A 60 year old man presents with bilateral vitreous floaters.
A vitreous washing is performed. The washings in the vitrectomy cassette are submitted for cytology. The washings are spun down and cell blocked. Immunohistochemistry is performed without pre-treatment because the cells have not been exposed to formalin. .
Figure 1,2 and 3 are H and E stained images of sections from the cell block.
Figure 4- Ki67
Figure 5 CD20
1. What do Figures 1,2 and 3 show?
2. What is the diagnosis?
3. Which ancillary investigations can be carried out on the cell block material?
1. Eosinophilic lytic cells, apoptotic debris, some atypical lymphoid blast cells and macrophages engulfing apoptotic debris.
2. The diagnosis is high grade B-cell non-Hodgkin’s lymphoma in the vitreous. Likely clinical scenarios are of primary intra-ocular lymphoma / CNS lymphoma or systemic lymphoma involving the vitreous. In this case there were no sub-retinal infiltrates, indicating a pure vitreous ‘effusion-type’ presentation.
3. PCR for IgH rearrangements. This can be performed on sections of the cell block or better still, by micro-dissecting out the lymphoid blast cells and then performing PCR on them. The latter reduces the ‘noise’ from background inflammatory cells.
Coupland SE. The pathologist’s perspective on vitreous opacities.
Wittenberg LA, Maberley DA, Ma PE, Wade NK, Gill H, White VA. Contribution of vitreous cytology to final clinical diagnosis fifteen-year review of vitreous cytology specimens from one institution.
Zhai J, Harbour JW, Smith ME, Dávila RM. Correlation study of benign cytomorphology and final clinical diagnosis.
Cassoux N, Giron A, Bodaghi B, Tran TH, Baudet S, Davy F, Chan CC, Lehoang P, Merle-Béral H. IL-10 measurement in aqueous humor for screening patients with suspicion of primary intraocular lymphoma.
Karma A, von Willebrand EO, Tommila PV, Paetau AE, Oskala PS, Immonen IJ. Primary intraocular lymphoma: improving the diagnostic procedure.