Utilità dell'esame citologico del liquido cerebrospinale

Cerebrospinal fluid (CSF) of a 64 year old male patient was sent from the hematology unit to laboratory for cell count and morphology and chemical-physical examination. CSF was clear, colourless and with increased total protein concentration. Cell count was first performed in Burker camera with a result of 40/µL; some of the cells showed an abnormal morphology. Our laboratory workflow includes the CSF examination utilizing an automatic cell counter: it showed a few white blood cells (3/µL), but a high number 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 been diagnosed as IgA lambda MM, with bone involvement that caused progressive loss of walk. Positron Emission Tomography revealed hyperdense areas, but it wasn't able to distinguish between lymphoproliferative disease and thrombotic phlogosis. In spite of the therapy, patient neurological conditions worsened till irreversible coma. He died a few days later.