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lymphoma. FCA of 7 cases showed a significant increase in the percentage of B cells in 5 patients, indicating
B cell lymphoma, and NK/T-lymphocyte predominance in 1 case, indicating an NK/T lymphoma. On
analysis of the IgH and TCR genes in CSF of 4 patients, IgH monoclonal was found in 3 cases and TCR
monoclonal in 1 case [Figure 2]. In fact, PCNSL is now one of the most common primary CNS neoplasms
identified by comprehensive CSF cytological studies.

The application of molecular diagnostic techniques, including polymerase chain reaction and next-
generation sequencing in CSF studies is booming in an era of precision medicine [19,20] . These novel
techniques may be used to diagnose neoplastic meningopathy without cytological evidence [19,20] . However a
final diagnosis based only on molecular techniques without morphological or cytological evidence should be
avoided in clinical practice in order to prevent risks of over-diagnosis and misdiagnosis. CSF cytology is still
the cornerstone of neurological diagnosis. The classical CSF examinations, including CSF cytology, still has
their horizon in the era of precision neurology.

DECLARATIONS
Acknowledgments
The authors thank Yi-Ning Yang, Guo-Dong Feng, Jun-Ying He, Hui Bu and Yue-Li Zou for their
correspondence on the information of their CSF lab.

Authors’ contributions
Both authors drafted the manuscript, read and approved the final manuscript.

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Patient consent
Not applicable.

Ethics approval
Not applicable.

Copyright
© The Author(s) 2018.

REFERENCES
1. Dufour H. Classics in cytology. VIII: diffuse meningeal sarcomatosis with invasion of the spinal cord and the spinal roots. Positive
cytological results, especially of the cerebrospinal fluid. 1904. Diagn Cytopathol 1997;17:67-9.
2. Sayk J. The results of the recent cytological studies of cerebrospinal fluid with sedimentation chamber. Arztl Wochensch 1954;9:1042-6. (in
German)
3. Hou XD, Zhou SR. Clinical cerebrospinal fluid cytology. Nanjing: Jiangsu Science and Technology Press; 1985. p. 1-120. (in Chinese)
4. Su XC, Kong FY. Cerebrospinal fluid cytology of neurological disease. Beijing: People’s Military Medical Press; 2001. p. 1-100. (in
Chinese)
5. He JY, Kong FY, Guo L. Dragnosis of clincal cerebrospinal fluid cytology. Shijiazhuang: Hebei Science and Technology Press; 2007. p. 1-150.
(in Chinese)
6. Chen P, Shi M, Feng GD, Liu JY, Wang BJ, Shi XD, Ma L, Liu XD, Yang YN, Dai W, Liu TT, He Y, Li JG, Hao XK, Zhao G. A highly
efficient Ziehl-Neelsen stain: identifying de novo intracellular Mycobacterium tuberculosis and improving detection of extracellular M.
tuberculosis in cerebrospinal fluid. J Clin Microbiol 2012;50:1166-70.
7. Guan HZ, Chen L, Cui LY, Guo YP, Huang Y, Zhou Y, Wang JM, Ren HT. Eosinophilic meningitis caused by angiostrongylus cantonensis:
a clinical and cerebrospinal fluid cytology report of 9 cases. Chin J Neurol 2010;43:268-72. (in Chinese)