Neoplastic meningitis laboratory tests: Difference between revisions
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==Overview== | ==Overview== | ||
The proposed algorithm for the diagnosis of neoplastic meningitis include the following:<ref name="BerzeroDiamanti2015">{{cite journal|last1=Berzero|first1=Giulia|last2=Diamanti|first2=Luca|last3=Di Stefano|first3=Anna Luisa|last4=Bini|first4=Paola|last5=Franciotta|first5=Diego|last6=Imarisio|first6=Ilaria|last7=Pedrazzoli|first7=Paolo|last8=Magrassi|first8=Lorenzo|last9=Morbini|first9=Patrizia|last10=Farina|first10=Lisa Maria|last11=Bastianello|first11=Stefano|last12=Ceroni|first12=Mauro|last13=Marchioni|first13=Enrico|title=Meningeal Melanomatosis: A Challenge for Timely Diagnosis|journal=BioMed Research International|volume=2015|year=2015|pages=1–6|issn=2314-6133|doi=10.1155/2015/948497}}</ref> | |||
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==Laboratory Findings== | ==Laboratory Findings== | ||
Laboratory findings consistent with the diagnosis of neoplastic meningitis include:<ref name=dxnm123>Diagnosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref> | Laboratory findings consistent with the diagnosis of neoplastic meningitis include:<ref name="dxnm123">Diagnosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref><ref name="AhnLim2013">{{cite journal|last1=Ahn|first1=Shin|last2=Lim|first2=Kyung Soo|title=Three Cases of Neoplastic Meningitis Initially Diagnosed with Infectious Meningitis in Emergency Department|journal=Case Reports in Emergency Medicine|volume=2013|year=2013|pages=1–4|issn=2090-648X|doi=10.1155/2013/561475}}</ref> | ||
'''CSF analysis''' | '''CSF analysis''' | ||
*Neoplastic meningitis is multifocal and cerebrospinal fluid at a particular site may show no abnormalities, if the pathological site is far away. Only 50% of those suspected with neoplastic meningitis are actually diagnosed and only the '''presence of malignant cells in the CSF''' is diagnostic.<ref name=dxnm123>Diagnosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref> | *Neoplastic meningitis is multifocal and [[cerebrospinal fluid]] at a particular site may show no abnormalities, if the pathological site is far away. Only 50% of those suspected with neoplastic meningitis are actually diagnosed and only the '''presence of malignant cells in the CSF''' is diagnostic.<ref name="dxnm123">Diagnosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref> | ||
*The criteria for CSF abnormalities that are consistent with the diagnosis of neoplastic meningitis include:<ref name=dxnm123>Diagnosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref> | *The criteria for CSF abnormalities that are consistent with the diagnosis of neoplastic meningitis include:<ref name="dxnm123">Diagnosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016</ref> | ||
:*Increased opening pressure (> 200mm of H2O) | :*Increased opening pressure (> 200mm of H2O) | ||
:*Increased Leukocytes (>4/mm3) | :*Increased Leukocytes (>4/mm3) | ||
:*Elevated protein (>50 mg/dL) | :*Elevated protein (>50 mg/dL) | ||
:*Decreased glucose (<60 mg/dL) | :*Decreased glucose (<60 mg/dL) | ||
:* | :*Positive tumor markers in CSF | ||
::*[[Carcinoembryonic antigen | ::*[[Carcinoembryonic antigen|Carcinoembryonic antigen (CEA)]] | ||
::*[[Alpha-fetoprotein]] | ::*[[Alpha-fetoprotein]] | ||
::*[[Beta-human chorionic gonadotropin]] | ::*[[Beta-human chorionic gonadotropin]] | ||
::*[[creatine kinase|Creatine-kinase BB isoenzyme]] | ::*[[creatine kinase|Creatine-kinase BB isoenzyme]] | ||
::*[[Beta-2 microglobulin]] | ::*[[Beta-2 microglobulin|β2 microglobulin]] | ||
::*[[Lactate dehydrogenase|Lactate dehydrogenase isoenzyme-5]] | ::*[[Lactate dehydrogenase|Lactate dehydrogenase isoenzyme-5]] | ||
::*[[VEGF|Vascular endothelial growth factor]] | ::*[[VEGF|Vascular endothelial growth factor]] | ||
::*These markers can be good indirect indicators of n eoplastic meningitis, but most are not sensitive enough to improve cytological diagnosis. | :::*These markers can be good indirect indicators of n eoplastic meningitis, but most are not sensitive enough to improve cytological diagnosis. | ||
:*CSF cytology ('''gold standard''') | |||
::*Malignant cells, if present, are diagnostic | |||
::*CSF cytology is estimated to have >95% specificity for neoplastic meningitis | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
The proposed algorithm for the diagnosis of neoplastic meningitis include the following:[1]
Laboratory Findings
Laboratory findings consistent with the diagnosis of neoplastic meningitis include:[2][3]
CSF analysis
- Neoplastic meningitis is multifocal and cerebrospinal fluid at a particular site may show no abnormalities, if the pathological site is far away. Only 50% of those suspected with neoplastic meningitis are actually diagnosed and only the presence of malignant cells in the CSF is diagnostic.[2]
- The criteria for CSF abnormalities that are consistent with the diagnosis of neoplastic meningitis include:[2]
- Increased opening pressure (> 200mm of H2O)
- Increased Leukocytes (>4/mm3)
- Elevated protein (>50 mg/dL)
- Decreased glucose (<60 mg/dL)
- Positive tumor markers in CSF
- Carcinoembryonic antigen (CEA)
- Alpha-fetoprotein
- Beta-human chorionic gonadotropin
- Creatine-kinase BB isoenzyme
- β2 microglobulin
- Lactate dehydrogenase isoenzyme-5
- Vascular endothelial growth factor
- These markers can be good indirect indicators of n eoplastic meningitis, but most are not sensitive enough to improve cytological diagnosis.
- CSF cytology (gold standard)
- Malignant cells, if present, are diagnostic
- CSF cytology is estimated to have >95% specificity for neoplastic meningitis
References
- ↑ Berzero, Giulia; Diamanti, Luca; Di Stefano, Anna Luisa; Bini, Paola; Franciotta, Diego; Imarisio, Ilaria; Pedrazzoli, Paolo; Magrassi, Lorenzo; Morbini, Patrizia; Farina, Lisa Maria; Bastianello, Stefano; Ceroni, Mauro; Marchioni, Enrico (2015). "Meningeal Melanomatosis: A Challenge for Timely Diagnosis". BioMed Research International. 2015: 1–6. doi:10.1155/2015/948497. ISSN 2314-6133.
- ↑ 2.0 2.1 2.2 Diagnosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016
- ↑ Ahn, Shin; Lim, Kyung Soo (2013). "Three Cases of Neoplastic Meningitis Initially Diagnosed with Infectious Meningitis in Emergency Department". Case Reports in Emergency Medicine. 2013: 1–4. doi:10.1155/2013/561475. ISSN 2090-648X.