Qian Xiaohua, Goumnerova Liliana C, De Girolami Umberto, Cibas Edmund S
Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Cancer. 2008 Oct 25;114(5):307-14. doi: 10.1002/cncr.23799.
Ependymoma cells are known to occasionally exfoliate into cerebrospinal fluid (CSF). However, the frequency of CSF involvement in patients with ependymoma is unclear, and to the authors' knowledge the cytomorphologic features of the tumor cells have not been described in detail to date. In this study, the CSF findings in patients with ependymal neoplasms are summarized and the cytomorphologic features of ependymoma, including its variants, are illustrated.
A search of the pathology databases of 2 medical centers was performed to identify all patients with a histologic diagnosis of ependymoma in whom CSF samples were examined. Slides from CSF samples originally reported as atypical, suspicious, or positive were reviewed and the cytomorphologic features assessed. Follow-up included a review of the medical records and histologic correlation.
In all, 177 patients with a diagnosis of ependymoma were identified. Of these, 48 had a total of 94 cytologic preparations of CSF. Positive, suspicious, atypical, negative, and nondiagnostic results were noted in 6.4%, 5.3%, 4.3%, 79.7%, and 4.3%, respectively, of the specimens. The detection rate of tumor cells in CSF was 6.7% in 15 adults and 21.2% in 33 children, with an overall rate of 16.7%. Of the 8 patients with positive and/or suspicious diagnoses, 5 ependymomas exhibited anaplastic features and 1 tumor was a myxopapillary ependymoma. The positive samples were usually hypercellular, with cohesive epithelioid cells; long cytoplasmic processes resembling bipolar tanycytes were observed in the tanycytic variant of ependymoma.
Exfoliated cells from ependymomas are recognizable in CSF samples, especially in patients with myxopapillary tumors and tumors with anaplastic features.
已知室管膜瘤细胞偶尔会脱落至脑脊液（CSF）中。然而，室管膜瘤患者脑脊液受累的频率尚不清楚，据作者所知，肿瘤细胞的细胞形态学特征迄今尚未详细描述。在本研究中，总结了室管膜瘤患者的脑脊液检查结果，并阐述了室管膜瘤及其变异型的细胞形态学特征。
检索2个医学中心的病理数据库，以确定所有经组织学诊断为室管膜瘤且接受脑脊液样本检查的患者。对最初报告为非典型、可疑或阳性的脑脊液样本玻片进行复查，并评估细胞形态学特征。随访包括查阅病历及组织学相关性分析。
共识别出177例诊断为室管膜瘤的患者。其中，48例患者共有94份脑脊液细胞学标本。标本的阳性、可疑、非典型、阴性及无法诊断的结果分别占6.4%、5.3%、4.3%、79.7%和4.3%。成人脑脊液中肿瘤细胞的检出率为6.7%（15例），儿童为21.2%（33例），总体检出率为16.7%。在8例诊断为阳性和/或可疑的患者中，5例室管膜瘤表现为间变特征，1例肿瘤为黏液乳头型室管膜瘤。阳性样本通常细胞增多，细胞呈上皮样且相互黏附；在室管膜瘤的伸长细胞型变异中可观察到类似双极伸长细胞的长细胞质突起。
室管膜瘤脱落的细胞在脑脊液样本中可识别，尤其是在黏液乳头型肿瘤和具有间变特征的肿瘤患者中。
