Role of Cytology in the Intraoperative Diagnosis of Central Demyelinating Disease

Background:Intraoperative diagnosis of central nervous system (CNS) lesions is of utmost importance for neurosurgeons to modify the approach at the time of surgery and to decide on further plan of management. The intraoperative diagnosis is challenging for neuropathologists.Aims:The study was undertaken to determine the accuracy of cytological techniques (crush smears and touch imprints), frozen sections of space occupying lesions of the CNS and compare it with histopathological diagnosis.Materials and Methods:A total of 75 specimens received intraoperatively were subjected to cytology and frozen section study.Results:Neoplastic lesions formed the major group with 62 (82.7%) cases while 13 (17.3%) were nonneoplastic. The diagnostic accuracy of “squash smears” was found to be 89.2%. “Touch imprints” showed diagnostic accuracy of 78.4%. The low accuracy of touch imprints was attributed to poor cellular yield. The diagnostic accuracy of “frozen section” was 75.7%. However, the overall diagnostic accuracy was 96%.Conclusion:We believe that the cytololgical methods and frozen sections are complimentary to each other and both should be used to improve the intraoperative diagnostic accuracy in the CNS lesion.

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“…Folkerth also pointed out the abovementioned advantages and disadvantages of squash smear cytology. [ 5 7 8 9 ]…”

Section: Discussionmentioning

confidence: 99%

“…It was also stated in other studies that frozen section was more suitable for firmer lesions and that freezing artifacts usually hampered its diagnostic utility. [ 6 7 ]…”

Section: Discussionmentioning

confidence: 99%

Intraoperative diagnosis of central nervous system lesions: Comparison of squash smear, touch imprint, and frozen section

Nanarng

Jacob

Mahapatra

et al. 2015

J Cytol

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“…PML is also associated with enlarged, atypical cells having smudgy and glassed basophilic oval-shaped nuclei with nuclear inclusions, i.e. polyomavirus-infected oligodendroglial cells [8]. Those cells have coarse granular chromatin with cytoplasm which is rarely discernible.…”

Section: Discussionmentioning

confidence: 99%

“…Those cells have coarse granular chromatin with cytoplasm which is rarely discernible. The cytologic features of MS are the same as those of PML, and these two types of lesions are distinguishable only by the absence of virus-infected oligodendroglial cells [7,8]. Numerous infiltrated inflammatory cells in these two demyelinating disorders correspond well to promote myelin digestion.…”

Section: Discussionmentioning

confidence: 99%

Crush Cytologic Findings of a Cerebral Granular Cell Astrocytoma

Kang

Kim²,

Chung³

et al. 2012

Acta Cytologica

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Background: Granular cell astrocytoma (GCA) is a rare variant of astrocytoma, characterized by an aggressive prognosis compared to conventional astrocytomas of the same World Health Organization grade. Intraoperative smears provide useful clues in diagnosing neuropathology, especially in rarely encountered central nervous system tumors. Case: The patient was a 53-year-old man who presented with a huge mass at the left temporal lobe with peritumoral edema on MRI. The crush smears revealed singly-scattered, large eosinophilic cells with eccentrically located nuclei as well as plump, finely-granular cytoplasm with distinct borders. Mild cellular atypia and absence of mitotic activity were noted. These cells were admixed with small mature lymphoid cells. Histology showed scattered large granular cells which were positive for glial fibrillary acidic protein. Conclusion: The most helpful imprint cytologic findings of GCA were as follows: (1) large cells containing eosinophilic granular cytoplasm rather than the foamy or bubbly cytoplasm associated with macrophages or renal cell carcinomas; (2) distinct granular cell borders in contrast to the ruffled membrane of macrophages, and (3) markedly large-sized granular cells, ranging from 60 to 100 µm in diameter.

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“…These macrophages often contain Luxol fast blue (LFB) material in their cytoplasm. 8,9 Crush preparations of cases of progressive multifocal leukoencephalopathy have shown to contain abundant macrophages along with atypical reactive astrocytes. However, cells with effaced, smudgy, and glassed chromatin ''virally infected oligodendrocytes'' may also be present.…”

Section: Dear Dr Bedrossianmentioning

confidence: 99%