A prospective study on the relevance of crush or squash cytology of central nervous system lesions, in the present-day surgery

Background:Theintra-operative cytology in the evaluation of central nervous system (CNS) lesions isasimpleandrapidtechnique, and a usefultool. There is not much literature available on the value of crush cytology during the operation. The current study was planned to assess the feasibility and efficacy of intra-operative squash cytology as standalone method in the rapid intra-operative diagnosis of intracranial tumor.Methods:A prospective observational study was carried out in the department of neurology in collaboration with department of pathology, Medanta: The Medicity, Gurugram, for a period of six months from January 2019 toJune 2019, on randomly selected 60 patients, aged: 18 years and above. Two to three tissue bits, from different sites of the mass, were taken to prepare squash cytology smear.Results:Out of 60 patients operated, 54 had neoplastic and 6 had non-neoplastic lesions. Neoplastic benign lesions were observed in 41 patients and neoplastic malignant lesions were diagnosed in 13 patients. There was 17.67% offering a wrong diagnosis on crush cytology. Out of the 13 cases of meningioma, there was a discrepancy in 3 (three) cases.Conclusions:Crushcytologyisausefuladjuncttothediagnosisinneurosurgicalpractice.Thisstudysuggests and confirms the reliability of squash cytology, but further multicentre studies with larger number of patients may help to decide its use in clinical practice.

Intraoperative Frozen Cytology of Central Nervous System Neoplasms: An Ancillary Tool for Frozen Diagnosis

BACKGROUND: Pathologic diagnosis of central nervous system (CNS) neoplasms is made by comparing light microscopic, immunohistochemical, and molecular cytogenetic findings with clinicoradiologic observations. Intraoperative frozen cytology smears can improve the diagnostic accuracy for CNS neoplasms. Here, we evaluate the diagnostic value of cytology in frozen diagnoses of CNS neoplasms. METHODS: Cases were selected from patients undergoing both frozen cytology and frozen sections. Diagnostic accuracy was evaluated. RESULTS: Four hundred and fifty-four cases were included in this retrospective single-center review study covering a span of 10 years. Five discrepant cases (1.1%) were found after excluding 53 deferred cases (31 cases of tentative diagnosis, 22 cases of inadequate frozen sampling). A total of 346 cases of complete concordance and 50 cases of partial concordance were classified as not discordant cases in the present study. Diagnostic accuracy of intraoperative frozen diagnosis was 87.2%, and the accuracy was 98.8% after excluding deferred cases. Discrepancies between frozen and permanent diagnoses (n = 5, 1.1%) were found in cases of nonrepresentative sampling (n = 2) and misinterpretation (n = 3). High concordance was observed more frequently in meningeal tumors (97/98, 99%), metastatic brain tumors (51/52, 98.1%), pituitary adenomas (86/89, 96.6%), schwannomas (45/47, 95.8%), high-grade astrocytic tumors (47/58, 81%), low grade astrocytic tumors (10/13, 76.9%), non-neoplastic lesions (23/36, 63.9%), in decreasing frequency. CONCLUSIONS: Using intraoperative cytology and frozen sections of CNS tumors is a highly accurate diagnostic ancillary method, providing subtyping of CNS neoplasms, especially in frequently encountered entities.

Crush Cytologic Findings of Myxopapillary Ependymoma in Spinal Cord: A Case Report / 대한세포병리학회지

Myxopapillary ependymoma generally arise in the conus medullaris and filum terminale of adult spinal cord. These tumors are readily recognized due to unique histopathologic features, however, their cytologic features are not well described. When only a tiny sample is obtained, cytologic examination using crush preparation may be a useful diagnostic tool to help appropriate intraoperative diagnosis. We present the crush cytologic features of myxopapillary ependymoma arising in thoracic and lumbar spinal cord of a 13-year-old boy. The patient had complained of paraparesis and back pain for 1 month. The MRI image revealed a relatively well demarcated intramedullary mass in T11-L1 levels. Crush preparation for cytology were performed by biopsy material. Crush cytologic findings revealed high cellularity and small sized branching papillary clusters on fibrillary or mucinous background. The tumor cells had uniform round or elongated nuclei. The cytoplasmic process of tumor cells were attached to the vascular wall. Between the tumor cells and vascular walls, the perivascular collar of globoid acellular stroma with metachromatic reaction on toluidin blue stain was noted. The crush preparation of myxopapillary ependymoma is considered as a simple and highly accurate diagnostic tool for differentiation from other intramedullary neoplasms of central nervous system.

Hypocalcemic Convulsion in Formula Feeding Young Infants

Adenoid cystic carcinoma arising from the submucosal glands of the trachea and bronchial tree is rare. The histopathology and natural history of bronchial adenoid cystic carcinoma have been well documented, but detailed descriptions of its cytomorphology are few. We report a case of primary bronchial adenoid cystic carcinoma in a 20-year-old female, diagnosed by bronchial brushing cytology. The cytologic specimens showed large clusters of small cells arranged around cystlike spaces containing globular basophilic material.