You are on page 1of 2

Veterinary Clinical Pathology ISSN 0275-6382

What is your diagnosis? Cerebrospinal fluid from a dog


F. Cian1, V. Palus2, G.B. Cherubini2, J. Archer1, E. Villiers2
1
Department of Veterinary Medicine, University of Cambridge, Cambridge, UK and 2Dick White Referrals, Six Mile Bottom, UK

Correspondence
Francesco Cian, Animal Health Trust, Lanwades Park,
Newmarket, Suffolk CB8 7UU, UK
E-mail: francesco.cian@aht.org.uk

DOI:10.1111/vcp.12120

Case Presentation
An 8-year-old female neutered Springer Spaniel dog was pre-
sented as an emergency case for investigation of progressive
ataxia of all 4 limbs, staggering and behavioral changes. Neu-
rologic signs started 2 weeks before referral with further
acute deterioration. The dog had a solid mammary carcinoma
surgically removed one year previously, which recurred
6 months later and was also resected. B
On physical examination, the dog was tachypneic with
hyperemic mucous membranes. The dog was obtunded, non-
ambulatory tetraparetic with decreased postural reactions
and increased spinal cord segmental reflexes in all 4 limbs.
The neurologic examination was indicative of multifocal
brain localization.
Hematology, biochemistry, electrolytes, and urinalysis
were unremarkable and there were no abnormalities on tho-
racic radiographs and in an abdominal ultrasound examina-
tion. Magnetic resonance imaging (MRI) revealed a mass
lesion with perilesional edema in the left temporal lobe that
was hyperintense on the T2-weighted and fluid-attenuated
inversion recovery (FLAIR) images. The mass was enhanced
after contrast administration.
A cerebrospinal fluid (CSF) sample was collected asepti-
cally from the cisterna magna immediately after the MRI Figure 1. Cytocentrifuged preparation of cerebrospinal fluid from a
study (Figure 1). Springer Spaniel. Wright–Giemsa (A) 950 and (B) 9100 objective.

Vet Clin Pathol 43/1 (2014) 115–116 ©2014 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology 115
CSF from a dog Cian et al

Interpretation: Neoplastic pleocytosis of undetermined


origin.

Cerebrospinal fluid findings included a total nucleated cell


count of 30 cells/lL (reference interval [RI] 0–5 cells/lL), the
majority being atypical discrete cells (82%) with a lower pro-
portion of neutrophils (13%) and lymphocytes (5%). The
RBC count was 90 cells/lL and the protein concentration
was 0.25 g/L (RI < 0.35 g/L). The pleomorphic cells were
large with moderate amounts of lightly granular basophilic
cytoplasm and well-defined borders. Nuclei were round, cen-
tral to paracentral, with a diameter of 20–25 lm, granular
chromatin and small round multiple nucleoli. Anisocytosis
and anisokaryosis were marked. A few binucleated and trinu-
cleated cells were seen, and frequent atypical mitotic figures
were noted (Figure 2). The cytologic interpretation was
malignant neoplasia of unknown origin. The main differen-
tials were primary CNS neoplasia, metastatic tumors, lym- Figure 3. Immunocytochemical staining of a cytocentrifuged prepara-
phoma, and histiocytic neoplasia. Immunocytochemistry tion of cerebrospinal fluid from a Springer Spaniel with a presumed meta-
was performed and cells strongly expressed cytokeratin static carcinoma. Strong cytoplasmic expression of cytokeratin (MNF116,
(antibody clone MNF116, broad anti-human keratin reagent, broad anti-human keratin reagent, Dako, Glostrup, Denmark) by malig-
Dako, Glostrup, Denmark), but not vimentin, CD3, CD18, or nant epithelial cells. Diamino-benzidine chromogen.950 objective.
CD79a (Figure 3). A diagnosis of carcinoma was made.
latter was also considered unlikely, given the immunocyto-
A primary carcinoma of the CNS was considered unli-
chemistry results, as it is usually cytokeratin negative and
kely, based on the localization of the lesion, the MRI findings,
vimentin positive.2 Metastatic mammary carcinomas are
and the results of cytology and immunocytochemistry. With
characterized by extensive diffuse meningeal involvement,
the prior history of mammary carcinoma, this was assumed
although focal involvement has been described, in both cases
to be a metastatic mammary carcinoma. The dog was treated
as a likely consequence of hematogenous dissemination.3,4
with chemotherapy, but did not improve and was euthanized
Epithelial tumors usually exfoliate in cohesive sheets because
after 6 days.
cells adhere to each other by desmosomes. However, meta-
static carcinomas in CSF with a discrete appearance have
Discussion been described. The reason is unclear, but downregulation of
cellular junctions and adhesion molecules on the cell mem-
Nonhemic neoplasias rarely exfoliate cells into CSF in dogs.1
branes of neoplastic cells are a possibility.3,5 Given the lack of
This is likely due to their location, often arising in a site
clustering of epithelial tumor cells in CSF, immunostaining is
remote from the ventricles, and their poorly exfoliative
considered a useful diagnostic tool for the identification of
nature. In this case, the overall findings were suggestive of a
the cellular lineage.
metastatic mammary carcinoma. Primary epithelial CNS neo-
plasia was considered unlikely. The location was considered
unusual for a choroid plexus tumor and ependymoma; the Key Words: Immunocytochemistry, mammary carcinoma,
pleocytosis

References
1. De Lorenzi D, Mandara MT. The central nervous system. In:
Raskin RE, Meyer DJ, eds. Canine and Feline Cytology. 2nd ed.
St. Louis, MO: Elsevier Saunders; 2010:345–347.
2. Koestner A, Higgins RJ. Tumours of the nervous system. In:
Meuten DJ, ed. Tumours in Domestic Animals. 4th ed. Ames, IA:
Iowa State Press; 2002:707–712.
3. Behling-Kelly E, Petersen S, Muthuswamy A, et al. Neoplastic
pleocytosis in a dog with metastatic mammary carcinoma and
meningeal carcinomatosis. Vet Clin Pathol. 2010;39:247–252.
Figure 2. Cytocentrifuged preparation of cerebrospinal fluid from a
4. Pumarola M, Balasch M. Meningeal carcinomatosis in a dog.
Springer Spaniel with a presumed metastatic carcinoma. Pleomorphic
Vet Rec. 1996;25:523–524.
large round cells with vacuolated cytoplasm suggesting a possible secre-
5. Chidgey M, Dawson C. Desmosomes: a role in cancer? Br J
tory origin. Two atypical mitotic figures are also seen. Wright Giemsa.
Cancer. 2008;96:1783–1787.
9100 objective.

116 Vet Clin Pathol 43/1 (2014) 115–116 ©2014 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology