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Diagnostic vitrectomy
서울성모병원 안과
김규섭
primary intraocular lymphoma : masquerade syndrome
diagnostic delay (11-21.4 months)
- 60-80% : CNS tumor within 29 months
- poor Px : 80% died within 2 years
*** Clinical suspicion of intraocular lymphoma : most important
- severe vitritis and poor VA –> vitrectomy
2009 Ocular Immunology & Inflammation
Diagnositc vitrectomy
• lymphoma cell : fragile and easily degenerate in the vitreous
-> appropriate handling and processing : critical
-> ocular pathologist involvement : essential
• stop or taper steroid before vitrectomy : for better diagnostic yield
• Obtaining
- undiluted vitreous (1-2 mL)
- diluted vitreous (3-5 mL)
• Handling
- cell culture medium (RPMI, Roswell Park Memorial Institute)
or normal saline or direct transfer
- sent immediately to an awaiting cytologist
- Importantly, alcohol fixation may jeopardize the identification of PIOL cells
in the vitreous sample. No fixative is required.
<Diagnostic testing>
• undiluted vitreous (1-2 mL) -> cytocentrifuge
- cells : cytology, immunohistochemistry
- supernatant : cytokine analysis, molecular analysis with PCR
• diluted vitreous (3-4 mL)
- flow cytometry
- bacterial, funagl culture
<Diagnostic testing>
• Cytology : gold standard
- atypical lymphoma cell 확인 (mostly B cell origin)
** The monoclonality supports the cytological diagnosis of lymphoma
• Immunohistochemistry
- stain cell surface marker
- differentiate B- (CD19, 20…) and T-cell (CD3…) origin
• Flow cytometry
- analyze several different markers
- require fewer cells than slide-based immunohistochemistry
• microdissection and PCR
- DNA extracted from B-lymphocyte is amplified with PCR
- detecting clonal rearrangement of the Ig heavy chain (CDR3)
• Cytokine analysis
- IL 10 (malignant B-cell) / IL-6 (Inflammatory cells) ratio > 1.0
(suggestive of PIOL)
* Chorioretinal Bx:
- lymphoma cell: typically between RPE and Bruch’s memb
may invade vitreous
- Superficial : necrotic
- Deep : viable
2009 Ocular Immunology & Inflammation