title: Diagnostic efficacy of cell block method for vitreoretinal lymphoma.
abstract: BACKGROUND
  Vitreoretinal 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.
  
  
  METHODS
  Sixteen 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.
  
  
  RESULTS
  Atypical 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.
  
  
  CONCLUSIONS
  Cell 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.
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo City, Hokkaido, 060-8638, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kase
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo City, Hokkaido, 060-8638, Japan. knamba@med.hokudai.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Namba
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo City, Hokkaido, 060-8638, Japan.
authors.forename: Daiju
authors.initials: D
authors.lastname: Iwata
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo City, Hokkaido, 060-8638, Japan.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Mizuuchi
authors.affiliation: Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Kitaichi
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo City, Hokkaido, 060-8638, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tagawa
authors.affiliation: Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Okada-Kanno
authors.affiliation: Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Matsuno
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo City, Hokkaido, 060-8638, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Ishida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D015321:Gene Rearrangement; D050438:Genes, Immunoglobulin Heavy Chain / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry; D064090:Intraocular Lymphoma / Q000737:chemistry / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015864:Panuveitis / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D019572:Retinal Neoplasms / Q000737:chemistry / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D013048:Specimen Handling / Q000379:methods*; D016707:Tissue Fixation; D014821:Vitrectomy; D014822:Vitreous Body / Q000737:chemistry / Q000473:pathology* / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor
keywords: CD20; Cell block; Cytology; Lymphoma; Masquerade syndrome; Uveitis