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Squash cytology of primary central nervous system lymphoma in an immunocompetent patient
Aneel Myageri1, U G Vandana1, Sateesh Melkundi2
1Department of Pathology, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India.
Insights
Diagnosing primary central nervous system lymphoma (PCNSL) can be challenging. This case highlights how cytology and immunohistochemistry confirmed diffuse large B-cell lymphoma, even when initial imaging suggested glioma.
Area of Science:
- Neurology
- Oncology
- Pathology
Background:
- Primary central nervous system lymphoma (PCNSL) diagnosis can be suggested by MRI, often showing homogeneous enhancement in immunocompetent patients.
- Confirmation typically requires lymphoma cells from biopsy or cerebrospinal fluid.
Observation:
- A case initially diagnosed as glioma via imaging underwent micro-neurosurgical resection.
- Tumor tissue was analyzed using squash smear, frozen section, and paraffin sections.
Findings:
- Cytologic examination of squash smears revealed lymphoid-origin tumor cells, ruling out other diagnoses.
- Immunocytochemistry and immunohistochemistry confirmed diffuse large B-cell lymphoma with a non-germinal center B-cell phenotype.
Implications:
- This case underscores the importance of integrating cytologic and advanced tissue analysis for accurate PCNSL diagnosis.
- Definitive diagnosis through immunophenotyping is crucial for appropriate treatment strategies in CNS lymphomas.
Abstract:
The diagnosis of primary central nervous system lymphoma (PCNSL) can be suggested by magnetic resonance imaging (MRI). Cerebral PCNSL in immunocompetent patients generally shows marked homogeneous contrast enhancement in MRI. However, confirmation of it requires demonstration of lymphoma cells in stereotactic biopsy of the lesion or in cerebrospinal fluid. In the present case, with radiologic diagnosis of glioma, complete resection of the lesion by micro-neurosurgical technique was performed. The tumor tissue was examined by squash smear, frozen section and paraffin sections. Cytologic appreciation of tumor cells as lymphoid origin in squash smears negated the other possibilities. The immunocytochemistry on squash smear and immunohistochemistry on paraffin sections confirmed the diagnosis of diffuse large B cell lymphoma of non-germinal center B cell phenotype.
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