Neoplastic Meningitis: A Study from a Tertiary Care Hospital from Coastal India
Pooja K Suresh1, Jyoti Ramanath Kini1, Sridevi H Basavaiah1
1Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, 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.
Insights
Neoplastic meningitis, a serious complication of cancer, was diagnosed in 9% of cerebrospinal fluid (CSF) samples. Cytological examination of CSF is crucial for detecting malignant cells and confirming this diagnosis.
Area of Science:
- Neurology
- Oncology
- Cytopathology
Background:
- Neoplastic involvement of cerebrospinal fluid (CSF) signifies advanced disease (Stage IV).
- Accurate diagnosis of neoplastic meningitis is critical for patient prognosis and management.
Purpose of the Study:
- To analyze the cytological features of neoplastic meningitis.
- To evaluate the diagnostic utility of CSF cytology in a tertiary care setting.
Main Methods:
- Retrospective analysis of 400 consecutive CSF samples.
- Samples underwent microbiological, biochemical, and cytological evaluation.
- Inclusion criteria: presence of malignant cells in CSF smears.
Main Results:
- Neoplastic meningitis detected in 9% (36/400) of cases.
- Carcinomatous meningitis was most common (58%), followed by leukemic (36%) and lymphomatous (6%) infiltration.
- Significant findings included pleocytosis (58%), elevated protein, and hypoglycorrhachia (68%).
Conclusions:
- Combined diagnostic approaches aid in differentiating neoplastic from infectious meningitis.
- CSF cytology is the gold standard for diagnosing neoplastic meningitis.
- Cytological examination of CSF is recommended for all patients with suspected malignancy and meningismus.
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