Page 290 - Textbook of Pathology, 6th Edition

274 ii) Correct cytological processing and technique, since the
cell yield of CSF is generally low and faulty technique may
result in loss of cellular material or poor morphology.
Normal CSF. CSF is an ultrafiltrate of plasma with a total
volume of about 150 ml (in the adult). Cell content is low
(0-4/μl) comprising mainly lymphocytes or monocytes.
CSF in non-neoplastic diseases. Changes in CSF in various
non-neoplastic diseases are discussed in Chapter 30 (see
Table 30.1).
SECTION I
CSF in neoplastic disease. Neoplasms that are in direct
contact with the CSF are most likely to shed cells which are
recoverable for scrutiny. Metastatic cancers (leukaemia,
lymphoma and adenocarcinoma), medulloblastomas, and
ependymomas shed the greatest amount of material. Though
meningioma occurs in the subarachnoid space, it rarely
exfoliates sufficient material for diagnosis. Low-grade
Figure 11.7 Pleural fluid positive for signet ring cells (adeno- gliomas do not generally shed sufficient cells although high-
carcinoma stomach). There are large number of malignant cells scattered grade gliomas may yield adequate cellular material for
singly or in small clusters having characteristic cytoplasmic vacuoles, diagnosis.
nuclear hyperchromasia and prominent nucleoli.
Seminal Fluid (Semen)
the effusion. Epithelial cells of mesothelioma require to be Examination of seminal fluid (semen analysis) is one of the
distinguished from adenocarcinoma cells. tests for investigating infertile couples, and is also used to
Adenocarcinomas. These are the most common malignant check the adequacy of vasectomy. Samples are obtained by
cellular component in the effusions. They mostly represent masturbation or coitus interruptus after observing at least 4
metastasis from primary adenocarcinomas such as from the days of sexual abstinence and assessed on the following lines:
stomach, lung, breast, colon, and ovary. Less frequent sources
are adenocarcinoma of the biliary system, pancreas and liver. 1. Volume. Normal volume is between 2.5 and 5 ml.
Most adenocarcinomas show similar morphologic 2. Viscosity and pH. When ejaculated, semen is fairly viscid
General Pathology and Basic Techniques
appearance and thus it may not be possible to comment on but liquefies in about 10 to 30 minutes. It is usually alkaline
the possible primary site of origin of the adenocarcinoma on (pH about 8).
morphology alone (Fig. 11.7). 3. Motility. Normally, within 2 hours of ejaculation, at least
Squamous cell carcinoma. Effusion may rarely have 60% of the spermatozoa are vigorously motile; in 6 to 8 hours
malignant squamous cells in it and represent metastasis from 25 to 40% are still motile.
carcinoma lung, oesophagus or uterine cervix.
4. Count. Counting is done in a Neubauer chamber after
Small cell carcinoma. Cytologic features of small cell suitable dilution. Normally, 60 million or more spermatozoa
carcinoma of the lung are quite characteristic—hyper- are present per ml. Currently, automated counters for semen
chromatic moulded nuclei and scanty or no cytoplasm. are also available.
Lymphomas-leukaemias. Effusions may sometimes have 5. Morphology. Stained smears are used to assess
malignant cells of leukameia and lymphoma in line with morphology. Normally, not more than 20% of spermatozoa
primary disease in the body. are morphologically abnormal (e.g. double-head, pointed-
head, or swollen).
B. FLUIDS OF SMALL VOLUME
6. Fructose. Seminal fructose estimation (normal levels 150-
Of the miscellaneous fluids included in this category, the 600 mg/dl) complements cytological analysis. Low levels of
most common samples submitted for cytological evaluation seminal fructose indicate obstruction at the level of
are cerebrospinal fluid (CSF) and seminal fluid (semen). ejaculatory ducts.
Results of semen analysis need to be interpreted with
Cerebrospinal Fluid (CSF) caution as infertility is caused by several factors in the couple.

CSF examination is an important part of complete neurologic As discussed in Chapter 23, other causes of infertility need
evaluation, both in non-neoplastic and neoplastic diseases to be evaluated before it is ascribed to abnormalities in semen.
of the central nervous system. Samples are usually obtained Even specimens with several abnormal features need not
by lumbar puncture. Factors that are critical to the successful necessarily be the cause of infertility.
cytological evaluation of CSF are as under:
VI. BUCCAL SMEARS FOR SEX CHROMATIN BODIES
i) Speed of delivery to the laboratory and immediate
processing, as diagnostic material may disintegrate within Sex-specific chromatin bodies are observed in interphase
an hour resulting in false-negative diagnosis. nuclei and comprise the Barr body (X chromatin) and the