Cerebrospinal fluid cytology : A Theragnostic and Prognostic tool- Experience from a tertiary cancer care Centre in Central India

• Dr. Shraddha Rajan Mahindra,  
• Dr. Meena Pangarkar,  
• Dr. Kishor Deshpande,  
• Dr . Radhika Pagey,  
• Dr. Shweta Deulkar

Abstract

Background : CSF examination is the gold standard in the diagnosis of leptomeningeal metastases. Malignant cells gain access to the subarachnoid space by hematogenous dissemination, direct extension from a parenchymal brain lesion or by tracking along the spinal or cranial nerves. Despite advances in CNS imaging and biochemical analysis, cytological identification of malignant cells in the CSF remains the decision node for systemic chemotherapy, intrathecal chemotherapy and carries prognostic implications. Material and Methods : A total of 397 patients of both genders and ages ranging from 1-70 years, studied over a period of 2 years. 64 cases: 22 cases of solid tumours and 42 cases of haematological malignancies with CNS involvement were documented. Smears were prepared using the Cytocentrifuge technique and cell blocks were studied wherever possible. Results : On cytological examination, metastatic tumors are much more frequent than primary CNS tumors in the CSF. In the present study lung was the most common primary site, followed by breast, tumours of gastrointestinal & female genital tracts. Amongst the haematological malignancies, patients with Leukemia (most frequently ALL, also AML and JMML) and Lymphoma (DLBCL) presented with CNS involvement. In the paediatric age group, we encountered 2 cases of Retinoblastoma and 1 case each of Atypical Teratoid/Rhabdoid tumour and Medulloblastoma. Conclusion : Cytological examination of CSF is a simple and useful technique which serves as a first-line diagnostic modality in the evaluation of leptomeningeal metastases. It aids in the early detection of secondary CNS involvement, enabling timely intervention, prognostication and predicting the overall survival.

Keywords

Cerebrospinal fluid, leptomeningeal metastases,chemotherapy,cytocentrifuge, cell blocks, prognostication

Ahead of Print Date : 2024-05-28