Abstract
Assessing the number and type of CSF cells are integral parts of the diagnostic workup of CSF analysis. However, microscopic evaluation of cell morphology provides additional important details that may be missed, if omitted, such as different stages of leukocyte activation, stages of phagocytosis, atypical cells, or tumor cells. While such level of detail may be not required for each and every sample, microscopic evaluation is recommended at least for all cases of differential diagnosis. This chapter provides a review of standard techniques and guidance for interpretation, including comments about potential pitfalls and advice for special cases.
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References
Quincke H (1891) Die Lumbalpunktion des Hydrocephalus. Berl Klin Wochenschr 28:929–933
Lundie A, Thomas DJ, Fleming S (1915) Cerebro-spinal meningitis: diagnosis and prophylaxis is lumbar puncture justifiable? Br Med J 1:628–629
Heller T, Nagel I, Ehrlich B et al (2008) Automated cerebrospinal fluid cytology. Anal Quant Cytol Histol 30:139–144
Strik H, Luthe H, Nagel I et al (2005) Automated cerebrospinal fluid cytology: limitations and reasonable applications. Anal Quant Cytol Histol 27:167–173
Bremell D, Mattsson N, Wallin F et al (2014) Automated cerebrospinal fluid cell count—new reference ranges and evaluation of its clinical use in central nervous system infections. Clin Biochem 47(1–2):25–30
Hod EA, Brugnara C, Pilichowska M et al (2018) Automated cell counts on CSF samples: a multicenter performance evaluation of the GloCyte system. Int J Lab Hematol 40(1):56–65
Kölmel HW (2003) Konventionelle Liquorzytologie. In: Zettl U, Lehmitz R, Mix E (eds). Klinische Liquordiagnostik. De Gruyter, Berlin. isbn:3-11-016846-4, pp 135–160
Østergaard AA, Sydenham TV, Nybo M, Andersen AB (2017) Cerebrospinal fluid pleocytosis level as a diagnostic predictor? A cross-sectional study. BMC Clin Pathol 17:15
Strik H (2015) Cell count and staining. In: Deisenhammer F, Sellebjerg F, Teunissen CE, Tumani H (eds) Cerebrospinal fluid in clinical neurology. Springer, Basel., isbn:978-3-319-01225-4, pp 81–100
de Graaf MT, de Jongste AHC, Kraan J et al (2011) Flow cytometric characterization of cerebrospinal fluid cells. Cytometry B Clin Cytom 80:271–281
Djukic M, Trimmel R, Nagel I, Spreer A, Lange P, Stadelmann C, Nau R (2017) Cerebrospinal fluid abnormalities in meningeosis neoplastica: a retrospective 12-year analysis. Fluids Barriers CNS 14(1):7
Den Hartog Jager WA (1980) Color atlas of Csf cytopathology. Lippincott Williams & Wilkins, Philadelphia
Fishman RA (1992) Cerebrospinal fluid in diseases of the nervous system. W.B. Saunders, Philadelphia
Kölmel HW (1986) Zytologie des Liquor cerebrospinalis. Edition Medizin, VCH, Weinheim
Oehmichen M (1976) Cerebrospinal fluid cytology: An introduction and atlas. W.B. Saunders, Philadelphia
Schmidt RM (1978) Atlas der Liquorzytologie. Barth, Leipzig
Worofka B, Lassmann J, Bauer K et al (1997) Praktische Liquorzelldiagnostik. Springer, Wien - New York
Kranz BR (1991) Methodik und Wert immunzytochemischer Differenzierung benigner und maligner Zellen im Liquor cerebrospinalis. Lab Med 15:61–68
Kleine TO, Albrecht J (1991) Vereinfachte Druchflusszytometrie von Liquorzellen mit FACScan. Lab Med 15:73–78
Lueg G, Gross CC, Lohmann H et al (2015) Clinical relevance of specific T-cell activation in the blood and cerebrospinal fluid of patients with mild Alzheimer’s disease. Neurobiol Aging 36:81–89
Gross CC, Schulte-Mecklenbeck A, Runzi A et al (2016) Impaired NK-mediated regulation of T-cell activity in multiple sclerosis is reconstituted by IL-2 receptor modulation. Proc Natl Acad Sci U S A 113:E2973–E2982
Han S, Lin YC, Wu T et al (2014) Comprehensive immunophenotyping of cerebrospinal fluid cells in patients with neuroimmunological diseases. J Immunol 192:2551–2563
Hegde U, Filie A, Little RF et al (2005) High incidence of occult leptomeningeal disease detected by flow cytometry in newly diagnosed aggressive B-cell lymphomas at risk for central nervous system involvement: the role of flow cytometry versus cytology. Blood 105:496–502
Windhagen A, Maniak S, Heidenreich F (1999) Analysis of cerebrospinal fluid cells by flow cytometry and immunocytochemistry in inflammatory central nervous system diseases: comparison of low- and high-density cell surface antigen expression. Diagn Cytopathol 21:313–318
Bommer M, Nagy A, Schopflin C et al (2011) Cerebrospinal fluid pleocytosis: pitfalls and benefits of combined analysis using cytomorphology and flow cytometry. Cancer Cytopathol 119:20–26
Sancho JM, Orfao A, Quijano S et al (2010) Clinical significance of occult cerebrospinal fluid involvement assessed by flow cytometry in non-Hodgkin’s lymphoma patients at high risk of central nervous system disease in the rituximab era. Eur J Haematol 85:321–328
Acknowledgments
We thank all technicians, scientists, and physicians of the CSF laboratory of the Department of Neurology at the University Hospital Ulm. Our special thanks go to Dagmar Vogel, Dr. Andreas Junker, MD, and Dr. Vera Lehmensiek, PhD for preparation of the cyto-images.
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Süssmuth, S.D., Tumani, H. (2021). CSF Cells: Cell Count, Cytomorphology, Cytology, and Immunophenotyping. In: Teunissen, C.E., Zetterberg, H. (eds) Cerebrospinal Fluid Biomarkers. Neuromethods, vol 168. Humana, New York, NY. https://doi.org/10.1007/978-1-0716-1319-1_1
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DOI: https://doi.org/10.1007/978-1-0716-1319-1_1
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