Plasmacytoid urothelial carcinoma--diagnostic challenge in cytology.

Plasmacytoid urothelial carcinoma (PUC) is a very rare variant of urothelial carcinoma with an aggressive clinical course. According to small series reported to date, it is a high grade cancer usually diagnosed at an advanced stage, and with poor prognosis. Descriptions of the cytologic features of this type of carcinoma in literature are limited. Plasmacytoid appearance of tumor cells could cause diagnostic dilemma and potential incorrect diagnosis as multiple myeloma (MM). This report describes cerebrospinal fluid, bone marrow, and urine sediment cytomorphologic and immunocytochemical findings in a patient with meningeal carcinomatosis as the first manifestation of a PUC, initially misdiagnosed as MM with a brief review of the literature.

Blastic plasmacytoid dendritic cell neoplasm: cytopathologic findings.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive hematopoietic neoplasm, which in the past was also known variously as blastic NK cell lymphoma, agranular CD4+ natural killer cell leukemia, and CD4+/CD56+ hematodermic neoplasm. BPDCN is now believed to arise from plasmacytoid dendritic cells, but its exact etiology is still unknown. We report here on the cerebrospinal fluid (CSF) cytology of a BPDCN, a hypercellular specimen comprised of malignant, singly dispersed cells with scant to moderate amounts of pale blue, agranular cytoplasm, and uniform round to oval nuclei, fine chromatin, prominent nucleoli, occasional cytoplasmic microvacuoles, and pseudopodia. Neither mitoses nor karyorrhexis were identified. Flow cytometry of the CSF demonstrated that the malignant cells expressed bright CD45, HLA-DR and CD33, dim CD4, heterogeneous CD56, and partial CD123. The importance of clinical, histopathological, and phenotypic correlation is emphasized. Clinical and histopathological correlation and a literature review are also presented. The poor clinical outcome makes it important to accurately report this rare tumor in a CSF specimen.

Automated cerebrospinal fluid cytology: limitations and reasonable applications.

OBJECTIVE: To evaluate the precision and clinical applicability of the Bayer ADVIA 120 cytometer (Bayer Healthcare, Fernwald, Germany) for cerebrospinal fluid (CSF) cell count and differentiation. STUDY DESIGN: One hundred six analyses of CSF from 98 patients by the ADVIA 120 were compared with routine cell count and microscopic differentiation. Correlation coefficients were calculated. RESULTS: In general, the total cell counts of both methods correlated well. The best correlations were seen at higher cell counts, > or = 100 cells per microliter with < 100 erythrocytes per microliter. The best correlations of cell differentiation were seen for lymphocytes and neutrophils, while the results for monocytes and eosinophils were less precise. In some cases, considerable differences between automated and microscopic cell counts and differentiation were seen that were relevant to clinical decision making. The detection of pathologic cell types, such as hemosiderophages, mitoses and neoplastic cells, was not provided by automated cytometry. CONCLUSION: When experienced personnel are not available, a preliminary cell count and differentiation between neutrophilic and lymphocytic reactions by automated cytometry may be valuable in allowing initial therapeutic decision making. Since the detection of pathologic cell types is not provided and the precision at low cell counts is only moderate, a personal microscopic evaluation of each sample is still indispensable to avoid misdiagnoses.

Meningeal and cerebral involvement in multiple myeloma patients.

Cerebral involvement is an unusual complication in multiple myeloma: herein four patients who presented myelomatous meningitis with multiple intraparenchymal lesions or a localized cerebral plasmacytoma are described. Two of these patients relapsed with meningeal involvement and a very limited disease outside the central nervous system after an initial complete remission obtained with induction chemotherapy. In the other two cases, the cerebral tumor appeared during first-line treatment. Cytological examination of the cerebrospinal fluid and magnetic resonance were essential for diagnosis. Different modalities of treatment were used, including intrathecal chemotherapy, cranial irradiation, and systemic chemotherapy with high-dose methotrexate and cytarabine, achieving improvement of neurological symptoms in three of four patients.

Solitary plasmacytoma of the skull: report of two cases.

We report two cases of solitary plasmacytoma of the skull, a very unusual presentation and location of this tumor. There seems to be no difference in prognosis between the tumor originating from the skull (osseous form) and from the dura mater (non-osseous form), differently from the data of other parts of the body. The risk of secondary multiple myeloma appears to be low but the mean follow-up is too short for any conclusion on this point.

[Specific meningeal involvement in multiple myeloma]. / Atteinte méningée spécifique au cours du myélome multiple.

Meningeal involvement is extremely rare in multiple myeloma. Its characteristic features can be derived from the 3 cases presented here and from the 11 cases previously published. Specific signs of meningeal myelomatosis include convulsions, confusion, cranial nerve palsies and plasma cells in the cerebrospinal fluid. Meningitis develops in patients with high tumoral mass myeloma, leukaemic in one-half of the cases. Treatment is ineffective, and death occurs within a few months.

Solitary plasmacytoma in the cerebellopontine angle.

A case of solitary plasmacytoma of the skull base growing into the cerebellopontine angle is reported. Myeloma protein of the lambda type light chain was identified in the patient's cerebrospinal fluid. The difficulty in differentiating solitary plasmacytomas of the skull base from other tumors in this location, such as chordoma and meningioma, is discussed.

[Cerebellopontile angle symptomology in plasmocytoma: a case report]. / Kleinhirnbrückenwinkelsymptomatik bei Plasmozytom--Kasuistischer Beitrag.

The author reports on a patient with cerebellopontile angular symptomatology in the case of a plasmocytoma. The diagnosis of plasmocytoma was established from the pathological results of gamma globulin subfractionation and immune electrophoresis. Also commented in this discussion is the problem of essential cryptogenetic paraproteinosis.