An Analysis of CNS Tumors in Squash Preparations with Histological Correlation.

The Brain Is The Most Vital Organ In Our Body. Tumors Of The Brain Have Unique Characteristics That Set Them Apart From Neoplastic Processes Elsewhere In The Body. Even Though They Amount To Less Than 2% Of All Malignant Neoplasms Their Increased Incidence In Recent Years Has Created Great Interest In Studying Them Intraoperative Consultation Is An Important Component In The Surgical Management Of Brain Tumors. Critical Decisions Regarding Treatment And Extent Of Surgical Aggression Can Sometimes Depend On An Appropriate Intraoperative Cytodiagnosis. At The Operating Table Many A Times The Neurosurgeon Wants To Know If The Tissue Taken For Biopsy Is From A Representative Site. The Pathologist Has To Bear All This In Mind And Must Be Able To Arrive At A Diagnosis While The Patient Is At The Operating Table. The Procedure Adopted To Achieve All These Parameters Must Be Simple, Easy To Perform, Rapid And Accurate. Crush Cytology Could Meet Most Of These Requirements. Dr. William Cone Was An Early Proponent Of This Technique As Were Dorothy Russell And Lucein Rubinstein. Small Fragments Of Tissue Are Crushed Between Two Slides And Then Pulled Apart To Produce Two Thin Well Prepared Smears. It Takes Less Than 5 Minutes To Prepare And Stain The Smear. In Neurosurgical Practice A Rapid Pathological Diagnosis Of The Space Occupying Lesion Of The Nervous System Helps The Surgeon To Monitor And Modify The Approach At Surgery. If The Biopsy Tissue Reveals A Benign And Surgically Treatable Condition It May Be Vital To Proceed For Complete Resection By Craniotomy. Hence It Is Vital To Obtain An Accurate Pathological Diagnosis Of The Lesion While The Patient Is Still On The Operating Table. The Capability Of Diagnosing A Lesion From A Small Tissue Within A Brief Period Of Time Is Difficult With Other Methods. In Experienced Hands The Smear Technique Attains A High Degree Of Accuracy. But Errors Do Occur And In That Case Decision Should Always Be Made On The Basis Of H&E Stained Paraffin Section. Hence Histopathology Is Still The Gold Standard In Diagnosis Of CNS Tumors Though Squash Preparation Has Its Advantages In Terms Of Rapidity And Timely Patient Management. Interpretation Of Crush Cytology Is Based On The Appraisal Of Many Regions Of A Smear And Often On One Or More Smears From The Same Biopsy But Occasionally Diagnosis Can Be Made From A Single Field Which May Be Representative. Thus Tissue Smears Are Not Purely Cytological Preparations, Some Intrinsic Architecture Still Remains. It Is Important To Have A Proper Approach To The Examination Of Smears. The Entire Clinical History, Radiographic And CT Findings Should Be Known To The Neuropathologist. In Case Of Difficulties He/She Should Not Hesitate To Discuss With The Neurosurgeon. As In Any Branch Of Diagnostic Histopathology Or Cytopathology It Is Only With Experience, That One’s Diagnostic Expertise Can Improve. It Is Fair To Say That One Can Attain An Accurate Diagnosis In 80-90% Of Smears. Crush Cytology Is A Simple, Safe And Easily Accessible Procedure But Still It Can Only Be Used As A Diagnostic Adjunct To Histopathology Which Is The Gold Standard For Diagnosing CNS Lesions. An Analysis Of Brain Tumors Received At Stanley Medical College, Pathology Department Was Done By Squash Preparation With Histopathological Correlation To Evaluate The Usefulness Of This Procedure