Vol. 34 No. 4 September 2017
KARAKTERISTIK CAIRAN SEREBROSPINAL PADA KEGANASAN HEMATOLOGI
Yunni Diansari,* Tiara Aninditha,** Rini Andriani***
CHARACTERISTICS OF CEREBROSPINAL FLUID IN HEMATOLOGIC
ABSTRACT
Introduction: Hematologic malignancies such as leukemia and lymphoma demonstrates leptomeningeal cell infiltration more frequently than solid tumors. A special approach in diagnosis and management is necessary, including analysis of cerebrospinal fluid (CSF) obtained from lumbar puncture (LP). The obtained CSF may have properties similar to CNS inflammation. There has been no specific research describing the CSF characteristics of hematologic malignancy in Indonesia; nonetheless, it is essential because, if found, the subsequent management of the patient will be quite distinct.
Aim: To find out about the characteristics of CSF in hematologic malignancy.
Methods: This study was performed retrospectively, from medical records of patients with hematologic malignancy, admitted to Dharmais Cancer Hospital in 2014-2015 and the Neurology patient in wards of Cipto Mangunkusumo Hospital from 2014-2016. The LCS withdrawal is done based on suspected leptomeningeal metastases, according to the clinical sign and/or head MRI with contrast as a diagnostic procedure as well as for intrathecal chemotherapy.
Results: 23 subjects were found, with equal frequency between male (11 subjects) and female (12 subjects), with mean age of 37,4+13,8 years, diagnosed with leukemia (19 subjects) dan 4 subjects with lymphoma. In routine CSF analysis, median cell count was 3 (1-356)/mm, protein level 37 (16-129)mg/dl, and glucose level 63 (8-181)mg/dl. An increase in cell count (>5/mm3) were found in 6/23 subjects and protein level >45mg/dl were found in 7/23 subjects. Reduced of glucose level (<40 mg/dl) was found only in 2/23 subjects.
Of 23 subjects with cytology analysis, only five yielded positive results. MRI were performed on only 7 subjects, with the positive results of leptomeningeal enhancement upon contrast, and neurologic deficits were only found on 4 subjects.
Discussion: CSF analysis cytology among patients with hematologic malignancy would only yield positive results when there is clinical correlation.
Keywords: CSF analysis and cytology, hematologic malignancy, CNS involvement, leptomeingeal metastasis
ABSTRAK
Pendahuluan: Keganasan hematologi, seperti leukemia dan limfoma, lebih sering berinfiltrasi ke leptomeningeal dibandingkan tumor padat. Hal ini memerlukan diagnosis dan tata laksana khusus, antara lain melalui analisis cairan serebrospinal (CSS) yang diperoleh melalui tindakan pungsi lumbal. Gambaran CSS tersebut dapat menyerupai gambaran inflamasi susunan saraf pusat. Namun sejauh ini belum ada penelitian khusus tentang pola gambaran CSS tersebut di Indonesia, padahal tatalaksananya jauh berbeda.
Tujuan: Mengetahui karakteristik CSS pada penderita keganasan hematologi.
Metode: Penelitian retrospektif dari rekam medis pasien dengan keganasan hematologi yang dirawat di RSUPN Dr. Cipto Mangunkusumo dan RS Kanker Dharmais, Jakarta, tahun 2014-2016. Pengambilan CSS dilakukan atas indikasi kecurigaan metastasis leptomeningeal berdasarkan gejala klinis dan/atau gambaran MRI kepala dengan kontras sebagai tindakan diagnostik maupun untuk pemberian kemoterapi intratekal.
Hasil: Didapatkan 23 subjek dengan rerata usia 37,4+13,8 tahun, proporsi yang hampir sama antara laki-laki (11 subjek) dan perempuan (12 subjek), serta mayoritas subjek (19 orang) menderita leukemia dan limfoma (4 subjek). Pada pemeriksaan analisis rutin CSS, didapatkan median jumlah sel 3 (1-356)/mm3, kadar protein 37 (16-129)mg/dl, serta kadar glukosa CSS 63 (8-181)mg/dl. Terdapat peningkatan jumlah sel (>5/mm3) pada 6 subjek dan peningkatan kadar protein CSS (>45mg/dl) pada 7 subjek. Sebanyak 2 subjek memperlihatkan penurunan kadar glukosa (<40 mg/dl). Pada pemeriksaan sitologi hanya 5 subjek menunjukkan hasil positif, MRI dilakukan hanya pada 7 subjek dengan hasil positif tampak penyangatan leptomeningen, dan defisit neurologis hanya pada 4 subjek.
Diskusi: Analisis dan sitologi CSS pada penderita dengan riwayat keganasan hematologi menunjukkan jumlah sel, kadar protein, dan kadar glukosa yang hampir sama dengan normal.
Kata kunci: Cairan serebrospinal, keganasan hematologi, metastasis leptomeningeal
----------------------------------------------------------------------------*Departemen Neurologi FK Universitas Sriwijaya/RSUP Dr. Moh. Hoesin, Palembang. **Departemen Neurologi FK Universitas
Indonesia/RSUPN Dr. Cipto Mangunkusumo, Jakarta. ***RS Kanker Dharmais, Jakarta.
Korespondensi: yunni.diansari@gmail.com
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Vol. 34 No. 4 September 2017 |
Terakreditasi DIKTI Nomor: 12/M/Kp/II/15
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