Cytological Examination Of Cerebrospinal Fluid Research Articles

Myelitis associated with COVID-19: clinical, radiological, and laboratory characteristics

Aim: The current study aimed to describe various types of myelitis associated with a novel coronavirus infection [coronavirus disease 2019 (COVID-19)] as well as to analyze cytokine profiles and cerebrospinal fluid (CSF) parameters in affected patients and to compare them to patients with other immune-mediated disorders—multiple sclerosis (MS), in order to identify possible common pathogenetic pathways and consequently treatment targets. Methods: Clinical, radiological, and laboratory characteristics were studied based on patients’ history. CSF from patients with myelitis associated with COVID-19 (11 patients) was compared with CSF of healthy controls (HC) (7 patients) and patients with MS (37 patients) from the non-COVID era. CSF cytological examination, protein levels and oligoclonal bands (OCBs) evaluation, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus detection and cytokine profiling using Bio-Plex Pro Human Inflammation Panel 1, 37-Plex were performed. Results: In total 11 patients with different types of myelitis developed up to 3 months after COVID-19 were enrolled in the study. Radiological findings were diverse: short transverse myelitis (lesion of fewer than 3 segments) (n = 6), longitudinal extensive transverse myelitis (LETM) (n = 2), multifocal spinal cord lesions (n = 1), and myelitis involving dorsal and lateral columns (n = 2). The most pronounced response to treatment was observed in patients with partial transverse myelitis and patients with anti-myelin oligodendrocyte glycoprotein (MOG) antibodies (MOG Abs). Multiple comparisons have demonstrated decreased levels of interleukin-10 (IL-10), interferon-α2 (IFN-α2), IFN-β, and thymic stromal lymphopoietin (TSLP), and increased IL-19 and B cell activating factor (BAFF) in patients with COVID-19 myelitis (CM) compared to the MS group. The highest BAFF and a proliferation-inducing ligand (APRIL) concentrations were found in patients with the most profound neurological disability. Conclusions: Myelitis associated with COVID-19 is clinically and radiologically heterogeneous. Evaluation of cytokine profiles in patients with myelitis associated with COVID-19 revealed their relative similarity with ones of MS patients, except for a few cytokines. BAFF/APRIL system as well as IL-10 is well-known for the role in the development and progression of autoimmune diseases, however, their links with COVID-19 and effects on the development of immune-mediated central nervous system (CNS) disorders after SARS-CoV-2 remain to be further studied.

Cryptococcal Meningitis in an Apparently Immunocompetent Individual: A Case Report

Cryptococcus neoformans, a saprophyte, is commonly found in soil contaminated with pigeon droppings but has also been isolated from the wood of several tree species in South America and India, including the flowers and bark of eucalyptus trees. Inhalation of small, encapsulated yeasts may lead to an initial pulmonary infection. However, this is usually short-lived and frequently silent, especially in immunocompetent individuals. Immunocompromised patients are usually tested for Cryptococcus as a causative agent when presenting with features of meningitis, but when dealing with immunocompetent patients, it is seldom considered. This report presented a case of a 39-year-old male who was apparently immunocompetent, yet developed cryptococcal meningitis. He had no prior history of any chronic illness, malignancy, immunosuppressive medication, or steroid use. Routine blood investigations were within normal limits. Autoimmune workup and viral markers were negative. He had raised Intracranial Pressure (ICP), Cerebrospinal Fluid (CSF) leukocytosis, and encapsulated yeast forms consistent with cryptococcal meningitis initially demonstrated by CSF cytology examination with Papanicolaou stain and May-Grunwald-Giemsa, and further confirmed by special stains. This case highlights the role of initial cytological workup in detecting cryptococcal infection through morphological and special stain studies in an immunocompetent host.

Patient with AIP gene mutation presenting with pituitary adenomatosis

Abstract Introduction/Objective Familial isolated pituitary adenoma (FIAP) is frequently associated with germline mutation in the AIP gene. Clinically, it is characterized by the occurrence of isolated pituitary adenoma in 2 or more members of a family. In this case report, we describe a patient who presented with a pituitary adenoma and concurrent disseminated leptomeningeal adenomatosis. Methods/Case Report A 17-year-old female presented with amenorrhea and visual impairment. Brain MRI showed a 2.6 x 2.8 x 2.4 cm mass in the sella turcica extending to the suprasellar region. Multiple separate smaller (5-7 mm) masses in the leptomeninges of the anterior and middle cranial fossa, and small enhancing masses within the internal auditory canals bilaterally were also seen. She underwent craniotomy for resection of the pituitary tumor which was diagnosed pathologically as sparsely granulated somatotroph adenoma with co-expression of human growth hormone and prolactin. Postoperatively, she was found to have persistent hormone imbalance for which she received proton beam therapy. Genetic testing revealed mutations in the AIP gene. No mutations were detected in NF2, MEN1, and CDKN1B. At age 21, radiologic follow-up revealed recurrent pituitary adenoma, for which she underwent trans- sphenoidal resection, revealing the same histopathologic diagnosis. At age 22, MRI showed diffuse nodular enhancement throughout the subarachnoid spaces, most pronounced within the Sylvian fissures. Cytologic examination of cerebrospinal fluid (CSF) showed several loose aggregates of neuroendocrine cells, positive for synaptophysin by immunocytochemistry, consistent with the diagnosis with dissemination of pituitary adenoma cells in the leptomeninges. Results (if a Case Study enter NA) N/A Conclusion In all 136 previously reported cases, leptomeningeal dissemination of pituitary adenoma has been exclusively described in post-surgical settings or after pituitary apoplexy. To our knowledge, this is the first case of disseminated pituitary adenomatosis noted at initial clinical presentation

Myelomatous meningitis diagnosed by cerebrospinal fluid cytology examination.

Myelomatous meningitis diagnosed by CSF cytology. The combined use of cytology with immunocytochemistry can identify the presence of multiple myeloma cells in cerebrospinal fluid specimens.

Reliable Cerebrospinal Fluid Cytology and Immunocytochemistry Reporting over an Extended Period by the Addition of Aldehyde and Osmolyte-Based Preservative Solution

Introduction: The cytological examination of cerebrospinal fluid (CSF) is an important investigation in the workup of various inflammatory, malignant, or traumatic disorders of the central nervous system. The cells in the CSF lyse and degenerate at a very fast rate owing to its low tonicity, buffering capacity, redox potential, and pH, making it crucial to examine it within 2 h of sampling. We have hereby designed an aliphatic aldehyde, osmolyte, metal halide, and a buffer-based solution which will preserve the cellular components of CSF for 48 h. Methods: Thirty-nine CSF specimens were examined within 2 h of collection, and this reading was recorded as time zero reading. The CSF specimens were then divided into two tubes with (i) pre‐servative:CSF ratio of 1:5; and (ii) no preservative. Total and differential leukocyte counts and immunocytochemistry were performed on the paired specimens at 24 h and 48 h and were compared with the readings at zero hours. Results: The preservative-containing CSF showed significantly higher cellularity than the undiluted samples at 24 h and 48 h (p < 0.001). Median cell counts observed in the preservative-containing CSF were 5 times and 12 times higher than in the undiluted CSF. Neutrophils, lymphocytes, and RBCs showed immunopositivity for MPO, CD45, and GLUT-1 at both time intervals. Conclusion: Adding the prepared preservative solution to CSF in the ratio of 1:5 can optimally preserve the CSF cells for absolute and differential quantitation, morphological assessment, and immunological testing at a later date.

Leptomeningeal metastasis in primary uterine cervical cancer: a rare case and review of the literature

Objectives. Leptomeningeal metastasis (LM) of primary uterine cervical cancer is rare and treatment options are limited. In this case report and literature review, we aimed to present a patient with cervical cancer with LM and discuss previously reported cases in the literature. Case presentation. Our case was a 58-year-old patient who was initially diagnosed with metastatic primary uterine cervical cancer and treated with chemotherapy and chemoradiotherapy. During follow-up, she developed neurological symptoms, and LM was detected in the craniospinal regions. Cerebrospinal fluid cytology examination has confirmed metastatic disease. The patient was treated with concurrent intrathecal methotrexate and whole-brain radiotherapy (WBRT). A good clinical and cytological response was obtained. However, while intrathecal methotrexate was being continued after WBRT, she succumbed to hematological toxicity before the radiological response could be evaluated. Conclusions. LM is an extremely rare and catastrophic distant spread pattern in patients with cervical cancer. In the literature, a total of 26 patients were reported up to date. Median survival after detection of LM was nine weeks, including our case. Multimodal treatment combinations such as systemic and intrathecal chemotherapy and radiotherapy (RT) were used. However, most of these reports did not have detailed information about toxicity. Despite the combined use of aggressive treatment modalities, patients have limited survival and very high risks of hematologic toxicity. Concurrent use of intrathecal chemotherapy and radiotherapy should be avoided due to increased risk of morbidity.

Cryptococcal meningoencephalitis with Actinomyces odontolyticus sepsis: a case report and literature review

BackgroundThe combined infection of actinomyces odontolyticus sepsis and cryptococcal encephalitis is rare in routine clinical practice. Thus, we presented this case report and literature review to provide clues to improve such patients' diagnoses and treatment processes.Case presentationThe main clinical manifestations of the patient were high fever and intracranial hypertension. Then, we completed the routine cerebrospinal fluid examination, biochemical detection, cytological examination, bacterial culture, and India ink staining. Firstly, the blood culture suggested actinomyces odontolyticus infection, considering the possibility of actinomyces odontolyticus sepsis and intracranial actinomyces odontolyticus infection. Accordingly, the patient was administered penicillin for treatment. Although the fever was slightly relieved, the symptoms of intracranial hypertension did not relieve. After 7 days, the characteristics of brain magnetic resonance imaging and the results of pathogenic metagenomics sequencing and cryptococcal capsular polysaccharide antigen suggested that cryptococcal infection. Based on the above results, the patient was diagnosed with a combined infection of cryptococcal meningoencephalitis and actinomyces odontolyticus sepsis. Anti-infection therapy with ‘penicillin, amphotericin, and fluconazole’ was provided, improving the clinical manifestations and objective indexes.ConclusionThe combined infection of Actinomyces odontolyticus sepsis and cryptococcal encephalitis is first reported in this case report, and combined antibiotics with ‘penicillin, amphotericin, and fluconazole’ are effective.

High-throughput sequencing unravels the cell heterogeneity of cerebrospinal fluid in the bacterial meningitis of children

Bacterial meningitis (BM) is a common life-threatening infection in children that occurs in the central nervous system (CNS). The cytologic examination of cerebrospinal fluid (CSF) is a key parameter in the diagnosis of BM, but the heterogeneity of cells in the CSF has not been elucidated, which limits the current understanding of BM neuroinflammation. In this study, CSF samples were collected from a number of BM patients who were in different stages of disease progression. Single-cell RNA-sequencing (scRNA-seq), with additional bulk transcriptome sequencing, was conducted to decipher the characteristics of CSF cells in BM progression. A total of 18 immune cell clusters in CSF were identified, including two neutrophils, two monocytes, one macrophage, four myeloid dendritic cells, five T cells, one natural killer cell, one B cell, one plasmacytoid dendritic cell, and one plasma cell subtype. Their population profiles and dynamics in the initial onset, remission, and recovery stages during BM progression were also characterized, which showed decreased proportions of myeloid cells and increased proportions of lymphoid cells with disease progression. One novel neutrophil subtype, FFAR2+TNFAIP6+ neutrophils, and one novel monocyte subtype, THBS1+IL1B+ monocytes, were discovered, and their quantity changes positively correlated with the intensity of the inflammatory response in the CSF during BM. In addition, the CSF of BM patients with unsatisfactory therapeutic responses presented with different cell heterogeneity compared to the CSF of BM patients with satisfactory therapeutic responses, and their CSF featured altered intercellular communications and increased proportions of type II myeloid dendritic cells and plasmacytoid dendritic cells. Moreover, the bulk transcriptome profiles of autologous CSF cells and peripheral blood leukocytes of BM patients showed that the immune cells in these two physiological compartments exhibited distinct immune responses under different onset conditions. In particular, the CSF cells showed a high expression of macrophage characteristic genes and a low expression of platelet characteristic genes compared with peripheral blood leukocytes. Our study conducted an in-depth exploration of the characteristics of CSF cells in BM progression, which provided novel insights into immune cell engagement in acute CNS infection.

Prognostic significance of CNSL at diagnosis of childhood B-cell acute lymphoblastic leukemia: A report from the South China Children's Leukemia Group.

ObjectivesThe prognostic significance of acute lymphoblastic leukemia (ALL) patients with central nervous system leukemia (CNSL) at diagnosis is controversial. We aimed to determine the impact of CNSL at diagnosis on the clinical outcomes of childhood B-cell ALL in the South China Children’s Leukemia Group (SCCLG).MethodsA total of 1,872 childhood patients were recruited for the study between October 2016 and July 2021. The diagnosis of CNSL depends on primary cytological examination of cerebrospinal fluid, clinical manifestations, and imaging manifestations. Patients with CNSL at diagnosis received two additional courses of intrathecal triple injections during induction.ResultsThe frequency of CNLS at the diagnosis of B-cell ALL was 3.6%. Patients with CNSL at diagnosis had a significantly higher mean presenting leukocyte count (P = 0.002) and poorer treatment response (P <0.05) compared with non-CNSL patients. Moreover, CNSL status was associated with worse 3-year event-free survival (P = 0.030) and a higher risk of 3-year cumulative incidence of relapse (P = 0.008), while no impact was observed on 3-year overall survival (P = 0.837). Multivariate analysis revealed that CNSL status at diagnosis was an independent predictor with a higher cumulative incidence of relapse (hazard ratio = 2.809, P = 0.016).ConclusionCNSL status remains an adverse prognostic factor in childhood B-cell ALL, indicating that additional augmentation of CNS-directed therapy is warranted for patients with CNSL at diagnosis.

Clinical and paraclinical approach to patients with steroid-responsive meningitis-arteritis (SRMA)

Steroid-responsive meningitis-arteritis (SRM) is an inflammatory disease of the central nervous system, commonly seen in medium and large canine juveniles under two years of age. The examination of cerebrospinal fluid is the most reliable diagnostic method for diagnosing inflammatory diseases of the central nervous system (CNS). Six patients with a clinical presentation of hyperthermia and hyperalgesia on paraspinal palpation of the cervical segment were included in this study. Paraclinical examinations included serum C-reactive protein (CRP) determination, cytological examination of cerebrospinal fluid and determination of total CSF proteins. For 33.33% of the patients, the neurological examination revealed proprioception and/‌or locomotion deficits. The evolution of patients with MASR was acute, progressive, and after the initiation of medication, 100% complete remission was achieved.

Recommendations for Cerebrospinal Fluid Cytology. A Review Article

The description of cytological findings in cerebrospinal fluid (CSF) is very inconsistent in the literature since no generally recognized uniform classification of these findings has been proposed to date. The need for developing such a classification system becomes quite obvious against the background of renaissance CSF cytology is currently experiencing in our country. A precondition sine qua non for developing a uniform classification system is its general applicability and recognition as well as a capacity to establish, using precisely formulated conclusions, the aetiological diagnosis, something quite impossible with today's terminology. Our draft classification is that used by a team of physicians working previously in the CSF Laboratory of the Department of Neurology of Charles University School of Medicine I in Prague. The classification employed there is based on monitoring pathology in the cytological picture both according to the presence of the prevailing cellular population in CSF and to the presence of activation in elements of lymphocyte and monocyte lines. We were able to combine both criteria into a single viable system expressing the current status of cellular response in CSF. The presence of a pathological cytological finding provides the basis for defining individual cytological CSF syndromes closely related to the etiological diagnosis of the patient, which in the great majority of cases make it possible to formulate the diagnostic conclusion. The classification employed allows to establish the diagnosis in diseases manifesting themselves by at least a mild alteration of the cytological picture. In general, it is useful for classifying inflammatory, neoplastic diseases, inter-meningeal haemorrhage and morphological manifestations of CNS tissue destruction. A distinct advantage is the plausible classification of cytological findings in oligo-cellular CSF specimens which to date has been difficult to make due to the low numbers of cellular elements detected in samples. In cytological examination of CSF, the parameters evaluated include, in addition to the number of elements, qualitative representation of individual cellular lines. (1-Monografie). When evaluating the monocyte-macrophage system and/or the reticuloendothelial system, attention is focused on the proportions of activated monocytes and, particularly, on the presence of macrophages showing a specific substrate of phagocytosis. It is according to this substrate that macrophages are further divided into erythron-phages, sidero-phages, lipo-phages, lympho-phages, leuko-phages or myco-phages, etc. To visualize a substrate, it is often necessary to use additional staining e.g., staining by Oil Red for lipids, Berlin Blue for iron, etc. If inter-meningeal haemorrhage is suspected, monitoring of the phagocytosis of red blood cells and haematogenic pigments allows us to determine the approximate age and course of the bleeding. Monitoring of lipo-phagocytosis visualizing the scavenging response on CNS parenchymal damage also has a number of potential applications. As the number of CSF examinations increases, proportionately increasing numbers of cells are being detected. This is true especially of diseases involving the presence of primary or secondary neoplastic processes right in the CNS or in the vicinity of CSF pathways. The currently employed cytological methods of CSF examination, whenever malignant elements were detected, have made it possible to establish the presence of a tumor disease in general only. For instance, monitoring of the functional status of nucleoli, PAS positivity, or the presence of adipose droplets in the cytoplasm suggest only indirectly an increased metabolic activity of the cells monitored. Other morphological markers of atypical cells (polymorphism of cells, nuclei, polynuclear elements, cytoplasm basophilia, atypical mitoses, etc.,) may only raise suspicion of the presence of a tumorous process, but not identify the cellular system the belong to. Another problem which by no means is negligible is the low number of cells detected. As a result, we started to study the mode of reaction of atypical elements with certain monoclonal antibody binding to individual antigens, tumor markers specific for the respective cellular populations. Moreover, the method can be used to determine the degree of their maturity, presence of individual receptors, state of activation in the course of their cellular cycle.

Estimation of cerebrospinal fluid lactate level to differentiate between pyogenic and non-pyogenic meningitis: a prospective analytical study

Background: Meningitis is one of the common causes of serious morbidity and mortality and is one of the common causes of intensive care unit (ICU) admissions. The meningitis can be broadly divided into bacterial, viral or fungal meningitis. It is important to differentiate between pyogenic and non-pyogenic meningitis because of obvious management implications. Cerebrospinal fluid (CSF) lactate levels can be used for differentiating pyogenic and non-pyogenic (viral/tubercular) meningitis.Methods: This was a prospective analytical study in which cases diagnosed to be having meningitis were included on the basis of a predefined inclusion and exclusion criteria. Demographic details such as age, gender and socioeconomic status was note in all the cases. A detailed clinical history was taken and a through clinical examination was done. Imaging (computerized tomography) was done in selected cases. CSF cytology, biochemistry and culture sensitivity were done in all cases. CSF lactate was determined in all cases.Results: The CSF cytological examination showed that the mean total cell count was more (643.23±102.02) in pyogenic meningitis as compared to non-pyogenic (viral/tubercular) meningitis (121.76±59.74) and the difference was found to be statistically highly significant (p&lt;0.0001). The analysis of CSF lactate levels showed that pyogenic meningitis cases had a significantly high level of CSF lactate as compared to non-pyogenic meningitis cases and the difference was found to be statistically highly significant (p&lt;0.0001).Conclusions: CSF lactate level is a good indicator in differentiating pyogenic and non-pyogenic meningitis.

Evaluating the cerebrospinal fluid ctDNA detection by next-generation sequencing in the diagnosis of meningeal Carcinomatosis

BackgroundMeningeal carcinomatosis (MC) is the most severe form of brain metastasis and causes significant morbidity and mortality. Currently, the diagnosis of MC is routinely confirmed on the basis of clinical manifestation, positive cerebrospinal fluid (CSF) cytology, and/or neuroimaging features. However, negative rate of CSF cytology and neuroimaging findings often result in a failure to diagnose MC from the patients who actually have the disease. Here we evaluate the CSF circulating tumor DNA (ctDNA) in the diagnosis of MC.MethodsA total of 35 CSF samples were collected from 35 patients with MC for CSF cytology examination, CSF ctDNA extraction and cancer-associated gene mutations detection by next-generation sequencing (NGS) at the same time.ResultsThe most frequent primary tumor in this study was lung cancer (26/35, 74%), followed by gastric cancer (2/35, 6%), breast cancer (2/35, 6%), prostatic cancer (1/35, 3%), parotid gland carcinoma (1/35, 3%) and lymphoma (1/35, 3%) while no primary tumor could be found in the remaining 2 patients in spite of using various inspection methods. Twenty-five CSF samples (25/35; 71%) were found neoplastic cells in CSF cytology examination while all of the 35 CSF samples (35/35; 100%) were revealed having detectable ctDNA in which cancer-associated gene mutations were detected. All of 35 patients with MC in the study underwent contrast-enhanced brain MRI and/or CT and 22 neuroimaging features (22/35; 63%) were consistent with MC. The sensitivity of the neuroimaging was 88% (95% confidence intervals [95% CI], 75 to 100) (p = 22/25) and 63% (95% CI, 47 to 79) (p = 22/35) compared to those of CSF cytology and CSF ctDNA, respectively. The sensitivity of the CSF cytology was 71% (95% CI, 56 to 86) (n = 25/35) compared to that of CSF ctDNA.ConclusionsThis study suggests a higher sensitivity of CSF ctDNA than those of CSF cytology and neuroimaging findings. We find cancer-associated gene mutations in ctDNA from CSF of patients with MC at 100% of our cohort, and utilizing CSF ctDNA as liquid biopsy technology based on the detection of cancer-associated gene mutations may give additional information to diagnose MC with negative CSF cytology and/or negative neuroimaging findings.

Leptomeningeal Metastasis: The Role of Cerebrospinal Fluid Diagnostics.

Background: Metastatic spread into the cerebrospinal fluid (CSF) represents a severe complication of malignant disease with poor prognosis. Although early diagnosis is crucial, broad spectrums of clinical manifestations, and pitfalls of magnetic resonance imaging (MRI) and CSF diagnostics can be challenging. Data are limited how CSF parameters and MRI findings relate to each other in patients with leptomeningeal metastasis.Methods: Patients with malignant cells in CSF cytology examination diagnosed between 1998 and 2016 at the Department of Neurology in the Hannover Medical School were included in this study. Clinical records, MRI findings and CSF parameters were retrospectively analyzed.Results: One hundred thirteen patients with leptomeningeal metastasis were identified. Seventy-six patients (67%) suffered from a solid malignancy while a hematological malignancy was found in 37 patients (33%). Cerebral signs and symptoms were most frequently found (78% in solid vs. 49% in hematological malignancies) followed by cranial nerve impairment (26% in solid vs. 46% in hematological malignancies) and spinal symptoms (26% in solid vs. 27% in hematological malignancies). In patients with malignant cells in CSF MRI detected signs of leptomeningeal metastasis in 62% of patients with solid and in only 33% of patients with hematological malignancies. Investigations of standard CSF parameters revealed a normal CSF cell count in 21% of patients with solid malignancies and in 8% of patients with hematological malignancies. Blood-CSF-barrier dysfunction was found in most patients (80% in solid vs. 92% in hematological malignancies). Elevated CSF lactate levels occurred in 68% of patients in solid and in 48% of patients with hematological malignancies. A high number of patients (30% in solid vs. 26% in hematological malignancies) exhibited oligoclonal bands in CSF. Significant correlations between the presence of leptomeningeal enhancement demonstrated by MRI and CSF parameters (cell count, lactate levels, and CSF/Serum albumin quotient) were not found in both malignancy groups.Conclusion: CSF examination is helpful to detect leptomeningeal metastasis since the diagnosis can be challenging especially when MRI is negative. CSF cytological investigation is mandatory whenever leptomeningeal metastasis is suspected, even when CSF cell count is normal.

Clinical Features of Diffuse Leptomeningeal Glioneuronal Tumor with Rapid Blindness Misdiagnosed as NMOSD and Literature Review

Diffuse leptomeningeal glioneuronal tumor has various clinical manifestations and is easily misdiagnosed. This article aims to describe the clinical features of a patient with diffuse leptomeningeal glioneuronal tumor misdiagnosed as optic neuromyelitis lineage disease (NMOSD), analyze the causes of misdiagnosis, and identify the disease with similar clinical manifestations. Adolescent women with decreased vision and headache, nausea, and vomiting were initially diagnosed as NMOSD. Immunotherapy was ineffective; enhanced MRI and cerebrospinal fluid cytology examination were completed and compared with classic meningeal carcinoma, NMOSD, multiple sclerosis, and Vogt-Koyanagi-Harada (VKH) syndrome. Diffuse leptomeningeal glioneuronal tumor was finally diagnosed in adolescent women with no history of tumor. Compared with NMOSD: no history of infection, no AQP4, MOG antibody, no spinal segmental abnormalities, immunotherapy was ineffective; compared with multiple sclerosis: no history of infection, no plaque, no oligoclonal antibody, immunotherapy was ineffective; compared with VKH syndrome: no history of infection, no fever, no treatment for immunotherapy; and compared with classic meningeal carcinoma: adolescents, no extracranial tumor lesions, super high protein, more different sugar excess. Patients with acute visual impairment should consider not only NMOSD, but also diffuse leptomeningeal glioneuronal tumor (DLGNT) and other diseases. DLGNT could not be excluded when CSF cytology and MRI plain scan were negative. The positive rate of malignant cells can only be increased by repeatedly sending fresh cerebrospinal fluid for examination; DLGNT needs to be differentiated from NMOSD, multiple sclerosis, VKH syndrome, and other diseases. Early diagnosis and molecular targeted therapy can improve the quality of life and prolong life.

Guillain-Barr\xe9 syndrome following bacterial meningitis: a case report and literature review

BackgroundWe reported a case of an adult that presented Guillain-Barré syndrome (GBS) after bacterial meningitis which was secondary to chronic suppurative otitis media (CSOM). To our knowledge, this is the first case involving an adult presenting with GBS following bacterial meningitis.Case presentationA 46-year man with type 2 diabetes and otitis media (OM) suffered with fever, headache, and vomiting for 6 days. The patient’s neck stiffness was obvious and the Kernig and Brudzinski signs were produced. The result of cerebrospinal fluid (CSF) analysis and cytological examination of the CSF supported the diagnose of bacterial meningitis. On day 17 the patient felt numbness in both hands and feet, which gradually progressed to weakness of the limbs. Bladder dysfunction occurred, which required catheterization. The patient showed a tetraparesis with emphasis on the legs. The deep tendon reflexes of limbs were absent. The patient had peripheral hypalgesia and deep sensory dysfunction. The symptoms were possibly a result of GBS. Nerve conduction study showed that the F wave latency of the upper and lower limbs was prolonged, particularly the lower limbs. 8 days later the repeated nerve conduction study showed a low compound muscle action potential (3.3 mV) with a normal distal motor latency (14.2 ms) and a low motor nerve conduction velocity (34.3 m/s) in the tibial nerve. The patient still required assistance when walking 3 months after onset.ConclusionsGBS following bacterial meningitis is rare and limbs weakness in patients with bacterial meningitis was usually considered because of weakness. This case should serve as a reminder for clinical doctors that when a patient with bacterial meningitis complains about limbs numbness or weakness, GBS should be considered, especially when the patient had diabetes mellitus (DM) history.

Novel methods to diagnose leptomeningeal metastases in breast cancer.

Leptomeningeal metastases (LM) in breast cancer patients are rare but often accompanied by devastating neurological symptoms and carry a very poor prognosis, even if treated. To date, two diagnostic methods are clinically used to diagnose LM: gadolinium MRI of the brain and/or spinal cord and cytological examination of cerebrospinal fluid (CSF). Both techniques are, however, hampered by limited sensitivities, often leading to a long diagnostic process requiring repeated lumbar punctures and MRI examinations. To improve the detection rate of LM, numerous studies have assessed new techniques. In this review, we present the current workup to diagnose LM, set out an overview of novel techniques to diagnose LM, and give recommendations for future research.

Neoplastic Meningitis: A Study from a Tertiary Care Hospital from Coastal India.

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.

The clinical application of cerebrospinal fluid cytological examination

Cerebrospinal fluid contains various types of cells, and in disease state, the appearance, disappearance and quantity of these cells will change significantly, the cell composition and morphology characteristic of cerebrospinal fluid have great clinical relevance. morphological observation and classification of cerebrospinal fluid provide accurate diagnosis, differential diagnosis, clinical observation and prognosis evaluation. for Central Nervous System(CNS) diseases, Especially for CNS infection and metastasis diseases, it is almost impossible to diagnose without reference to cerebrospinal fluid cytology. Therefore, cerebrospinal fluid cytology is simple, fast and effective, and its uniqueness, accuracy and determination cannot be replaced by simple cell classification.(Chin J Lab Med, 2017, 40: 916-919) Key words: Cerebrospinal fluid; Cytodiagnosis; Central nervous system diseases

A Rare Case of Lymphomatoid Granulomatosis With Multisystemic Involvement

SESSION TITLE: Pulmonary Manifestations of Systemic Disease 1 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Lymphomatoid granulomatosis (LYG) is a rare Epstein-Barr virus (EBV)-driven lymphoproliferative disease. Clinical manifestations often mimic infectious diseases, malignancy and vasculitis, frequently leading to diagnostic delays. CASE PRESENTATION: A 53-year-old Chinese man with recurrent perianal abscesses, was found to have bilateral nodular opacities on a pre-operative chest radiograph (Figure 1A). Shortly after, he developed an acute onset of diplopia. On examination, bilateral cranial nerve 6, and left cranial nerve 7 and 8 palsies were noted. His medical history was notable for polymyositis treated with mycophenolate mofetil and prednisolone for the past 4 years. Imaging of the thorax was consistent with bilateral pulmonary nodules of varying sizes, and several demonstrated cavitation (Figure 1). Magnetic resonance imaging of the brain detected T2/FLAIR hyper intense signals in the left cerebellar superior sulci, left hemi pons and right 6th cranial nerve (Figure 1). Lumbar puncture was performed, and cerebrospinal fluid cytological examination yielded atypical CD20+ B cells. Transbronchial lung biopsy revealed florid fibrinohemorrhagic exudates and polymorphous infiltrates consisting of numerous B lymphocytes, some T lymphocytes, histiocytes and scattered atypical large lymphoid cells, focally involving vessel walls. EBV by in situ hybridization showed diffuse positive reaction (Figure 2). Histology of the recurring perianal abscess reported at another institution was reviewed at our hospital, demonstrating involvement by LYG. Fungal and acid fast bacilli stains were negative. A diagnosis of LYG, grade 3 was made. DISCUSSION: LYG is a rare EBV-associated lymphoproliferative disorder. The lungs are almost invariably affected, presenting classically as bilateral pulmonary nodules1. Central nervous system (CNS) involvement occurs in one-third of patients, and portends a poor prognosis1. Our patient presented with synchronous pulmonary, CNS and perianal skin/soft tissue involvement, which is uncommon in LYG. Reported associations of LYG are immune-related (autoimmune conditions, immunodeficiency states e.g. common variable immunodeficiency)1, and it is postulated that immune dysregulation may result in inadequate control of EBV infected B-cells. Our patient was immunosuppressed with mycophenolate mofetil, which may have contributed to the development of LYG. Management involves a consideration for stopping immunosuppression if possible, and chemotherapy which should be started immediately in high grade disease or CNS involvement. CONCLUSIONS: We describe a rare case of multi-systemic LYG with bilateral cavitary nodules, cranial nerve palsies, and recurring perianal abscess. Differential diagnoses for multiple pulmonary nodules are extensive. However, the possibility of LYG should be suspected, especially in immunosuppressed patients. Reference #1: Roschewski M, Wilson WH. Lymphomatoid granulomatosis. Cancer J. 2012; 18(5):469-74. DISCLOSURE: The following authors have nothing to disclose: Ken Junyang Goh, Angela Takano, Pei Yee Tiew, Ming Hui Yong, Chee Kiang Tay No Product/Research Disclosure Information