Role of Cerebrospinal Fluid Cytology in Diagnosis of Primary Central Nervous System Lymphoma
Role of Cerebrospinal Fluid Cytology in Diagnosis of Primary Central Nervous System Lymphoma
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脑脊液细胞学检查在原发性中枢神经系统淋巴瘤诊断中的作用
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发表时间：
2012
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通讯作者：
Guo Yupu
中科院分区：
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作者：
Guo Yupu
目的探讨脑脊液（CSF）细胞学检查对原发性中枢神经系统淋巴瘤（PCNSL）的诊断价值。方法回顾性分析21例脑脊液细胞学阳性的PCNSL患者的临床资料。采用常规脑脊液细胞学、免疫细胞化学、流式细胞免疫表型分析（FCA）和PCR检测重排的脑脊液IgH和TCR基因。结果21例患者的临床及影像学分型包括脑膜型（13例）、实质型（4例）、室管膜型（3例）和视神经型（1例）。21例患者脑脊液均有大量胚细胞或非典型淋巴细胞，常规细胞学检查怀疑淋巴瘤。20例患者行脑脊液免疫细胞化学检查，17例显示B淋巴细胞优势，与B细胞淋巴瘤的诊断一致。7例FCA中，5例患者B细胞百分比明显升高，提示B细胞淋巴瘤，1例患者NK/T淋巴细胞占优势，提示NK/T淋巴瘤。对4例患者脑脊液中IgH和TCR基因进行分析，发现3例为IgH单克隆，1例为TCR单克隆。结论脑脊液细胞学、免疫细胞化学、FCA和PCR检测重排的IgH和TCR基因对PCNSL的诊断有重要意义。
Objective To study the diagnostic value of cerebrospinal fluid(CSF) cytology in the diagnosis of primary central nervous system lymphoma(PCNSL).Methods We retrospectively analyzed the clinical data of 21 PCNSL patients with positive CSF cytological findings.Conventional CSF cytology,immunocytochemistry,flow cytometric immunophenotypic analysis(FCA),and PCR of the rearranged IgH and TCR genes of CSF were performed.Results The clinical and neuroimaging types of 21 patients included meningeal type(n=13),parenchymal type(n=4),ependymal type(n=3),and optic type(n=1).The CSF of all the 21 patients had a number of blast cells or atypical lymphocytes,suspected of lymphoma on conventional cytology.Of the 20 patients undergoing the immunocytochemical studies of the CSF,17 showed B-lymphocyte predominance,which was consistent with the diagnosis of B cell lymphoma.FCA of 7 cases showed a significant increase in the percentage of B cells in 5 patients,indicating B cell lymphoma,and NK/T-lymphocyte predominance in 1 case,indicating an NK/T lymphoma.On analysis of the IgH and TCR genes in the CSF of 4 patients,IgH monoclonal was found in 3 cases and TCR monoclonal in 1 case.Conclusion CSF cytology,immunocytochemistry,FCA,and PCR of the rearranged IgH and TCR genes of CSF are useful in the diagnosis of PCNSL.