The Role of Flow Cytometry in the Diagnosis of Intraocular Lymphoma
H Olteanu, AM Harrington, SH Kroft. Medical College of Wisconsin, Milwaukee, WI
Background: Intraocular lymphoma (IOL) is a difficult diagnosis to establish, particularly due to its ability to mimic other ophthalmologic conditions and the limited material available for examination. Patients (pts) with vitritis of unknown cause usually undergo a diagnostic vitrectomy for a suspected intraocular infection or malignancy. For IOL, cytology is often cited as the “gold standard”, although adjunct techniques, such as flow cytometry, molecular studies, and cytokine measurement, are also used. We report our findings in a series of pts with vitritis of unknown etiology.
Design: 11 consecutive pts (14 eyes) with posterior segment inflammation underwent pars plana vitrectomy for diagnostic purposes. All samples underwent morphologic and flow cytometry (FC) evaluation, and 8/11 also had PCR for EBV, HSV, VZV, CMV, and Toxoplasma. Four-color FC was performed with an antibody panel including, at a minimum, CD5, CD19, kappa and lambda. Clinical data were available from chart review.
Results: The pts consisted of 4 men and 7 women, mean age of 59 years (range, 14-82), and a median follow-up of 12 months (11-38). 3 pts had a history of diffuse large B-cell lymphoma (DLBCL) involving the CNS, calf, and maxillary sinus, respectively; 2 had prior acute lymphoblastic leukemia; and 1 had chronic lymphocytic leukemia/small lymphocytic lymphoma. 2 pts had a history of kidney transplant and 1 a prior allogeneic stem cell transplant. FC in 4/11 (36%) pts demonstrated the presence of a light-chain restricted B-cell population with high forward light scatter, consistent with large B-cell lymphoma. Of these, 2 had prior DLBCL (CNS and calf), and one was a kidney transplant patient. EBV(+) PCR was + in this last patient, and the eye was the only clinical site of involvement. All patients with FC findings of DLBCL had atypical cells on cytologic examination, although a definite diagnosis of lymphoma was not rendered on a morphologic basis alone. In the 7 patients with negative FC, PCR was CMV(+) in 2 patients and HSV(+) in 1 patient. The remaining patients did not have any positive diagnostic findings, including 1 with a negative conjunctival biopsy.
Conclusions: Our study shows that FC is an effective method for diagnosing IOL. Although follow-up was limited, none of the patients with negative FC developed lymphoma. Interestingly, one of the IOL DLBCLs occurred in a kidney transplant patient with + EBV by PCR, thus qualifying as a post-transplant lymphoproliferative disorder (PTLD). There are few case reports of isolated IOL PTLDs, mostly occurring in pediatric patients.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 259, Wednesday Afternoon