Primary Intraocular Lymphoma Diagnosed by Transvitreal Fine-Needle Aspiration Biopsy

Abstract

Purpose:: Primary intraocular lymphoma (PIL) is an uncommon lymphoid neoplasia that is frequently associated with independent foci of primary CNS lymphoma. Typical ocular features of PIL include vitreous cells and multifocal geographic yellow sub-RPE infiltrates. Although vitreous biopsy is the standard diagnostic method for this disorder, this procedure occasionally yields inconclusive results. The purpose of this study was to describe a clinical experience with transvitreal fine-needle aspiration biopsy (FNAB) for selected patients with suspected primary intraocular lymphoma.

Methods:: Transvitreal fine-needle aspiration biopsy (FNAB) was performed in seven patients with suspected PIL. These included three patients with few or no clinically demonstrable vitreous cells, one patient with a single nodular white fundus lesion and no vitreous cells, one patient who had previously undergone a nondiagnostic vitreous biopsy, and two patients with hemorrhagic retinal infiltrates that resembled viral retinitis. All patients had at least one infiltrative retinal, subretinal or choroidal mass that was ≥ 1.5 mm thick by B-scan ultrasonography.

Results:: FNAB confirmed PIL in all seven patients. A prominent feature of virtually all of the aspirates was a large proportion of dead lymphoid cells in the background. Viable tumor cells ranged from relatively homogeneous small round cells with large nucleus to cytoplasm ratio to pleomorphic large cells with irregular knob-like nuclear protrusions. Immunocytochemical stains for lymphoid markers were frequently helpful in making the pathologic diagnosis of lymphoma. No visually significant complications of the biopsy occurred in any of these patients.

Conclusions:: FNAB was a valuable diagnostic study in the described subgroup of patients with suspected intraocular lymphoma. FNAB should be considered as a diagnostic option in selected patients with suspected primary intraocular lymphoma, especially if there are few or no vitreous cells or a prior diagnostic vitrectomy has been inconclusive.

Keywords: oncology • pathology: human • tumors