Cytologic Examination of Vitreous Fluids: A Retrospective Review of Our 15 Years Experience.
Thomas Watkins, Lisa Duncan, Elizabeth Hubbard, Stuart VanMeter, Laurentia Nodit. University of Tennessee, Knoxville
Background: Cytologic analysis of vitreous fluid is requested in a variety of ocular disorders. This is rare in a busy cytology practice and interpretation may be challenging due to lack of exposure of pathologists and residents during their training to these samples. The purpose of this study is to review our 15 years experience of cytologic evaluation of vitreous fluids.
Design: Our department electronic records were searched for vitreous fluids and review of pathology, clinical reports and cytologic slides was performed. Indications, mode of preparation, cytologic patterns, ancillary studies and diagnoses were assessed to appreciate the usefulness of this technique and our ability to identify pathology specific to these fluids.
Results: 15 years review of vitreous fluids samples revealed 132 fluids from 116 patients, 65 females, 51 males, age 3-83 year-old. Seventy-nine samples (60%) were examined due to clinical signs of infection/inflammation, 18 samples (14%) were submitted to rule out intraocular lymphoma, 9 fluids for reasons like intravitreal foreign bodies or vitreous opacities, 9 samples for intraocular hemorrhage (7%), 6 fluids to rule out amyloidosis (4%), 4 to rule out melanoma (3%), and in 7 samples (5%) no clinical history was provided. The amount of fluid received varied from 0.5 – 150 cc and cytospins and Thin Preps were the methods of preparation used. Fluids displayed few patterns: paucicellular (37%), mixed chronic inflammation (36%), acute inflammation (17%), malignant (4%) and hemorrhage (4.5%). GMS stain performed in 56% of fluids where infection was suspected showed presence of fungal hyphae in 4 cases. No viral inclusions were seen (in 2 cases PCR for herpes simplex and CMV viruses was negative) and one fluid showed present Gram positive cocci on Gram stain performed. Flow cytometry studies were attempted in 72% of cases where intraocular lymphoma was in the differential diagnosis; 5 of them had insufficient cellularity or were technically suboptimal, 7 were negative for a B-cell proliferation and 1 was positive. In 2 cases immunohistochemical stains were performed on smears or concomitant biopsy. Two cases showed high grade lymphoma (1.5%), one large cell B-cell type, one high grade T-cell type, natural killer phenotype. Three cases (2%) were positive for malignant melanoma and abundant amyloid deposition was found in 1 case by Congo Red stain.
Conclusions: Cytologic analysis of vitreous fluid is very useful in evaluation of ocular pathology. The addition of special stains and modern techniques like flow cytometry or PCR, further expands the diagnostic possibilities.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 215, Monday Morning