Abstract
BackgroundVitreoretinal lymphoma (VRL) is a life- and sight-threatening disorder. The aim of this study was to analyze the usefulness of the cell block method for diagnosis of VRL.MethodsSixteen eyes in 12 patients with VRL, and 4 eyes in 4 patients with idiopathic uveitis presenting with vitreous opacity were enrolled in this study. Both undiluted vitreous and diluted fluids were isolated during micro-incision vitrectomy. Cell block specimens were prepared in 19 eyes from diluted fluid containing shredding vitreous. These specimens were then submitted for HE staining as well as immunocytological analyses with antibodies against the B-cell marker CD20, the T-cell marker CD3, and cell proliferation marker Ki67. Conventional smear cytology was applied in 14 eyes with VRL using undiluted vitreous samples. The diagnosis of VRL was made based on the results of cytology, concentrations of interleukin (IL)-10 and IL-6 in undiluted vitreous, and immunoglobulin heavy chain gene rearrangement analysis.ResultsAtypical lymphoid cells were identified in 14 out of 15 cell block specimens of VRL (positive rate: 93.3 %), but in 5 out of 14 eyes in conventional smear cytology (positive rate: 35.7 %). Atypical lymphoid cells showed immunoreactivity for CD20 and Ki67. Seven cell block specimens were smear cytology-negative and cell block-positive. The cell block method showed no atypical lymphoid cells in any patient with idiopathic uveitis.ConclusionsCell block specimens using diluted vitreous fluid demonstrated a high diagnostic sensitivity and a low pseudo-positive rate for the cytological diagnosis of VRL. The cell block method contributed to clear differentiation between VRL and idiopathic uveitis with vitreous opacity.Electronic supplementary materialThe online version of this article (doi:10.1186/s13000-016-0479-1) contains supplementary material, which is available to authorized users.
Highlights
Vitreoretinal lymphoma (VRL) is a life- and sight-threatening disorder
The recent study showed that the diagnostic power of conventional cytology was not high compared to other laboratory tests including the ratio of IL-10/IL-6 and immunoglobulin heavy chain (IgH) gene rearrangement analysis [2]
This study demonstrated that, cytologically, malignant cells were detected in only 35.7 % of VRL patients based on conventional smear cytology, in which the positive rate determined in this study seems to be consistent with previous reports [8, 12]
Summary
The aim of this study was to analyze the usefulness of the cell block method for diagnosis of VRL. It was proposed that the detection of malignant lymphoma cells using cytological examination could have a definitive impact on making a diagnosis of VRL [4]. Cytological examinations using other samples such as vitreous infusion fluids obtained in vitreous surgery may be useful to complement the differential diagnoses of VRL/uveitis. Matsuoka et al reported that smear cytology using vitreous infusion fluid contributed to the diagnosis of VRL in 2 patients [5]. With recent advances in pathological techniques, cell block preparations using vitreous infusion fluids could be used for the improvement of the diagnostic efficacy for VRL/uveitis [6, 7]. There have been no reports comparing the diagnostic utility for VRL between conventional smear cytology and cell block preparations
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