Journal of Cytology
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REVIEW ARTICLE
Year : 2011  |  Volume : 28  |  Issue : 4  |  Page : 147-158

Intraoperative neurocytology of primary central nervous system neoplasia: A simplified and practical diagnostic approach


1 Department of Pathology, Georgia Health Sciences University Medical College of Georgia, Augusta, Georgia, USA
2 Department of Pathology, Armed Forces Medical College, Pune, India

Correspondence Address:
Prabal Deb
Associate Professor and Neuropathologist, Department of Pathology, Armed Forces Medical College, Pune
India
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Source of Support: Research incentive from the Dean of Medical College of Georgia to Suash Sharma, Conflict of Interest: None


DOI: 10.4103/0970-9371.86339

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Intraoperative consultations may pose considerable diagnostic challenge to the neuropathologist in diagnosing primary and metastatic neoplasms of the central nervous system (CNS). Cytological preparations in the form of squash, touch, imprint or smears are few of the available modalities in addition to the frozen section (FS). Although the latter is superior in providing both histologic patterns and cytomorphologic details yet smears are of vital importance when tissue available is limited (stereotactic biopsy), scrutinisation of intercellular matrix (astrocytoma versus oligodendroglioma) and evaluation of discohesive cells (lymphoma, pituitary adenoma) and in inflammatory lesions. This review is intended to emphasize the value, applicability and limitations of neurocytology aiming to expedite the intraoperative smear-based diagnoses of CNS neoplasia as per the World Health Organization (WHO) classification. We recommend that whenever possible, both smears and FS should be examined concomitantly and in a correlative manner. In the unlikely event of a mismatch between the findings on smear and FS, intraoperative diagnosis is primarily based on FS, if adequate tissue is available. However, each case must be evaluated on its own merit and in difficult cases relevant differential diagnoses should be offered to facilitate surgical decisions and optimally triage patient management.


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