) revealed leukemic infiltration, 2 (6%) lymphomatous infiltration and 21 (58%) carcinomatous meningitis. The leukemia cases included seven cases of acute lymphoblastic leukemia and six cases of acute myeloid leukemia. Among the carcinomatous meningitis cases, eight were metastasis from carcinoma breast, six from lung carcinoma and one each from malignancies of gallbladder, stomach and retinoblastoma. Four cases were metastatic adenocarcinoma from unknown primary. Pleocytosis was a significant finding seen in 58% cases (n = 21). Elevated protein and hypoglychorrhachia was noted in 68% cases (n = 18). Conclusion: A combined diagnostic approach including biochemical, microbiological and pathological evaluation was useful in eliminating infectious meningitis and confirming neoplastic meningitis in these cases. Cytology should be performed on cerebrospinal specimens from all patients with known or suspected malignancy with meningismus. Detection of malignant cells on cytological examination of CSF is the diagnostic gold standard for neoplastic meningitis.
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Affiliation(s)
- Pooja K Suresh
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Jyoti Ramanath Kini
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Sridevi H Basavaiah
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Hema Kini
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Urmila N Khadilkar
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Shrijeet Chakraborti
- Department of Cellular Pathology, Leighton Hospital, Crewe, Cheshire, United Kingdom
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Rao R, Hoda SA, Marcus A, Hoda RS. Metastatic Breast Carcinoma in Cerebrospinal Fluid: A Cytopathological Review of 15 Cases. Breast J 2017; 23:456-460. [DOI: 10.1111/tbj.12766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rema Rao
- The Papanicolaou Cytology Laboratory, Department of Pathology; New York Presbyterian Hospital-Weill Cornell Medical College; New York City New York
| | - Syed A. Hoda
- The Papanicolaou Cytology Laboratory, Department of Pathology; New York Presbyterian Hospital-Weill Cornell Medical College; New York City New York
| | - Alan Marcus
- The Papanicolaou Cytology Laboratory, Department of Pathology; New York Presbyterian Hospital-Weill Cornell Medical College; New York City New York
| | - Rana S. Hoda
- The Papanicolaou Cytology Laboratory, Department of Pathology; New York Presbyterian Hospital-Weill Cornell Medical College; New York City New York
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Toyoshima M, Tsuji K, Shigeta S, Tokunaga H, Ito K, Watanabe Y, Yoshinaga K, Otsuki T, Niikura H, Yaegashi N. Leptomeningeal metastasis from gynecologic cancers diagnosed by brain MRI. Clin Imaging 2017; 41:42-47. [DOI: 10.1016/j.clinimag.2016.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022]
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Pan Z, Yang G, Wang Y, He H, Pang X, Gao Y, Shi W, Li Y, Dong L, Song Y. Thinprep plus Papanicolaou stain method is more sensitive than cytospin-coupled Wright Giems stain method in cerebrospinal fluid cytology for diagnosis of leptomeningeal metastasis from solid tumors. PLoS One 2015; 10:e0122016. [PMID: 25850010 PMCID: PMC4388538 DOI: 10.1371/journal.pone.0122016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/05/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The present study was designed to determine whether the Thinprep plus Papanicolaou stain (Thinprep) method is more sensitive than the Cytospin-coupled Wright-Giemsa (WG) stain (Cytospin) method in diagnosis of leptomeningeal metastasis (LM) from malignant solid tumors in cerebrospinal fluid (CSF). We also explored if the Thinprep method could be used in the differential diagnosis of the type of primary tumor cells based on the morphology of tumor cells in CSF samples. METHODS The morphological features of tumor cells in fresh CSF samples were analyzed using both methods. The tumor cell detection rates were compared between the two methods. RESULTS Using the Thinprep method, we found that each type of tumor cells in the CSF samples had specific identifiable morphological features linked to their primary cancer origins, such as adenocarcinomas originated from the lungs, breast, and stomach, and lung squamous cell carcinomas, small cell lung cancer, large-cell neuroendocrine lung cancer, hepatocellular carcinoma, and malignant melanoma. In a retrospective study with 88 LM patients, cancer cells were detected in 80 out of the 88 CSF samples. In the comparative study with 45 LM patients, the initial detection rate of the Thinprep method was significantly higher than that of the Cytospin method (73.3% vs. 57.8%, P<0.01). The cell morphology was better preserved and subcellular structures were clearer using the Thinprep method, compared to the Cytospin method. CONCLUSIONS The Thinprep method is more sensitive and suitable for LM diagnosis in CSF in patients with malignant solid tumors than the Cytospin method. The Thinprep method may facilitate primary tumor detection and help design early treatment regimens for LM patients with tumors of unknown primary origin.
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Affiliation(s)
- Zhenyu Pan
- Department of Radiation Oncology, the First Hospital, Jilin University, Changchun, China
| | - Guozi Yang
- Department of Radiation Oncology, the First Hospital, Jilin University, Changchun, China
| | - Yongxiang Wang
- Department of Clinical Laboratory, the First Hospital, Jilin University, Changchun, China
| | - Hua He
- Cancer Center, the First Hospital, Jilin University, Changchun, China
| | - Xiaochuan Pang
- Department of Clinical Laboratory, the First Hospital, Jilin University, Changchun, China
| | - Yan Gao
- Department of Radiation Oncology, the First Hospital, Jilin University, Changchun, China
| | - Weiyan Shi
- Department of Radiation Oncology, the First Hospital, Jilin University, Changchun, China
| | - Yu Li
- Department of Radiation Oncology, the First Hospital, Jilin University, Changchun, China
| | - Lihua Dong
- Department of Radiation Oncology, the First Hospital, Jilin University, Changchun, China
- * E-mail: (LD); (YS)
| | - Yuanyuan Song
- Department of Clinical Laboratory, the First Hospital, Jilin University, Changchun, China
- * E-mail: (LD); (YS)
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Shidham VB, DeMay RM. Thank you CytoJournal reviewers for your 2012 and 2013 services! Cytojournal 2014. [PMCID: PMC4007383 DOI: 10.4103/1742-6413.129186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Vinod B. Shidham
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Detroit, MI 48201, USA
| | - Richard M. DeMay
- Department of Pathology, University of Chicago, Chicago, IL, USA
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