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Updated: Oct 16, 2026
Multiplex Cyclic Fluorescent Immunohistochemistry
Published on: January 26, 2024
Diagnostic value of immunocytochemistry in leptomeningeal tumor dissemination
J E Thomas1, E Falls, M E Velasco
1Department of Pathology, Medical College of Ohio Hospitals, Toledo, OH 43614-2598, USA.
Abstract:
Differentiating chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis can be difficult, particularly when the differentiation is based solely on routine cytologic examination. The diagnosis of cerebrospinal fluid tumor dissemination in at-risk patients requires cytologic examination of cerebrospinal fluid and radiography of the leptomeninges. Routine cytologic examination alone has proven less than desirable, in most instances providing confirmation in as little as 50% of cases in the first lumbar puncture. This percentage increases to 85% to 90% after multiple lumbar punctures. We retrospectively reviewed 2 cases of leptomeningeal dissemination (one gliomatosis, the other carcinomatosis) with initial false-negative test results. However, after further examination of the cerebrospinal fluid by selected battery of immunocytochemical stains, both cases were identified as positive for malignancy (ie, false negatives). Immunocytochemistry can be useful in distinguishing chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis in patients at risk or when abnormal cells are seen on routine cerebrospinal fluid cytologic examination.
Insights
Distinguishing chronic meningitis from leptomeningeal tumor spread is challenging. Immunocytochemistry on cerebrospinal fluid aids in accurate diagnosis, especially when routine cytology is inconclusive.
Area of Science:
- Neurology
- Oncology
- Pathology
Background:
- Differentiating chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis is diagnostically challenging.
- Routine cerebrospinal fluid (CSF) cytology has limitations, with initial lumbar puncture confirming malignancy in only 50% of cases, increasing to 85-90% after multiple punctures.
Observation:
- Initial CSF cytologic examination can yield false-negative results in cases of leptomeningeal dissemination.
- Multiple lumbar punctures increase diagnostic yield but remain suboptimal.
Findings:
- Immunocytochemical stains applied to CSF samples identified malignancy in two cases initially missed by routine cytology.
- This technique proved effective in differentiating neoplastic meningitis from aseptic meningitis.
Implications:
- Immunocytochemistry offers a valuable adjunctive tool for diagnosing leptomeningeal tumor dissemination.
- Enhanced diagnostic accuracy can lead to timely and appropriate patient management.
