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Kenji Nagata, Tohru Inaba, Koji Kitazawa, Yuki Sekiyama, Shigeru Kinoshita, Chie Sotozono; Diagnostic significance of the vitreous fluid of patients with intraocular B-cell lymphoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4090.
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© ARVO (1962-2015); The Authors (2016-present)
Intraocular lymphoma (IOL) is a rare yet fatal disease that often masquerades as uveitis. Cytopathologic diagnosis of IOL is difficult because of the fragility and paucity of the lymphoma cells in the vitreous. The purpose of this study was to investigate the diagnostic significance of various types of analysis in the vitreous fluid of patients with intraocular B-cell lymphoma.
We retrospectively evaluated 21 eyes of 15 patients with intraocular B-cell lymphoma. Undiluted and diluted vitreous samples were collected from those patients during pars plana vitrectomy. Cytological analysis, the levels of interleukin (IL)-10 and IL-6, and immunoglobulin heavy chain (IgH) gene rearrangement were examined by using undiluted vitreous samples. Diluted vitreous samples were examined by flow cytometric analysis.
The patients were comprised of 7 males and 8 females (mean age at the time of diagnosis: 73.0 years). Cytological analysis detected class V in 6 of 18 eyes (33.3%), and greater than class III in 13 of 18 eyes (72.2%). A ratio of vitreous IL-10 to IL-6 greater than 1.0 was found in 14 of 20 eyes (70%). Polymerase chain reaction examination detected IgH gene rearrangement in the vitreous in 9 of 16 eyes (56.3%). Flow cytometric analysis detected a more than 5% ratio of CD19 or CD20 positive cells (B-cell) in the CD45 positive cells (lymphocytes) in 16 of 21 eyes (76.2%).
Cytokine analysis and flow cytometric analysis of the vitreous sample were equally useful for the diagnosis of IOL. It is important to examine clonality when flow cytometric analysis detects a more than 5% B-cell ratio in all lymphocytes.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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