Departments of1Neurological Surgery and.
3Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
Neurosurg Focus. 2018 Jun;44(6):E8. doi: 10.3171/2017.8.FOCUS17403.
Metastatic glioblastoma is a rare condition, and several studies have reported the involvement of multiple organs including the lymph nodes, liver, and lung. The lung and pleura are reportedly the most frequent sites of metastasis, and diagnosis using less invasive tools such as cytological analysis with fine needle aspiration biopsy is challenging. Cytological analysis of fluid specimens tends to be negative because of the small number of cells obtained, whereas the cell block technique reportedly has higher sensitivity because of a decrease in cellular dispersion. Herein, the authors describe a patient with a history of diffuse astrocytoma who developed intractable, progressive accumulation of pleural fluid. Initial cytological analysis of the pleural effusion obtained by thoracocentesis was negative, but reanalysis using the cell block technique revealed the presence of glioblastoma cells. This is the first report to suggest the effectiveness of the cell block technique in the diagnosis of extracranial glioblastoma using pleural effusion. In patients with a history of glioma, the presence of extremely intractable pleural effusion warrants cytological analysis of the fluid using this technique in order to initiate appropriate chemotherapy.
转移性神经胶质瘤较为罕见，有几项研究报告称其涉及多个器官，包括淋巴结、肝脏和肺部。据报道，肺部和胸膜是最常见的转移部位，使用细胞穿刺活检等微创工具进行诊断具有挑战性。由于获得的细胞数量较少，液体标本的细胞学分析往往呈阴性，而细胞块技术据称由于细胞分散减少，具有更高的敏感性。在此，作者描述了一名患有弥漫性星形细胞瘤的患者，该患者出现难治性、进行性胸腔积液积聚。经胸腔穿刺获得的胸腔积液的初始细胞学分析为阴性，但使用细胞块技术重新分析显示存在神经胶质瘤细胞。这是首例报告提示细胞块技术在使用胸腔积液诊断颅外神经胶质瘤方面的有效性。对于有神经胶质瘤病史的患者，胸腔积液极其难治时，需要使用该技术对液体进行细胞学分析，以便启动适当的化疗。
