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Bone marrow elements in cerebrospinal fluid: Review of literature with a case study.

Thomas AA, Goh FT - Cytojournal (2013)

Bottom Line: Journal publications on this topic are few and majority of them were written over a decade ago mostly as case reports in young children or the elderly.The increased cellularity and presence of myeloid precursors can be a pitfall and may be misdiagnosed as leukemia or lymphoma or central nervous system infection, when the specimen is actually not representative.With the intention to create awareness of potential pitfalls and avoid erroneous diagnoses, as well as adding on to the current photo archive of bone marrow elements in CSF, we present a recent case of bone marrow contaminants in the CSF of a 16-year-old girl.

View Article: PubMed Central - HTML - PubMed

Affiliation: Address: Department of Tissue Pathology and Cytopathology, PathWest Laboratory Medicine, QEII Medical Centre, Hospital Ave, Nedlands WA 6009 ; School of Pathology and Laboratory Medicine, University of Western Australia, Western Australia.

ABSTRACT
Presence of bone marrow elements in cerebrospinal fluid is rare. Journal publications on this topic are few and majority of them were written over a decade ago mostly as case reports in young children or the elderly. The increased cellularity and presence of myeloid precursors can be a pitfall and may be misdiagnosed as leukemia or lymphoma or central nervous system infection, when the specimen is actually not representative. With the intention to create awareness of potential pitfalls and avoid erroneous diagnoses, as well as adding on to the current photo archive of bone marrow elements in CSF, we present a recent case of bone marrow contaminants in the CSF of a 16-year-old girl.

No MeSH data available.


Related in: MedlinePlus

Viral meningitis showing normal and activated lymphocytes with and scattered macrophages
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Figure 5: Viral meningitis showing normal and activated lymphocytes with and scattered macrophages

Mentions: Increased cellularity of CSF due to bone marrow elements presents an abnormal CSF picture and has many differential diagnoses. It is important to identify these cases and not over diagnose them as lymphomas or leukemia. Bone marrow elements in CSF should not be misdiagnosed as inflammatory infection caused by CNS infection to prevent the unnecessary antibiotic administration. A cytological picture of predominantly polymorphonuclear leukocytes may indicate non-specific mixed inflammation [Figure 2], bacterial meningitis [Figure 3], cerebral abscess and empyema, CNS hemorrhage and infarction or occasionally the early stages of viral and fungal infection.[58] Immune response caused by malignant processes may present a similar picture [Figure 4].[11] Other infective differential diagnoses include mycobacterial tuberculosis and viral meningoencephalitis in which the CSF contains predominantly lymphocytes and monocytes [Figure 5].[5] The presence of myeloid and lymphoid precursors may suggest CNS involvement by acute leukemia [Figure 6], lymphoma [Figure 7] or contamination by peripheral blood with abnormal blasts [Figure 8].[11] Increased numbers of red blood cells may also result in misdiagnosis of a traumatic tap [Figure 9].


Bone marrow elements in cerebrospinal fluid: Review of literature with a case study.

Thomas AA, Goh FT - Cytojournal (2013)

Viral meningitis showing normal and activated lymphocytes with and scattered macrophages
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814656&req=5

Figure 5: Viral meningitis showing normal and activated lymphocytes with and scattered macrophages
Mentions: Increased cellularity of CSF due to bone marrow elements presents an abnormal CSF picture and has many differential diagnoses. It is important to identify these cases and not over diagnose them as lymphomas or leukemia. Bone marrow elements in CSF should not be misdiagnosed as inflammatory infection caused by CNS infection to prevent the unnecessary antibiotic administration. A cytological picture of predominantly polymorphonuclear leukocytes may indicate non-specific mixed inflammation [Figure 2], bacterial meningitis [Figure 3], cerebral abscess and empyema, CNS hemorrhage and infarction or occasionally the early stages of viral and fungal infection.[58] Immune response caused by malignant processes may present a similar picture [Figure 4].[11] Other infective differential diagnoses include mycobacterial tuberculosis and viral meningoencephalitis in which the CSF contains predominantly lymphocytes and monocytes [Figure 5].[5] The presence of myeloid and lymphoid precursors may suggest CNS involvement by acute leukemia [Figure 6], lymphoma [Figure 7] or contamination by peripheral blood with abnormal blasts [Figure 8].[11] Increased numbers of red blood cells may also result in misdiagnosis of a traumatic tap [Figure 9].

Bottom Line: Journal publications on this topic are few and majority of them were written over a decade ago mostly as case reports in young children or the elderly.The increased cellularity and presence of myeloid precursors can be a pitfall and may be misdiagnosed as leukemia or lymphoma or central nervous system infection, when the specimen is actually not representative.With the intention to create awareness of potential pitfalls and avoid erroneous diagnoses, as well as adding on to the current photo archive of bone marrow elements in CSF, we present a recent case of bone marrow contaminants in the CSF of a 16-year-old girl.

View Article: PubMed Central - HTML - PubMed

Affiliation: Address: Department of Tissue Pathology and Cytopathology, PathWest Laboratory Medicine, QEII Medical Centre, Hospital Ave, Nedlands WA 6009 ; School of Pathology and Laboratory Medicine, University of Western Australia, Western Australia.

ABSTRACT
Presence of bone marrow elements in cerebrospinal fluid is rare. Journal publications on this topic are few and majority of them were written over a decade ago mostly as case reports in young children or the elderly. The increased cellularity and presence of myeloid precursors can be a pitfall and may be misdiagnosed as leukemia or lymphoma or central nervous system infection, when the specimen is actually not representative. With the intention to create awareness of potential pitfalls and avoid erroneous diagnoses, as well as adding on to the current photo archive of bone marrow elements in CSF, we present a recent case of bone marrow contaminants in the CSF of a 16-year-old girl.

No MeSH data available.


Related in: MedlinePlus