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Central nervous system Hodgkin's disease relapsing with eosinophilic pleocytosis
R J Hauke1, S R Tarantolo, R M Bashir
1Department of Internal Medicine, Section of Hematology/Oncology, University of Nebraska Medical Center, Omaha 68198, USA.
Insights
Diagnosing central nervous system Hodgkin's disease can be challenging. Fluoroscopy-guided cisternal puncture successfully identified Reed-Sternberg cells in cerebrospinal fluid (CSF) when lumbar punctures failed, aiding diagnosis.
Area of Science:
- Neurology
- Oncology
- Diagnostic Cytology
Background:
- Hodgkin's disease involvement of the central nervous system (CNS) is rare.
- Diagnosing CNS Hodgkin's disease often requires cerebrospinal fluid (CSF) cytological analysis.
- Standard lumbar punctures may not always yield diagnostic CSF samples.
Abstract:
Hodgkin's disease affecting the central nervous system is infrequent. Multiple lumbar punctures are sometimes required for cytological diagnosis. In this case fluoroscopy-guided cisternal puncture and routine lumbar punctures were used to obtain cerebrospinal fluid (CSF) samples for cytological analysis. Reed-Sternberg cells were observed on the CSF sample obtained through the cisternal puncture while none were seen in the samples obtained with routine lumbar punctures. Without cytology, the diagnosis of meningeal carcinomatosis remains elusive. In conclusion, cisternal punctures should be entertained early in the evaluation for meningeal carcinomatosis, particularly if lumbar punctures have been unsuccessful.