English 
Italian CASI CLINICI – Case Reports
Volume:
Biochimica Clinica 2019; 43(2) e17-e19
Pubblicato on-line:
April 16, 2019
DOI:
10.19186/BC_2019.029
Utilità dell’esame citologico del liquido cerebrospinale
AUTORI
1Unità Operativa Complessa Laboratorio Analisi, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano
2Unità Operativa Complessa Neuroradiologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano.
ABSTRACT
Clinical utility of cerebrospinal fluid cytological examination
Cerebrospinal fluid (CSF) of a 64 year old malepatient was sent from the hematology unit to laboratory for cell count and morphology and chemical-physicalexamination. CSF was clear, colourless and with increased total protein concentration. Cell count was first performedin Burker camera with a result of 40/μL; some of the cells showed an abnormal morphology. Our laboratory workflowincludes the CSF examination utilizing an automatic cell counter: it showed a few white blood cells (3/μL), but a highnumber of total cells (64/μL). The morphological evaluation, with cytocentrifugation and May-Grunwald Giemsa stain,identified the elements as mature plasma cells; the result was then confirmed by immunophenotyping.
These findings suggest a neurological localization of a multiple myeloma (MM). Actually, the patient had beendiagnosed as IgA lambda MM, with bone involvement that caused progressive loss of walk. Positron EmissionTomography revealed hyperdense areas, but it wasn’t able to distinguish between lymphoproliferative disease andthrombotic phlogosis. In spite of the therapy, patient neurological conditions worsened till irreversible coma. He dieda few days later.