Biopsy techniques and yields in diagnosing primary intraocular lymphoma

Gonzales, John A.; Chan, Chi Chao

doi:10.1007/s10792-007-9065-6

Cited by 99 publications

(116 citation statements)

References 54 publications

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“…[4][5][6][7]9,10,20,21,26,[30][31][32][33][34][35] These include: (1) vitreous 'filtration'; (2) a celloidin bag technique; (3) cytospin and (4) cell block preparation. We are most familiar with the latter two methods, whereby the vitreous is spun at 500 r.p.m.…”

Section: Sample Handling and Processingmentioning

confidence: 99%

“…Should sufficient material be available for examination, investigation of the vitreous specimens for rearrangements of the immunoglobulin heavy chain gene using PCR provides further evidence of the neoplastic nature of the lymphocytic infiltrate in retinal lymphoma. 17,18,20,22,25,35,49,51 Biochemical analysis of the vitreous specimen for interleukin ratios (IL10 : IL6) may also support the diagnosis of retinal lymphoma. [52][53][54] If possible, retinal lymphoma should be distinguished from other types of intraocular lymphoma, namely primary uveal lymphoma and secondary (metastatic) intraocular lymphoma.…”

Section: Neoplastic Diseasementioning

confidence: 99%

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The pathologist's perspective on vitreous opacities

Coupland

2008

Eye

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Section: Sample Handling and Processingmentioning

confidence: 99%

Section: Neoplastic Diseasementioning

confidence: 99%

The pathologist's perspective on vitreous opacities

Coupland

2008

Eye

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“…It is well known that lymphoma cells removed from the vitreous are liable to rapid degeneration unless fixed or exposed to tissue culture medium in a timely manner. 3,4,8 In this study, the core vitreous biopsy and PPV were performed and fixed by the same surgeon and the specimens handled by the same biomedical scientist in the histopathology lab according to standard operating protocols. No tissue was lost during the transport and handling of the fluids.…”

Section: Discussionmentioning

confidence: 99%

“…One is a vitreous biopsy that targets the core vitreous (1-2 ml obtained) and the other is a formal diagnostic pars plana vitrectomy (PPV) that samples the core and the cortical vitreous, resulting in a larger volume of fluid (50-100 ml), collected in a vitrectomy cassette/bag comprising the dispersed vitreous gel and balanced salt solution (BSS). 3 Although investigators have focused on stopping steroid treatment temporarily to enhance cell viability, prompt processing of the sample, use of tissue culture medium and the use of cytokine assay and PCR for monoclonal testing to improve the diagnostic yield in cases of suspected intraocular lymphoma, 3,4 one simple observation has been overlooked in our experience. In our institution, careful clinical observations have noted a differential distribution of vitreous cells in patients presenting with vitreous cellular infiltrates.…”

Section: Introductionmentioning

confidence: 99%

“…Some evidence highlights false negative rates with core vitreous biopsy, with patients exposed to repeated procedures and risk of complications. [3][4][5] We wanted to test whether the cellularity of vitreous biopsy obtained from a core vitreous biopsy would differ to that obtained from the cortical vitreous (sampled with a PPV). There are important reasons why this knowledge would be useful: to influence sampling technique; to reduce repeat procedures because of false negatives hence preventing repeat patient hospital visits with cost saving; to allow sufficient material to be obtained for ancillary investigations to secure a firm diagnosis and to reduce treatment delay in cases of lymphoma.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic cellular yield is superior with full pars plana vitrectomy compared with core vitreous biopsy

Mudhar

Sheard

2012

Eye

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Purpose Vitreous biopsy for the cytological assessment of suspected intraocular lymphoma and vitritis of uncertain aetiology is a standard investigation. The types of specimens generated and the diagnostic rate are variable within and between centres. There are many reasons for this but one observation that has not been considered previously is the differential distribution of cells in the vitreous gel. To test this possibility, five consecutive patients with suspected vitreous involvement by lymphoma or vitritis of uncertain aetiology underwent a core vitreous biopsy immediately before a planned full pars plana vitrectomy (PPV) and the cellularity of the two sampling techniques compared. Methods A prospective study of five consecutive patients requiring vitreous sampling to secure a firm diagnosis. For each of five patients, the core vitreous biopsy specimen was received in a universal tube and the PPV specimen was received in a vitreous cassette. Fluid (0.25 ml) was removed from both specimens, centrifuged and haematoxylin and eosin (H&E) stained slides prepared per sampling method. The slides were examined with a light microscope, the most cellular field selected and the number of cells per mm 2 counted and compared between sampling techniques. Results PPV specimen's, revealed a cellularity range that was 7.4 to 78 Â (average 31 Â ) greater than a core vitreous biopsy. In the two cases of a final diagnosis of intraocular lymphoma, the vitreous core biopsy was non-diagnostic. Furthermore, the PPV specimen generated additional cellular material for numerous ancillary investigations to permit a secure diagnosis. Conclusions The results of this differential vitreous sampling study has strengthened our anecdotal slit lamp clinical observations that inflammatory cells and lymphoma cells are concentrated more in the cortical vitreous. Therefore, vitreous cells have less chance to be sampled if a single core vitreous biopsy is performed. Indeed, the two cases of confirmed lymphoma generated a non-diagnostic core vitreous biopsy. In our centre, this study has lead to PPV being performed as a gold standard on all patients with suspected intraocular lymphoma or vitritis of uncertain aetiology.

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Vitreoretinal Presentation of Secondary Large B-Cell Lymphoma in Patients With Systemic Lymphoma

et al. 2013

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Intraocular lymphomas represent a diverse group of hematologic malignant neoplasms involving different tissues within the eye. Predominant involvement of the retina and vitreous without uveal infiltration in systemic lymphoma, mimicking a primary vitreoretinal lymphoma, is extremely rare. Our study emphasizes the importance of systemic evaluation in addition to central nervous system evaluation in all patients with newly diagnosed vitreoretinal lymphoma.OBJECTIVE To determine the incidence of secondary intraocular lymphoma presenting as vitreoretinal infiltrates without central nervous system involvement, mimicking primary vitreoretinal lymphoma in patients with systemic lymphoma.DESIGN Retrospective review of all vitreous aspiration biopsy samples acquired because malignant neoplasm was suspected clinically that were obtained at our institution from January 1, 2000, through December 31, 2010. Review included patient clinical history, radiographic study findings, cytologic and/or histologic preparations, immunophenotypic study findings, treatment, and outcomes. SETTING Mayo Clinic pathology database.PARTICIPANTS Fifty-five patients with vitreous specimens available for review.EXPOSURES Vitreous aspiration biopsy. MAIN OUTCOME AND MEASURE Confirmation of the diagnosis of diffuse large B-cell lymphoma (DLBCL).RESULTS Of the 55 patients with vitreous specimens available for review, 3 (5%) had a DLBCL infiltration in the vitreous without any central nervous system involvement as a manifestation of systemic lymphoma. All 3 patients were men, aged 54, 66, and 73 years, and had blurred vision and floaters for several weeks before undergoing diagnostic vitrectomy. Ophthalmic examinations revealed clumps of vitreous cells but no choroidal involvement. One patient had no history of lymphoma; the diagnosis of vitreoretinal lymphoma was followed by DLBCL after a lymph node biopsy. The other 2 patients had low-grade B-cell lymphoma and chronic lymphocytic leukemia for 29 and 7 months before large-cell transformation in the eye. Patients were treated with systemic chemotherapy plus intraocular injections of rituximab or methotrexate sodium. CONCLUSIONS AND RELEVANCEVitreoretinal symptoms of DLBCL in patients with systemic lymphoma may be more frequent than previously thought (5% in our study). Not all lymphomas with vitreoretinal involvement represent primary intraocular lymphomas; thorough ophthalmologic evaluation in patients with visual symptoms and complete staging in patients with documented ocular lymphoma are of utmost importance.

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Biopsy techniques and yields in diagnosing primary intraocular lymphoma

Cited by 99 publications

References 54 publications

The pathologist's perspective on vitreous opacities

The pathologist's perspective on vitreous opacities

Diagnostic cellular yield is superior with full pars plana vitrectomy compared with core vitreous biopsy

Vitreoretinal Presentation of Secondary Large B-Cell Lymphoma in Patients With Systemic Lymphoma

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