Cytological diagnosis of cystic brain tumors: A retrospective study of 88 cases

Abstract

The stereotaxic aspiration of cystic brain tumors is performed to provide cyst decompression and/or to facilitate surgical resection. The purpose of our study was to determine the diagnostic value of brain cyst fluid cytology, especially in clinically suspected recurrent tumors with no histological follow-up (HF), when a diagnosis is most needed. We reviewed the cytological diagnoses of 88 aspirates from 70 patients with cystic brain tumors between 1995 and 2001, of which 31 had a prior known malignancy including 18 primary brain tumors (PBTs) and 13 adenocarcinomas (ACAs). Sixty-nine of 88 aspirates were obtained intraoperatively. Nineteen of 88 aspirates were obtained from 10 patients with recurrent or persistent cystic brain tumors (8 patients with PBT and 2 patients with ACA), with available clinicoradiological correlation (magnetic resonance imaging/computed tomography [MRI/CT] scans) in 13 of them. The 88 aspirates were classified in three categories: 28 positive (32%), 15 atypical (17%), and 45 negative (51%). Eight of 28 positive cases (5 case of PBT, 2 cases of ACA, and 1 case of melanoma) were given a nonspecific diagnosis of malignant neoplasm (9% of all cases). Fifteen of 28 positive cases (6 cases of PBT, 8 cases of ACA, and 1 case of melanoma) were diagnosed correctly and confirmed by HF (17% of all cases). Four of 28 cases were ACA diagnosed solely by cytology (<4% of all cases). One neurocytoma (1/28) case was mistaken for an oligodendroglioma despite cell blocks (CBs) and immunophenotyping (IPT) (<1% of all cases). Eleven of 15 atypical cases were 8 cases of PBT, 2 cases of ACA, and 1 case of postoperative change (PC). Four of 15 atypical cases (from three patients with suspected PBT recurrence) could not be further characterized by CB/IPT and had no HF. Twenty-seven of 45 negative cases were falsely negative (23 cases of PBT, 3 cases of ACA, and 1 case of malignant neoplasm); 11/45 cases were PC, and 7/45 (from five patients with clinically suspected tumor recurrence) cases had no HF. Cytological evaluation of brain cyst fluid is not a reliable means of diagnosing cystic brain neoplasms (including recurrences) due to a high false negative rate and a low sensitivity. Most of the negative or atypical cases (68% of all cases) were recurrent PBT of glial origin that may not be prone to exfoliate. These cytological specimens consisted of lysed blood, obscuring inflammatory cells, and degenerated diagnostic cells if any, yielding inconclusive results.

Aspiration cytology of brain abscess from a fatal case of cerebral phaeohyphomycosis due to Ramichloridium mackenziei

“…R. mackenziei was almost always reported in individuals residing in the Middle East 2,4 whereas Exophiala dermatitidis is frequently seen in Asia. 14 On the other hand, Silverman et al gave support for the value of fine needle aspiration (FNA) biopsy in diagnosing lesions of the central nervous system. 12 Cerebral phaeohyphomycosis carries a high mortality rate of 73%.…”

Emprego da cromatografia líquida de alta eficiência na determinação de cortisol sérico em substituição à técnica de radioimunoensaio

“…Em relação às lesões císticas, houve maior discrepância entre os diagnósticos histopatológico e citopatológico em razão de o exame do conteúdo do cisto ser freqüentemente inconclusivo, enquanto a biópsia da parede cística revela quase sempre a natureza da lesão. Esses dados estão de acordo com o estudo realizado por Hernandez et al (39) , no qual o exame citopatológico do material aspirado de lesões cerebrais císticas de natureza neoplásica, incluindo tumores cerebrais primários e adenocarcinomas metastáticos, evidenciou elevado índice de resultados falso-negativos e baixa sensibilidade, principalmente para tumores cerebrais primários de origem glial, que mostram escassa tendência a esfoliar. O material aspirado, mesmo após centrifugação e confecção de esfregaço a partir do sedimento, consistiu principalmente em sangue lisado, células inflamatórias e células degeneradas, produzindo resultados inconclusivos.…”

Microvascular proliferation of brain metastases mimics glioblastomas in squash cytology

“…Abnormal vascular proliferation is an important feature in the histological and cytological diagnosis of tumours, including brain tumours. However, cytological analysis of the vasculature of primary gliomas or metastatic brain tumours is rarely reported . This study showed that microvascular proliferations were frequent in metastatic tumours, whereas none were identified in normal/reactive brain tissues and the majority of grade II DA/ODGs.…”