Survival and Recurrence in Vitreoretinal Lymphoma Simulating Uveitis at Presentation: The Possible Role of Combined Chemotherapy

Gozzi, Fabrizio; Aldigeri, Raffaella; Mastrofilippo, Valentina; Simone, Luca De; Bolletta, Elena; Marzano, Jacopo; Iannetta, Danilo; Coassin, Marco; Ilariucci, Fiorella; Ferrari, Ângela; Luminari, Stefano; Merli, Francesco; Croci, Stefania; Zerbini, Alessandro; Farnetti, Enrico; Nicoli, Davide; Valli, Riccardo; Tamagnini, Ione; Cavazza, Alberto; Salvarani, Carlo; Fontana, Luigi; Cimino, Luca

doi:10.1080/09273948.2021.1962916

Cited by 4 publications

(3 citation statements)

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“…It must be emphasised that patients later found to be affected by VRL are being referred more frequently to a uveitis specialist because these tumours may mimic inflammatory eye disease [42]. For this reason, recognising VRL, especially, in differential diagnosis with uveitis is a great challenge; the high rate of diagnostic delay worsens not only the visual prognosis, it also, and more importantly, shortens the patient's life [2]. It is important to objectively discriminate between vitreous infiltration in VRL and vitreous inflammation in uveitis.…”

Section: Discussionmentioning

confidence: 99%

“…Vitreoretinal lymphoma (VRL) is the most common uveitis masquerade syndrome and thus a diagnostic challenge [1]. The insidious clinical presentation as chronic and recurrent uveitis, combined with the transient response to lymphocytolytic steroids, leads to diagnostic and therapeutic delay, often resulting in a poor prognosis with high mortality if the central nervous system (CNS) is involved [2]. Therefore, a timely and accurate diagnosis is essential to improve the prognosis of patients with VRL, and overcoming the difficulties encountered in its diagnosis is an urgent need [3].…”

Section: Introductionmentioning

confidence: 99%

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Artificial Intelligence-Assisted Processing of Anterior Segment OCT Images in the Diagnosis of Vitreoretinal Lymphoma

et al. 2023

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Anterior segment optical coherence tomography (AS-OCT) allows the explore not only the anterior chamber but also the front part of the vitreous cavity. Our cross-sectional single-centre study investigated whether AS-OCT can distinguish between vitreous involvement due to vitreoretinal lymphoma (VRL) and vitritis in uveitis. We studied AS-OCT images from 28 patients (11 with biopsy-proven VRL and 17 with differential diagnosis uveitis) using publicly available radiomics software written in MATLAB. Patients were divided into two balanced groups: training and testing. Overall, 3260/3705 (88%) AS-OCT images met our defined quality criteria, making them eligible for analysis. We studied five different sets of grey-level samplings (16, 32, 64, 128, and 256 levels), finding that 128 grey levels performed the best. We selected the five most effective radiomic features ranked by the ability to predict the class (VRL or uveitis). We built a classification model using the xgboost python function; through our model, 87% of eyes were correctly diagnosed as VRL or uveitis, regardless of exam technique or lens status. Areas under the receiver operating characteristic curves (AUC) in the 128 grey-level model were 0.95 [CI 0.94, 0.96] and 0.84 for training and testing datasets, respectively. This preliminary retrospective study highlights how AS-OCT can support ophthalmologists when there is clinical suspicion of VRL.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Artificial Intelligence-Assisted Processing of Anterior Segment OCT Images in the Diagnosis of Vitreoretinal Lymphoma

et al. 2023

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“…A PVRL may develop as an isolated entity or present before or simultaneously with a central nervous system (CNS) lymphoma [ 4 ]. After 16–24 months from PVRL diagnosis, 56–90% of patients develop CNS involvement [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Primary Vitreoretinal Lymphoma: Current Diagnostic Laboratory Tests and New Emerging Molecular Tools

et al. 2022

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Primary vitreoretinal lymphoma (PVRL), a rare aggressive malignancy primarily involving the retina and/or the vitreous, is a major diagnostic challenge for clinicians (who commonly misdiagnose it as chronic uveitis) as well as for pathologists (for biological and technical reasons). Delays in diagnosis and treatment are responsible for visual impairments and life-threatening consequences, usually related to central nervous system involvement. The identification of lymphoma cells in vitreous fluid, obtained by vitrectomy, is required for diagnosis. Of note, the scarcity of neoplastic cells in small volumes of vitreous sample, and the fragility of lymphoma cells with degenerative changes caused by previous steroid use for presumed uveitis makes diagnosis based on cytology plus immunophenotyping difficult. Interleukin levels, immunoglobulin heavy chain or T-cell receptor gene rearrangements, and MYD88 mutation are applied in combination with cytology to support diagnosis. We aim to describe the current laboratory technologies for PVRL diagnosis, focusing on the main issues that these methods have. In addition, new emerging diagnostic strategies, such as next-generation sequencing analysis, are discussed. The genetic profile of PVRL remains largely unexplored. Better knowledge of genetic alterations is critical for precision medicine interventions with target-based treatments of this lymphoma for which no standardised treatment protocol currently exists.

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Interest of Regular Assays of Aqueous Humor Interleukin-10 Levels in Monitoring of Vitreoretinal Lymphoma

Metayer,

Kodjikian,

Nguyen

et al. 2024

Retina

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PURPOSE: To investigate the variation of interleukin-10 (IL-10) levels in the aqueous humor (AH) of patients with vitreoretinal lymphoma (VRL) throughout therapy and follow-up, and analyze the relation of these variations with VRL clinical course and relapse. METHODS: We retrospectively included consecutive patients diagnosed with VRL in a single center. AH IL-10 samples, as well as patient clinical course were evaluated. The response to treatment was evaluated according to the criteria set by the International Primary CNS Lymphoma Collaborative Group. RESULTS: A total of 59 eyes of 34 patients were included. IL-10 levels decreased significantly at first AH sample after therapy induction (median [IQR] 3.0 [2.8-3.6] months) among patients in complete clinical remission (CCR) (p<0.001). Among patients in CCR with residual detectable IL-10 in AH after therapy induction (85.3% systemic chemotherapy, 11.8% intravitreal methotrexate, 2.9% palliative care), 87.5% experienced ocular relapse within 5 years. The detection of IL-10 in AH at the first visit post-induction for CCR obtained a sensitivity of 77.8% [95%CI 0.45-0.96] and a specificity of 96.4% [95%CI 0.82-0.99] to predict ocular relapse. For relapsing eyes (N=26), IL-10 significantly increased between the last IL-10 measurement and the time of the first ocular relapse (p<0.001). In 76.0% of cases, increase in IL-10 was detected earlier than clinical relapse with a mean (SD) of 4.0 (2.4) months. CONCLUSION: The present study suggested the usefulness of IL-10 in the prognosis of VRL. We showed a relation between IL-10 in AH and tumoral activity, and for the first time with disease relapse.

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Survival and Recurrence in Vitreoretinal Lymphoma Simulating Uveitis at Presentation: The Possible Role of Combined Chemotherapy

Cited by 4 publications

References 43 publications

Artificial Intelligence-Assisted Processing of Anterior Segment OCT Images in the Diagnosis of Vitreoretinal Lymphoma

Artificial Intelligence-Assisted Processing of Anterior Segment OCT Images in the Diagnosis of Vitreoretinal Lymphoma

Primary Vitreoretinal Lymphoma: Current Diagnostic Laboratory Tests and New Emerging Molecular Tools

Interest of Regular Assays of Aqueous Humor Interleukin-10 Levels in Monitoring of Vitreoretinal Lymphoma

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