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- 脑脊液,其中是乳腺癌细胞吗?急!
Agree with above.
CSF should be quite hypocellular and contains only a few mononuclear cells. Even without reference cells, these cells apprear large even at 40X (we usually don't use oil lense for non-hematopathologic cases). My minimal diagnosis: highly atypical cells, consistent with metastatic carcinoma. With real slide, i may be able to push to: Positive for malignant cells, consistent with breast primary.
We usually don't do immunostains in CSF becaue CSF is always scanty in volume (several mililiter) and it is almost impossible to prepare a cell block. Not many places can do immunostains on direct smears or cytospin, you have to de-stain H&E and re-stain with the entire IHC protocol. Cells may fall off the slides.
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Though cytologic details are not very well preserved or shown in the photos, these cells do have atypical nuclei in terms of nuclear shapes and nucleocytoplasmic ratio. They are cohesive, too. From the photos it is difficult to tell how dense these cells are in CSF. And, as pointed out earlier, it would be great if a small lymphocyte can be compared for cellular size. Do we know what type of breast cancer she had (ductal vs lobular)? What was its grade? Is there any mitotic figure? If so, these cells are that of a metastatic carcinoma. It would be difficult if not impossible to stain immunohistochemistry on scant CSF specimen like this. My conclusion is that these are probably malignant epithelial cells (carcinomatous meningitis).
聞道有先後,術業有專攻
