Diagnostic Accuracy of Cell Block Preparations and Clinical Features Affecting It in Vitreoretinal Lymphoma.

Satoru Kase,Kenichi Namba,Keitaro Hase,Kazuomi Mizuuchi,Takako Ito,Nobuyoshi Kitaichi,Daiju Iwata,Kayo Suzuki,Susumu Ishida

doi:10.3390/jcm11051391

Satoru Kase, Kenichi Namba + Show 7 more

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https://doi.org/10.3390/jcm11051391

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Abstract

Purpose: The purpose of this study was to examine the diagnostic accuracy of the cell block (CB) method and clinical features affecting it in patients with vitreoretinal lymphoma (VRL). Methods: This study enrolled 38 eyes in 33 VRL patients, and 7 eyes in 7 patients with idiopathic uveitis who underwent diagnostic vitrectomy. Medical records including the results of CB cytology, interleukin (IL)-10/-6 concentrations, and immunoglobulin heavy chain gene (IgH) rearrangement were retrospectively searched. Results: Patients with VRL comprised 16 women and 17 men, and the age of onset ranged from 44 to 85 years (mean: 70 years). CB preparations detected large malignant cells in 35 eyes (92%), whereas the other 3 VRL eyes were negative. Two of the latter three eyes showed subretinal infiltrates, which existed in 7 of 35 CB-positive eyes. Intravitreal IL-10 and -6 concentrations were 1866 ± 4088 pg/mL and 98 ± 139 pg/mL, respectively, and the rate of IL-10/-6 >1 was 86.9%. The presence of IgH monoclonality was 63.2%. In patients with uveitis, CB specimens revealed no atypical but small inflammatory cells. IL-6 concentration was 311.1 ± 240 pg/mL, whereas IL-10 was undetectable in six eyes, and the IL-negative rate was 85.7%. Six eyes (85.7%) with uveitis showed no IgH monoclonality. Conclusions: Diagnostic accuracy of CB preparations in VRL could achieve an equivalent outcome to IL ratio calculation and IgH monoclonality detection. The appearance of subretinal infiltrates may diminish the CB positivity.

Highlights

Intraocular lymphoma is a vision- and life-threatening intraocular tumor
Diagnosis of vitreoretinal lymphoma (VRL) was made based on ophthalmological findings, including optical coherence tomography (OCT) findings such as subretinal/sub-RPE infiltration, as well as responsiveness to intravitreal methotrexate injections (IV-MTX); OCT findings such as sub-RPE infiltration [12] before vitrectomy or treatments for VRL; and the results of pathological tests including cytology, IL-10/-6 concentrations determined by conventional enzyme-linked immunosorbent assay (ELISA), and monoclonal immunoglobulin heavy chain gene (IgH) rearrangement detection
Malignant cells were cytologically detected in 35 eyes (92.1%) using cell block (CB) preparations

Summary

Introduction

The lymphomas can be divided into primary vitreoretinal lymphoma (PVRL), vitreoretinal lymphoma (VRL) from primary central nervous system lymphoma (PCNSL), and intraocular metastasis by systemic malignant lymphoma (secondary lymphoma). When the patients have medical histories such as PCNSL or systemic lymphoma, the diagnosis of VRL may not be difficult in selected patients. Pathological tests using the vitreous are required to make a correct diagnosis. Identification of malignant cells by cytological examination has been the most convincing evidence for diagnosis of VRL [2]; the diagnostic rates by cytological examinations are not high based on multicenter analyses in Japan [3]. That is why other pathological tests including intravitreal interleukin (IL)-10/-6 concentrations and immunoglobulin heavy chain gene (IgH) rearrangement combined with cytology might be recently considered a new stringent gold standard for diagnosis of VRL [4] and are helpful given the low cytological positivity [5]

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