Primary intraocular lymphoma: improving the diagnostic procedure.
OBJECTIVE
To analyze the clinical features of primary intraocular lymphoma (PIOL) and to describe cytochemical and immunocytochemical findings of the vitreous specimens as well as the reasons for delayed diagnosis of PIOL.


METHODS
Prospective noncomparative study.


METHODS
Eleven patients referred to the uveitis or medical retina units, Department of Ophthalmology, University of Helsinki, were diagnosed as having PIOL between 2000 and 2005. The median follow-up of the patients was 32 months.


METHODS
Clinical features and diagnostic workup of uveitis were described. Twelve vitrectomies were performed on 9 patients. The first 5 biopsies were fixed in an equal volume of 50% alcohol. The specimens of the next 7 vitrectomies were handled without alcohol, and tissue culture medium was added to the samples.


METHODS
Clinical features of PIOL, intervals from ocular symptoms and from first ophthalmological examination to diagnosis, and the role of a proper handling of the vitreous sample in the diagnosis of PIOL.


RESULTS
Six females (54%) and 5 males (46%) (median age, 61 years) were included. Ten patients had ocular symptoms for 1 to 30 months (median, 8) before the first contact with an ophthalmologist. Uveitis was bilateral in 9 patients. Vitreitis was seen in all patients, and it was severe in 8. Fundus lesions dominated in 3 patients. Six patients lost useful vision in one eye before the diagnosis of PIOL. Cytologic and immunohistochemical stainings prepared of the unfixed vitreous specimens showed PIOL in 6 patients. The samples fixed in alcohol were nondiagnostic in 4 patients, and in them, verification of diagnosis was based on brain biopsy (3) or cerebrospinal fluid (1) findings. Seven patients died due to primary nervous system lymphoma.


CONCLUSIONS
Diagnosis of PIOL is difficult but can be improved. Severe bilateral vitreitis in an elderly patient is a characteristic finding of PIOL. Alcohol fixation may jeopardize the identification of PIOL cells in the vitreous sample. Optimal handling of the vitreous specimens and examination of the slides by an experienced cytopathologist are critical in the diagnostic workup of PIOL.
Karma
Anni
A
Department of Ophthalmology, University of Helsinki, Helsinki, Finland. anni.karma@fimnet.fi
von Willebrand
Eva O
EO
Tommila
Petri V
PV
Paetau
Anders E
AE
Oskala
Pertti S
PS
Immonen
Ilkka J
IJ
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001921:Brain / Q000473:pathology; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D005134:Eye Neoplasms / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006651:Histocytochemistry; D006801:Humans; D007150:Immunohistochemistry; D007249:Inflammation / Q000209:etiology; D008223:Lymphoma / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009423:Nervous System Neoplasms / Q000401:mortality; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D014605:Uveitis / Q000209:etiology; D014822:Vitreous Body / Q000473:pathology