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Meningeal gliomatosis with "negative" CSF cytology

The value of GFAP staining

From the Departments of Neurology (Drs. Wechsler and Gross) and Neuropathology (Dr. Miller), Massachusetts General Hospital and Harvard Medical School, Boston, MA.

We report a patient with meningeal gliomatosis who had signs of meningitis, hypoglycorrhachia, and an intracranial mass. Despite suspicion of a primary intracranial neoplasm, repeated CSF cytologies were not diagnostic and led to a brain biopsy for diagnosis. Immunoperoxidase staining for glial fibrillary acidic protein stained CSF cells that had been thought inflammatory on routine cytology. This case and other reports demonstrate that multiple cytologic examinations may be negative despite extensive gliomatous infiltration of the meninges. Immunoperoxidase staining is useful in cases of suspected meningeal spread of glioma when suspicious cells are seen on routine CSF cytology.

Address correspondence and reprint requests to Dr. Wechsler, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114.

Presented in part at the thirty-sixth annual meeting of the American Academy of Neurology, Boston, MA, April 1984.

Accepted for publication April 4, 1984.

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