scholarly journals Leptomeningeal Carcinomatosis: A Call for Optimizing Diagnostic Sensitivity by the Hematology Laboratory

2021 ◽  
pp. 1248-1253
Author(s):  
Benjamin Lardinois ◽  
Laurence Miller ◽  
Adrien Randazzo ◽  
Terry Laurent ◽  
Régis Debois ◽  
...  
Keyword(s):  
Ductal Carcinoma ◽  
Leptomeningeal Metastasis ◽  
Leptomeningeal Carcinomatosis ◽  
Diagnostic Sensitivity ◽  
Malignant Cells ◽  
Blood Cell Count ◽  
Positive Cytology ◽  
Cytological Examination ◽  
Biochemical Alterations ◽  
Fluorescent Cells

In the cerebrospinal fluid (CSF), the demonstration of malignant cells by cytological examination is currently the gold standard for the diagnosis of leptomeningeal carcinomatosis (LC). However, a positive cytology is observed in only 50–60% of patients with LC and highly dependent on pre-analytical factors. The hematology laboratory could provide an immediate and accurate diagnosis, but diagnostic sensitivity is not always optimized once the sample is received. We hereby report a 49-year-old woman with a 3-year grade III invasive ductal carcinoma who was admitted to the emergency department due to headaches, nausea, and vomiting. The CSF revealed pleocytosis with suspicious high fluorescent cells on the hematology analyzer concomitantly with biochemical alterations. Cytomorphological examination confirmed tumor cells, thus diagnosing a leptomeningeal metastasis of her breast cancer. The patient was eventually transferred to palliative care. Cytological examination is a valuable tool for a rapid diagnosis of LC if diagnostic performance is optimized. In addition to repeated CSF collections with a sufficient volume (5–10 mL), this could be reached by processing the CSF as soon as possible, taking into account the fluorescence information from the analyzer, proceeding systematically to microscopic examination even with normal CSF white blood cell count, and providing quality improvement of the staff to identify malignant cells.

Two-site evaluation of high-fluorescent cells for the detection of malignant cells: The importance of clinical information

2019 ◽  
Vol 493 ◽  
pp. S428-S429
Author(s):  
J. Favresse ◽  
L. Boland ◽  
M. Schellen ◽  
B. Chatelain ◽  
J. Defour ◽  
...  
Keyword(s):  
Clinical Information ◽  
Malignant Cells ◽  
Site Evaluation ◽  
Fluorescent Cells

Detection and quantification of CSF malignant cells by the CellSearch® technology in patients with melanoma leptomeningeal metastasis

2013 ◽  
Vol 30 (2) ◽  
Author(s):  
Emilie Le Rhun ◽  
Qian Tu ◽  
Marcelo De Carvalho Bittencourt ◽  
Isabelle Farre ◽  
Laurent Mortier ◽  
...  
Keyword(s):  
Leptomeningeal Metastasis ◽  
Malignant Cells ◽  
Detection And Quantification

scholarly journals Leptomeningeal Carcinomatosis From Carcinoma of Unknown Primary in a Young Patient: A Case Report and a Literature Review

2019 ◽  
Vol 7 ◽  
pp. 232470961986938 ◽  
Author(s):  
Leila Moosavi ◽  
Carlos D’Assumpcao ◽  
Jonathan Bowen ◽  
Arash Heidari ◽  
Everardo Cobos
Keyword(s):  
Alkaline Phosphatase ◽  
Germ Cell ◽  
Germ Line ◽  
Locally Advanced ◽  
Cervical Lymphadenopathy ◽  
Leptomeningeal Metastasis ◽  
Leptomeningeal Carcinomatosis ◽  
Unknown Primary ◽  
Placental Alkaline Phosphatase ◽  
Carcinoma Of Unknown Primary

Leptomeningeal carcinomatosis, leptomeningeal meningitis, or, as referred here, leptomeningeal metastasis (LM), is a rare but frequently fatal complication seen in advanced stage of cancer either locally advanced or after a metastasis of a known primary cancer. We present a rare and uncommon case of leptomeningeal metastases from carcinoma of unknown primary. A 32-year-old female was diagnosed with LM; however, no known primary carcinoma was identified after 2 separate biopsies. The first biopsy of the right pre-tracheal lymph node showed poorly differentiated pan-keratin (AE1 and AE3) and placental alkaline phosphatase with the possibility of germ cell origin. Second cytology of cervical lymphadenopathy was remarkable for cytokeratin 7 and 20, placental alkaline phosphatase, and CDX2 suggestive of germ line tumor with both mucinous ovarian and gastrointestinal carcinomas. Unfortunately, the LM progressed rapidly despite multiple cycles of germ cell origin directed systemic and intrathecal chemotherapy, and the patient opted for hospice care without getting a chance to identify the primary source.

scholarly journals Weakly supervised learning for classification of lung cytological images using attention-based multiple instance learning

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Atsushi Teramoto ◽  
Yuka Kiriyama ◽  
Tetsuya Tsukamoto ◽  
Eiko Sakurai ◽  
Ayano Michiba ◽  
...  
Keyword(s):  
Supervised Learning ◽  
Classification Performance ◽  
Multiple Instance Learning ◽  
Cancer Type ◽  
Malignant Cells ◽  
Cytological Examination ◽  
Automated Method ◽  
Weakly Supervised ◽  
Better Than

AbstractIn cytological examination, suspicious cells are evaluated regarding malignancy and cancer type. To assist this, we previously proposed an automated method based on supervised learning that classifies cells in lung cytological images as benign or malignant. However, it is often difficult to label all cells. In this study, we developed a weakly supervised method for the classification of benign and malignant lung cells in cytological images using attention-based deep multiple instance learning (AD MIL). Images of lung cytological specimens were divided into small patch images and stored in bags. Each bag was then labeled as benign or malignant, and classification was conducted using AD MIL. The distribution of attention weights was also calculated as a color map to confirm the presence of malignant cells in the image. AD MIL using the AlexNet-like convolutional neural network model showed the best classification performance, with an accuracy of 0.916, which was better than that of supervised learning. In addition, an attention map of the entire image based on the attention weight allowed AD MIL to focus on most malignant cells. Our weakly supervised method automatically classifies cytological images with acceptable accuracy based on supervised learning without complex annotations.

scholarly journals Gambaran Hasil Pemeriksaan Sitologi Cairan Asites di Instalasi Patologi Anatomi RSUD Arifin Achmad Provinsi Riau Periode Januari 2013 – Desember 2017

2019 ◽  
Vol 13 (1) ◽  
pp. 51
Author(s):  
Ilhami Romus ◽  
Ina Farida Rangkuti ◽  
Vini Jum’atur Rahmah
Keyword(s):  
Ovarian Carcinoma ◽  
Gold Standard ◽  
Peritoneal Fluid ◽  
Underlying Disease ◽  
Age Group ◽  
Malignant Cells ◽  
Positive Cytology ◽  
Abnormal Accumulation ◽  
Anatomical Pathology ◽  
Fluid Cytology

Ascites is abnormal accumulation fluid in the peritoneal cavity. Many underlying disease can be responsiblefor causing ascites. Peritoneal fluid cytology remains the gold standard for detection of malignant cells inascites which is useful in determining staging, treatment and prognosis. This aim of this study is to describethe characteristic of the result ascitic cytology examination at Anatomical Pathology Department of ArifinAchmad Hospital Period January 2013 – December 2018. This study reviewed the anatomy pathology data.A total of 171 cases consisted of 91.8% were females and males were 8.2%. The highest number caseswere in the age group of 41-50 years (26.9%). Most ascitic fluid came from Department of Obstetric andGynecology (81.9%). The more frequent clinical diagnosis were ovarian carcinoma (19.3%) and ovariancyst (18.7%). Most ascitic cytology examination results was positive cytology (64,9%). Adenocarcinomawas commonest positive cytology (46,2%).

Nipple Abnormalities

2018 ◽  
Author(s):  
Nicole S. Winkler
Keyword(s):  
Inflammatory Response ◽  
Lymph Nodes ◽  
Clinical Features ◽  
Ductal Carcinoma ◽  
Imaging Features ◽  
Malignant Cells ◽  
Imaging Findings ◽  
Paget Disease ◽  
Imaging Protocols ◽  
Management Recommendations

New nipple retraction and new nipple inversion can be secondary to malignancy, post-surgical change, inflammation, or infection. Paget disease of the nipple is characterized by an inflammatory response of the nipple epidermis to malignant cells extending from ductal carcinoma in the lactiferous sinus. A mass arising within the nipple is rare and usually a variant of a papilloma arising in the nipple (nipple adenoma). This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for patients presenting with nipple retraction. Topics discussed include imaging features of nipple retraction, both benign and malignant causes of nipple retraction, Paget disease of the nipple, and masses occurring in the nipple.

Leptomeningeal carcinomatosis in colorectal cancer: The Mayo Clinic experience.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 710-710
Author(s):  
Gretchen E Taylor ◽  
Nina J. Karlin ◽  
Thorvardur Ragnar Halfdanarson ◽  
Kyle Coppola ◽  
Axel Grothey
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Disease ◽  
Mayo Clinic ◽  
Treatment Options ◽  
Palliative Radiotherapy ◽  
Leptomeningeal Metastasis ◽  
Leptomeningeal Carcinomatosis ◽  
Mri Findings ◽  
Lower Extremity Weakness ◽  
Neurologic Symptoms

710 Background: Leptomeningeal metastasis (LM) has been described as a rare form of metastatic disease progression in colorectal cancer (CRC). There remains a paucity of literature with regards to the course and management of LM in CRC. The aim of this study was to estimate the incidence of LM in CRC patients seen at our institution over a 15-year period, and to describe the clinical course and outcome of these cases. Methods: LM in CRC primary cases between 2000 and 2014 were identified in the Mayo Clinic databases. The charts were retrospectively reviewed. Results: Of 17,095 CRC primaries, we identified 10 patients with LM (0.058%) in this 15-year period. Nine cases were included in the analysis. Four had metastatic disease at the time of their initial CRC diagnosis. One patient also had a lung adenocarcinoma diagnosed during initial staging for the CRC primary. Median overall survival after CRC diagnosis was 25.7 months (range 4.7-74.8). Median time to diagnosis of LM after CRC diagnosis was 25.3 months (range 1-68.1). All patients had MRI findings consistent with LM: 3 patients with spinal LM, 5 patients with intracranial LM, 1 with both. One of three CSF analyses at the time of LM workup was positive for malignant cells; all had elevated protein. Neurologic symptoms correlated with site of the lesions, with headache, cranial nerve palsy, lower extremity weakness, and gait disturbance among the most frequently reported. However, not all patients had neurologic findings, with LM lesions found incidentally in two cases. Seven patients (78%) had palliative radiotherapy (RT) for LM. Three patients continued to receive systemic chemotherapy after diagnosis of LM. No patients underwent intrathecal chemotherapy. Median survival after LM diagnosis was 7 weeks (range 2-39). Conclusions: The diagnosis of LM is an exceedingly rare development in the natural course of CRC. It continues to confer an extremely poor prognosis with limited treatment options. At our institution, most patients had their disease addressed by palliative means, with many receiving RT to control their neurologic symptoms. Based on our series, supportive care remains a sensible approach to the management of LM in CRC.

Diagnostic Utility of Cyfra 21-1 and Cea Assays in Pericardial Fluid for the Recognition of Neoplastic Pericarditis

2005 ◽  
Vol 20 (1) ◽  
pp. 43-49 ◽  
Author(s):  
M. Szturmowicz ◽  
W. Tomkowski ◽  
A. Fijalkowska ◽  
W. Kupis ◽  
A. Cieślik ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Gold Standard ◽  
Pericardial Fluid ◽  
Optimal Cutoff ◽  
Positive Cytology ◽  
Cytological Examination ◽  
Malignant Pericardial Effusion ◽  
Negative Tumor ◽  
Cytology Result ◽  
Fluid Cytology

A positive cytology result in pericardial fluid is the gold standard for recognition of malignant pericardial effusion. Unfortunately, in 30–50% of patients with malignant pericardial effusion cytological examination of the pericardial fluid is negative. Tumor marker assessment in pericardial fluid may help to recognize malignant pericardial effusion. The aim of our study was to estimate the value of CYFRA 21-1 and CEA measurement in pericardial fluid for the recognition of malignant pericardial effusion. To our knowledge this is the first study on CYFRA 21-1 assessment in pericardial effusion. The examined group consisted of 50 patients with malignant pericardial effusion and 34 patients with non-malignant pericardial effusion. Median CEA concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 80 ng/mL (0–317) and 0.5 ng/mL (0–18.4), respectively (p<0.001). Median CYFRA 21-1 concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 260 ng/mL (5.3–10080) and 22.4 ng/mL (1.87–317.6), respectively (p<0.001). The optimal cutoff value for CYFRA 21-1 in pericardial effusion was 100 ng/mL. CYFRA 21-1 >100 ng/mL or CEA >5 ng/mL were found in 14/15 patients with malignant pericardial effusion and negative pericardial fluid cytology. We therefore strongly recommend the use of CYFRA 21-1 and/or CEA in addition to pericardial fluid cytology for the recognition of malignant pericardial effusion.

scholarly journals Response to Olaparib in a Patient with Germline BRCA2 Mutation and Breast Cancer Leptomeningeal Carcinomatosis

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Pedro Exman ◽  
Robert M. Mallery ◽  
Nancy U. Lin ◽  
Heather A. Parsons
Keyword(s):  
Breast Cancer ◽  
Metastatic Cancer ◽  
Parp Inhibitor ◽  
Treatment Options ◽  
Brca2 Mutation ◽  
Leptomeningeal Metastasis ◽  
Complete Response ◽  
Parp Inhibitors ◽  
Leptomeningeal Carcinomatosis ◽  
Response To Treatment

AbstractLeptomeningeal carcinomatosis (LC) is a devastating complication of metastatic cancer that disproportionately affects patients with advanced breast cancer. Moreover, those with BRCA1/2-mutated disease more often experience leptomeningeal metastasis. Treatment options for LC are limited and often include significant toxicities. PARP inhibitors offer an important potential treatment for patients with BRCA1/2-mutated breast and ovarian cancers, but clinical studies excluded patients with central nervous system (CNS) metastases, including LC. Efficacy data in this area are therefore limited, although a phase I study of olaparib in glioblastoma did show CNS penetration. Here we report a case of a patient with BRCA2-mutated breast cancer and solitary recurrence in the leptomeninges with ongoing complete response to treatment with the PARP inhibitor olaparib. PARP inhibitors may be an important treatment option for patients with BRCA-mutated disease and LC, and warrant further study.

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