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首页> 外文期刊>Diagnostic cytopathology >Glioblastoma Multiforme With Epithelial Differentiation: A Potential Diagnostic Pitfall in Cerebrospinal Fluid Cytology
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Glioblastoma Multiforme With Epithelial Differentiation: A Potential Diagnostic Pitfall in Cerebrospinal Fluid Cytology

机译：多形性胶质母细胞瘤与上皮分化：脑脊髓液细胞学的潜在诊断陷阱。

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Cerebrospinal fluid (CSF) cytology provides valuable diagnostic and prognostic information for diseases of the central nervous system (CNS) and remains the gold standard for the detection of neoplastic meningitis. Metastatic involvement of the CSF by non-CNS neoplasms far surpasses that of primary brain tumors, although conventional glioblastoma multiforme (GBM) can occasionally be identified in the CSF. GBM with epithelial differentiation is an uncommon variant that may contain features such as adenoid structures, signet ring cells, or squamous metaplasia. Herein, we present a case of GBM with epithelial differentiation to highlight a potential diagnostic pitfall in CSF cytology. A 55-year-old man presented with neurological symptoms and a 6.4 cm left temporal lobe cystic mass. Primary resection revealed GBM with focal epithelial differentiation confirmed by cytokeratin, epithelial membrane antigen, and glial fibrillary acidic protein immunohistochemical studies. Four months following primary resection, the patient developed severe headache for which a lumbar puncture with CSF cytologic evaluation was performed. The cytospin preparation showed numerous malignant epithelioid cells with high nuclear-cytoplasmic ratio and prominent cytoplasmic vacuoles resembling metastatic carcinoma. However, the lesional cells were cytomorphologically identical to the epithelial component present in the patient's recently diagnosed GBM. This case illustrates the potential for GBM with epithelial differentiation to closely mimic metastatic carcinoma from a non-CNS site in CSF cytology, which expands the differential diagnosis and emphasizes the necessity of clinical correlation. (C) 2015 Wiley Periodicals, Inc.
机译：脑脊液（CSF）细胞学为中枢神经系统（CNS）疾病提供有价值的诊断和预后信息，并且仍然是检测肿瘤性脑膜炎的金标准。非中枢神经系统肿瘤对CSF的转移参与远远超过了原发性脑肿瘤，尽管在CSF中偶尔可以鉴定出传统的多形胶质母细胞瘤（GBM）。具有上皮分化的GBM是一种罕见的变异，可能包含腺样结构，印戒细胞或鳞状化生等特征。在本文中，我们提出了一个具有上皮分化的GBM病例，以突出CSF细胞学的潜在诊断缺陷。一名55岁的男性出现神经系统症状，左侧颞叶囊性肿块6.4厘米。初次切除显示GBM具有局灶性上皮分化，已通过细胞角蛋白，上皮膜抗原和神经胶质原纤维酸性蛋白免疫组织化学研究证实。初次切除后四个月，患者出现严重头痛，并进行了腰穿穿刺并进行了CSF细胞学评估。 cytospin制剂显示出许多恶性上皮样细胞，具有高核质比和突出的细胞质液泡，类似于转移性癌。然而，病变细胞在细胞形态上与患者最近诊断出的GBM中存在的上皮成分相同。该病例说明了具有上皮分化的GBM在CSF细胞学中从非CNS部位紧密模拟转移性癌的潜力，这扩大了鉴别诊断并强调了临床相关性的必要性。 （C）2015威利期刊公司

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