Institute of Pathology 1st Faculty of Medicine Charles University and Faculty General Hospital Prague Czech Republic.
Laboratory for CSF, Neuroimmunology, Pathology and Special Diagnostics Topelex Ltd Prague Czech Republic.
Brain Behav. 2017 Aug 31;7(10):e00805. doi: 10.1002/brb3.805. eCollection 2017 Oct.
In tumorous impairment of CNS, cytological identification of the neoplastic cells in CSF frequently requires the use of ancillary techniques. Our methods are focused on identifying algorithms that increase the probability of identifying CSF malignant cells.
A total of 1.272 CSF samples from patients with tumorous infiltration of CNS of nonhematologic origin along with 721 samples from patients with hematologic malignancies were analyzed in a complex setting including cytological and immunocytochemical investigations.
In CSF diagnostics we are aware of the limited amount of sample combined frequently with neoplastic oligocytosis. Provided atypical, potentially malignant cells in CSF are found, further investigation(s) should maximize the of their identification-an appropriate cytological staining and immunocytochemical panel is to be applied. (i) In cases of known recent malignancy: immunoprofile of the recent neoplasm has been considered in immunocytochemical panel. (ii) In patients with a history of malignancy: The propensity to develop a new different malignancy must be taken into account. (iii) Atypical cells found in the CSF of a patient with a negative history of malignancy: Considering the most frequent clinically silent malignancies, stepwise immunocytochemistry is employed. Three milliliter of initial CSF sample represents the absolute minimum to start with.
The steps of the laboratory activity targeted on malignancy in the CSF detection can be expected as follows: (i) The sample will be divided for both nonmorphology and cytopathology investigations. (ii) Basic stainings will triage the samples into those with no suspicion of malignancy and the remaining ones. (iii) Special stainings and stepwise immunocytochemistry will be performed in parallel with the nonmorphology investigations.
在中枢神经系统肿瘤病变中，CSF 中的肿瘤细胞的细胞学鉴定通常需要辅助技术。我们的方法侧重于确定可提高鉴定 CSF 恶性细胞概率的算法。
在包括细胞学和免疫细胞化学研究的复杂环境中，分析了总共 1272 例来自非血液系统来源的中枢神经系统肿瘤浸润患者和 721 例血液系统恶性肿瘤患者的 CSF 样本。
在 CSF 诊断中，我们意识到样本量通常有限，并且经常伴有肿瘤细胞数量少。如果在 CSF 中发现异常的、可能恶性的细胞，应进一步进行调查，以最大限度地提高其鉴定率——应应用适当的细胞学染色和免疫细胞化学组合。（i）在已知近期恶性肿瘤的情况下：免疫细胞化学组合中考虑了最近肿瘤的免疫表型。（ii）在有恶性肿瘤病史的患者中：必须考虑发生新的不同恶性肿瘤的倾向。（iii）在无恶性肿瘤病史的患者 CSF 中发现异常细胞：考虑到最常见的临床无症状恶性肿瘤，采用逐步免疫细胞化学法。最初的 3 毫升 CSF 样本是开始的绝对最小值。
针对 CSF 中恶性肿瘤检测的实验室活动步骤可以预期如下：（i）将样本分为非形态学和细胞病理学检查。（ii）基本染色将将样本分为无恶性嫌疑和剩余样本。（iii）特殊染色和逐步免疫细胞化学将与非形态学研究同时进行。
