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Cerebral spinal fluid involvement by Hodgkin's disease diagnosed by CSF cytology and immunocytochemistry
L A Perez-Jaffe1, K E Salhany, R J Green
1Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA.
Insights
Cytologic examination of cerebrospinal fluid (CSF) detected central nervous system (CNS) involvement by Hodgkin's disease (HD) before imaging revealed lesions. This early detection facilitated timely treatment, leading to negative CSF cytology post-therapy.
Area of Science:
- Hematology
- Neurology
- Oncology
Background:
- Disseminated Hodgkin's disease (HD) poses challenges in detecting central nervous system (CNS) involvement.
- Autologous bone marrow transplantation is a treatment option for advanced HD.
- Diplopia in a patient with stage IV HD prompted investigation for CNS involvement.
Observation:
- Cerebrospinal fluid (CSF) cytology revealed Reed-Sternberg (RS) cells, indicative of HD.
- Magnetic resonance imaging (MRI) of the brain and spinal cord did not show leptomeningeal disease or intracranial masses.
- Immunocytochemical stains confirmed the RS cells' phenotype matched the bone marrow biopsy, verifying HD in the CSF.
Findings:
- Cytologic examination of CSF enabled early detection of CNS involvement by HD.
- The patient received intrathecal methotrexate post-bone marrow transplant.
- Subsequent CSF cytology specimens were negative for tumor after treatment.
Implications:
- CSF cytology is a valuable tool for early diagnosis of CNS involvement in HD.
- Early detection of CNS HD can guide timely therapeutic interventions.
- This case highlights the utility of CSF cytology in managing disseminated HD with potential CNS spread.
Abstract:
A 39-yr-old man with stage IV Hodgkin's disease (HD) involving bone marrow was being evaluated for autologous bone marrow transplantation when he developed diplopia, prompting a lumbar puncture tap for cerebral spinal fluid (CSF) examination. Cytologic examination of the CSF revealed numerous Reed-Sternberg (RS) cells in a polymorphous inflammatory background of small lymphocytes, monocytes, rare plasma cells, and eosinophils. However, magnetic resonance imaging (MRI) studies of the brain and spinal cord failed to reveal evidence of leptomeningeal disease or intracranial masses. Repeat CSF examination again demonstrated cytologic evidence of HD. Immunocytochemical stains established that the RS cells and mononuclear Hodgkin's cells were positive for CD30 and CD20 but negative for CD15; this phenotype was identical to that of RS cells in the initial diagnostic bone marrow biopsy, confirming CSF involvement by HD. The patient was treated with intrathecal methotrexate, 15 mg, 6 days after his bone marrow transplant. After treatment, all subsequent CSF cytology specimens were negative for tumor. In this case of disseminated HD, cytologic examination allowed for early detection of CNS involvement by lymphoma prior to development of radiographically detectable lesions.
