CSF and Serous Fluids Flashcards
1
Q
Production of CSF fluid
A
Made by Choroid Plexus cells that line the ventricular system of the brain
Normally have about 150mL, with <5 cells/mm3
2
Q
Common CSF Cells
A
- Lymphocytes
- Monocytes
3
Q
Uncommon CSF Cells:
Ependymal cells/choroid plexus cells
A
- Ventricular lining cells
- Round to slightly oval, paracentral to eccentric nuclei
- Dispersed chromatin texture
- Moderately abundant cytoplasm
- May be seen singly or in small clusters
4
Q
Uncommon CSF Cells:
Germinal matrix cells
A
- Underneath ependymal cells
- Exfoliate during (so-called “germinal matrix hemorrhage”)
- More common in neonates (especially preterm infants), with hydrocephalus, intraventricular hemorrhage, ventriculostomy, or placement of ventricular-peritoneal (VP) shunt
- Small cells with fine chromatin, scant cytoplasm, and high nucleus-to-cytoplasm ratio
- Often clustered with nuclear molding, blast-like cells with fine chromatin, may have a nucleolus
- May mimic a small cell malignancy
- Typically accompanied by hemosiderin-laden macrophages
5
Q
Uncommon CSF Cells: Brain Tissue
A
- Seen only in samples taken directly from the ventricles
- Fragments of brain tissue have a fibrillary texture and may contain glial cells, neurons, and/or capillaries
- Rarely, isolated neurons are present (large, angular cells with round to ovoid nucleus and prominent central nucleolus)
6
Q
Uncommon CSF Cells: Bone Marrow
A
If the needle is inserted too far, it can hit the vertebrae and contaminate the sample with Bone Marrow
7
Q
Degenerative/Hydropic Cells
A
- Displace but do not indent the nucleus (i.e., nucleus is not wrapping around vacuole, as in a true signet ring cell)
- Are “crystal clear” and contain no secretory material (typically pink)
- Keep your neighbors in mind!
8
Q
Normal Serous Cells: Mesothelial cells (“serosa”)
A
- Single layer lines Pleural, pericardial, and peritoneal cavities
- Round cells with dense, two-toned cytoplasm with outer “lacy skirt” (May have “blebbing” and vaculation)
- Round, central to paracentral nucleus (may be binucleated, multinucleated, or vacuolated) with (typically) single nucleolus
- Generally isolated, although occasional clusters (more than 12 is unusual)
- Spectrum = reassuring, two separate populations = suspicious
9
Q
“Potential” Spaces
A
- Contain a small amount of fluid, enough to lubricate surfaces for breathing, heartbeat, etc.
- In disease states, fliud can accumualte, causeing Effusion
10
Q
Transudative
A
- Low LDH, low protein
- Due to imbalance between hydrostatic and oncotic pressures (e.g., CHF, cirrhosis, nephrotic syndrome)
11
Q
Exudative
A
- High LDH, high protein
- Due to increased vascular permeability and/or disruption of mesothelial integrity (e.g., malignancy, pneumonia, infarction, trauma)
12
Q
Normal Serous Cells: Histiocytes and Macrophages
A
- Nucleus (smaller than mesothelial cells) oval to reniform (bean-like, folded or clefted)
- Fine chromatin, inconspicuous nucleoli (basically absent)
- Pale, ill-defined, vacuolated cytoplasm
- May contain phagocytized debris (phagocytized RBCs and/or hemosiderin is a sign of recent and/or remote hemorrhage, respectively)
- No intercellular windows
13
Q
Normal Serous Cells: Inflammatory Cells
A
- Lymphocytes, Neutrophils, Eosinophils
- Neutrophils considered significant at ≥25%
- Eosinophilic effusions (≥10% eosinophils) may be associated with allergic, parasitic, neoplastic, or medication-related processes, among others
14
Q
General Features of Malignant Cells in CSF/Serous Fluids
A
- Atypical nuclear chromatin (hyperchromasia or immature/blast-like chromatin)
- Macronucleoli
- Nuclear pleomorphism/membrane irregularity
- High N/C ratio
- Clusters (especially of 12 or more cells)
15
Q
Normal CSF Cell Count
A
- Neonates: 0-30 cells/mcL, mostly Monocytes
- Adults: 0-5 leukocytes/mcL (10e6/L), mostly Lymphocytes
- Pediatrics: 0-10 cells/mcL Higher counts are reported, mostly Monocytes
- RBCs are not found in normal CSF, rarely Neutrophils can be found without disease
16
Q
Cytocentrifuge Slides
A
- A drop of albumin added to the cytocup preserves fragile cells and helps the cells stick to the slide, then stained with Wright-Geimsa
- Recovered cells by cytocentrifugation is approximately 15-30 cells for each nucleated cell
- Cytocentrifugation can result in cellular artifacts which in come cases may make it difficult to tell normal from malignant. Higher speeds result in more artifact
17
Q
Telling a Traumatic Tap from an Intracranial Hemorrhage
A
- Erythrophagocytosis
- Hemosiderin pigment/hematoidin crystals (orange-yellow rectangular prisms)
- Xanthochromia
18
Q
Uncommon Body Fluid Cells: Mast Cells
A
- Small numbers associated with inflammatory conditions, foreign body reactions, and parasitic infections
- Morphology: abundant cytoplasmic purple granules obscuring nucleus
19
Q
Chondrocytes
A
- Cartilage cell
- A rare finding, more common in infants. Due to the needle nicks the vertebral cartilage (cartilage fragments can be seen along with the cells) “traumatic tap”
- Round oval nucleus, clear zone around the nucleus, dense purple/red cytoplasm
20
Q
Findings in a patient with recent ventriculo-peritoneal shunt or recent neurosurgery
A
- Ventricular lining cells (may have microvilli around cytoplasmic border)
- Neural tissue
- Capillaries
- Germinal matrix cells
21
Q
Cytocentrifuge Artifacts
A
- Cell flattening
- Smooth Chromatin
- Accentuations of nucleoli
- Peripheral distribution of granulocytic nuclear lobes
22
Q
Characteristics of Benign cell populations in CSF
A
- Cell type variation
- Spectrum of cellular maturation
- Low N:C ratio
- Regular nuclear borders
- Clumped nuclear chromatin
- Indistint nucleoli
23
Q
Characteristics of Non-hematopoetic neoplastic cells in CSF
A
- Tendency to form syncytial cell clusters
- Large nuclei with irregular borders
- Nuclear molding
- Prominent, large nucleoli
- High N:C ratio
- Fine nuclear chromatin
- Marked variation in cell and nucleus size
24
Q
Characteristics of Hematopoetic Neoplasms in CSF
A
- Monotonic cell population
- Variation in cell size
- Irregular nuclear borders
- High N:C ratio
- Fine nuclear chromatin
- Prominent nucleoli
25
Malignent Effusions in Pleural Cavity
* Lung or breast cancer
* Gastrointestinal or ovarian carcinoma
* Lymphomas
* Melanomas
* Sarcomas
* Mesotheliomas
26
Choroidal cells
27
Ependymal cells
28
Macrophage with Hemosiderin and Hematoin Crystals
29
Macrophage with Hemosiderin Granules
30
Macrophage
31
Adenocarcinoma
32
Chondrocyte
33
Germinal Matrix cells
34
Mesothelial cells
35
Neuronal cell
36
Ventricular cells
