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Nucleated Cells That May Be Present In CSF

The nucleated cells seen in normal adult CSF are predominantly lymphocytes and monocyte/macrophages. A rare neutrophil may be seen. An increased number of lymphocytes, monocytes, or neutrophils in CSF is termed pleocytosis. Morphologically normal cells can be seen in abnormal numbers in meningitis and inflammation.
The monocyte/macrophage appears when clean up of the CSF is necessary because of degenerating cells and debris, often due to a subarachnoid hemorrhage (SAH) or meningitis.
Cells that may be seen in cerebrospinal fluid may be divided into four categories:
  • Mature peripheral blood cells
  • Immature hematopoietic cells
  • Tissue cells
  • Malignant cells
Tissue cells are often seen in spinal fluid samples. It is important to recognize these cells so that they are differentiated from tumor and blast cells. Pathologists must review any slides that have presumptive malignant cells, unidentified cells, or immature stages of cells, such as blasts. Since criteria for review may vary from one laboratory to another, be sure to check the requirements in your laboratory before reporting the differential.

Cell Type
Appearance of Cell in CSF
Significance
Lymphocytes
  • Low number is normal.
  • Viral meningitis
  • Tubercular meningitis
  • Multiple sclerosis
  • Drug abuse
  • Lymphoma
  • Leukemia
  • Guillain-Barré syndrome
  • Chronic alcoholism
  • Polyneuritis
Monocyte/macrophages
  • Low number is normal.
  • Previous subarachnoid hemorrhage
  • Response to foreign material in the CSF
  • Meningitis
  • Inflammation
Neutrophils
  • Low number is normal following cytocentrifugation.
  • Prominent pleocytosis in bacterial meningitis
  • Early tuberculosis
  • Hemorrhage
  • Cerebral abscess
  • Tumors

Eosinophils
Increased in response to foreign CSF material including:
  • Allergic reaction
    • medications
    • shunts
    • dyes
  • Parasites
  • Fungal meningitis
Choroidal and ependymal cells
  • Epithelial lining cells of the CNS; not clinically significant.
  • May be seen in CSF following neurosurgical procedures.
  • Often seen in clumps with no nuclear or cytoplasmic irregularities.
Malignant cells
  • Metastatic carcinoma
Blast cells
  • Leukemia
  • Lymphoma