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Pathology/CSF Pathology Report--lymphocytes


QUESTION: CSF total protein = 46 = high (normal = 45 mg/dL or less)
(albumin WNL at 25)

CSF IgG = 4.1 = high (normal 3.4 mg/dL or less
CSF total cell counts (RBC, WBC) = WNL

CSF WBC cell differential*: 90% lymphocytes; 10% monocytes
*not sure how they do a differential if WBC = WNL (aren't there too few cells?)

CSF pathology report: negative for malingnancy, but:
Dx = Increased number of small mature appearing lymphocytes and rare activated forms, few monocytes and rare neutrophils.

Is this a 'normal' Dx??? They were looking for signs of chronic infection of CNS, but, didn't seem bothered by the CSF pathology report. I don't understand what the pathology report is saying.

ANSWER: Hello Karen:

The CSF report does not show evidence of cancer cells, which is good news.

The proteins and specific proteins albumin are within range.
The white cell count is also WNL that is within normal limits. Of these majority are lymphocytes which are cells normally seen in chronic infection. However their numbers are not elevated to indicate infection.

Overall the report is not clinically significant

---------- FOLLOW-UP ----------

QUESTION: (1)Thanks so very much for the answer. Could IV Ceftriaxone (x 30 days) 3 months prior to the LP have potenially masked chronic infection markers in the CSF? Regardless, I think I am understanding better now.

(2)I forgot to post originally that CSF IgG was H(igh), but, intrathecal IgG synthesis was L(ow). Is this a normal finding? Or, is there potential significance with respect to blood-brain-barrier issues? (Where is the IgG coming from to be elevated in the CSF if it's not being produced intrathecally? It was not a traumatic tap.)


Ceftriaxone is a strong antibiotic and will help reduce infection, it will not mask chronic infection. The current CSF values do not indicate presence of infection.
The CSF IgG is minimally elevated, and cause for elevation is either increase in inteathecal IgG or breach in blood brain barrier (BBB).
If the BBB is intact and with minimal elevation in IgG and low inteathecal it is possible that the patient with these values is stable and the IgG is slowly reverting to normal range and will stabilize  it is at the point of stabilize soon.

The report is not suggestive of any infection at present,


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Neha Dahiya MD


Help patients understand the medical terminology of their lab results and / or tissue biopsy reports.


I am a pathologist and director of clinical laboratory services. I have been a practicing pathologist for last 9 years in a 350 bed multi specialty hospital laboratory in India.

Indian association of pathologists and microbiologists.
International Academy of Cytology
International association of Pathologists - Indian division
Indian association of Cytology

MD (pathology) MBA

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