title: Vitreoretinal lymphomas misdiagnosed as uveitis: Lessons learned from a case series.
abstract: OBJECTIVE
  To present challenging cases of vitreoretinal lymphoma (VRL) that was misdiagnosed as uveitis because of the apparent intraocular inflammation. At the light of the new classification of intraocular lymphomas, we detail the characteristics that masqueraded the tumors and the clinical aspects that guided us to the correct diagnosis.
  
  
  METHODS
  We retrospectively reviewed the patients referred to our uveitis service between January 2006 and December 2014.
  
  
  RESULTS
  Seven patients referred with a presumptive diagnosis of idiopathic uveitis received a final diagnosis of VRL. The median time between the onset of symptoms and definitive diagnosis was 25 months for these complex cases. The median time from presentation at our clinic to final diagnosis was 1 month. The described clinical features including dense vitreous cells and subretinal infiltrates were characteristic and tend to be present in all these chronically ill patients. Vitreous samples were collected, and all demonstrated the pathognomonic tumor cells, the specific immunoglobulin heavy chain gene rearrangements, and an interleukin (IL)-10 to IL-6 ratio >1.
  
  
  CONCLUSIONS
  VRLs are severe diseases with a poor prognosis that may be misdiagnosed as idiopathic inflammatory conditions of the eye. Treatment with steroids may occult the tumors and delay the correct diagnosis. Appropriate evaluation may prompt to a timely vitreous sampling and therefore to a faster diagnosis in these peculiar cases where the correct diagnosis was delayed by several months.
authors.affiliation: Department of Ophthalmology, Uveitis Service, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cimino
authors.affiliation: Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Coassin
authors.affiliation: Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Chi-Chao
authors.initials: CC
authors.lastname: Chan
authors.affiliation: Department of Ophthalmology, Uveitis Service, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Marchi
authors.affiliation: Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Belpoliti
authors.affiliation: Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fanti
authors.affiliation: Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iovieno
authors.affiliation: Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Fontana
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D003951:Diagnostic Errors; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007378:Interleukins / Q000378:metabolism; D064090:Intraocular Lymphoma / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019572:Retinal Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014605:Uveitis / Q000175:diagnosis*; D014821:Vitrectomy; D014822:Vitreous Body / Q000378:metabolism / Q000473:pathology* / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D007378:Interleukins