Cerebral spinal fluid involvement by Hodgkin's disease diagnosed by CSF cytology and immunocytochemistry

A 39-yr-old man with stage IV Hodgkin's disease (HD) involving bane mat-row was being evaluated for autologous bone marrow transplantation when he dev eloped diplopia, prompting a lumbar puncture tap for cerebral spinal fluid (CSF) examination. Cytologic examination of the CSF revealed numerous Reed- Sternberg (RS) cells in a polymorphous inflammatory background of small lym phocytes, monocytes, rare plasma cells, and eosinophils. However magnetic r esonance imaging (MRI) studies of the brain and spinal cord failed to revea l evidence of leptomeningeal disease or intracranial masses. Repeat CSF exa mination again demonstrated cytologic evidence of HD. Immunocytochemical st ains established that the RS cells and mononuclear Hodgkin's cells were pos itive for. CD30 and CD20 but negative for CD15; this phenotype was identica l to that of RS cells in the initial diagnostic bone marrow biopsy, confirm ing CSF involvement by HD. The patient was treated with intrathecal methotr exate, 15 mg, 6 days after his bone marrow, transplant. After treatment, al l subsequent CSF cytology specimens were negative for tumor: in this case o f disseminated HD, cytologic examination allowed for early detection of CNS involvement by lymphoma prior to development of radiographically detectabl e lesions. (C) 1999 Wiley-Liss, Inc.