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J. L. Davis, T. A. Albini, E. Mandelcorn; Diagnostic Importance of T lymphocytes in Vitreous Specimens From Patients With Lymphoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4831.
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© ARVO (1962-2015); The Authors (2016-present)
To report the significance of T cell predominance in intraocular specimens.
Retrospective, interventional case series. Participants were 10 patients with a predominance of T cells on flow cytometry and a final diagnosis of lymphoma were identified from a series of patients who underwent diagnostic vitrectomy with flow cytometry and gene rearrangement studies. The biopsy specimens were collected by pars plana vitrectomy from the vitreous, subretinal space or choroid. Cytology, polymerase chain reaction (PCR) tests for T and B cell gene rearrangement, and flow cytometry for immunophenotyping were used to characterize the specimens.
We identified 10 patients with a majority of T cells on vitreous diagnostic specimens who had a final diagnosis of lymphoma out of a total 72 patients with intraocular lymphoma of all cell types. This included 3 cases of mycosis fungoides associated intraocular lymphoma, 2 cases of T cell enriched B cell lymphoma, 2 cases of adult T cell leukemia/lymphoma associated with human T cell lymphotropic virus type I (HTLV-1), 1 case of T cell chronic lymphocytic leukemia (CLL) lymphoma, and 2 cases of primary intraocular T cell lymphoma. Flow cytometric immunophenotyping of the biopsy specimens showed a predominant T cell population in each case. Cytology and immunogenotyping using PCR supported the diagnosis, as well as consistent medical evaluation and course.
T cells identified in vitreous or retinal biopsy may indicate a lymphomatous process including primary T cell lymphoma or intraocular metastasis of systemic lymphoma. T cell enriched B-cell lymphoma is a special subset of B cell lymphoma that presents with T cell predominance possibly related to an inflammatory response to malignancy. Combining techniques such as flow cytometry, gene rearrangement, and cytology to characterize vitreous diagnostic specimens is helpful in understanding and managing this rare ocular malignancy.
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