CSF/brain smear cytology - Rcpa.tv

-foreign material e.g. shunt-parasitic infection-some tumours e.g. lymphoma, Langerhans cell histiocytosisIncrease in macrophage count:-trauma-cerebral infarction-haemorrhage-sarcoidosis-demyelination-Whipple’s disease-vasculitis-treated lymphomaSpecific entities in the CSF:Reaction after subarachnoid haemorrhage:-proliferation of macrophages-phagocytosis of erythrocytes-enzymatic destruction of haemoglobin and ingested RBCs appear as emptycytoplasmic vacuoles in the macrophages-appearance of haemosiderin (after 4 days)-haemosiderin-laden macrophages may persist for more than 6 monthsInfectious conditions:-increased number of inflammatory cells, esp. polymorphs or activated lymphocytes,suggest infections-acute bacterial meningitis: infiltrate composed predominantly of polymorphs-viral meningoencephalitis: predominantly lymphocytic response-look for organisms (quantity, morphology, intra or extracellular)-needs microbiological culture for definitive diagnosisReactive lymphocytosis:-reactive and atypical lymphocytosis may be seen in multiple sclerosis, Guillain-Barrésyndrome, cryptococcal meningitis-activated lymphocytes and monocytes may become larger with multiple nuclei andprominent nucleoli, mimicking malignant cells-a heterogeneous population of lymphocytes may be difficult to appreciate if there arenot that many cells-clues:-heterogeneous population with lymphocytes of varying sizes; majority small andmature-intermixed with monocytes and plasma cells or neutrophils-cells do not have significant nuclear pleomorphism, coarsely clumped chromatin ormacronucleoli-look at the Pap stain (Diff-Quik exaggerates cell size)-immunostaining: most of the lymphocytes are T-cells-repeat sample and send fluid off for flow cytometryCryptococcus: