Analysis of the diagnostic value of gene rearrangement detection combined with vitreous fluid IL-10 and IL-6 cytokine detection for primary intraocular lymphoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the diagnostic value of gene rearrangement detection combined with vitreous fluid interleukin-10(IL-10)and interleukin-6(IL-6)cytokine detection for primary intraocular lymphoma(PIOL). <p>METHODS: A total of 27 patients with suspected PIOL who were admitted to the hospital between January 2015 and December 2019 were enrolled in this study according to the inclusion and exclusion criteria. Totally 21 cases of PIOL and 6 cases of uveitis were diagnosed by pathological examination of diagnostic vitrectomy. Results of gene rearrangement and cytokine levels were retrospectively analyzed. Receiver operating characteristic(ROC)curves were used to analyze the diagnostic value of gene rearrangement, cytokines detection and the combination of the two in PIOL. <p>RESULTS: Of the 21 patients with PIOL, 15 had IhH FR2 monoclonal rearrangement, with a positive rate of 71%(15/21), and 4 were detected with TCRG clonal gene rearrangement. ROC curve analysis showed that the area under the curve(AUC)of gene rearrangement for diagnosis of PIOL was 0.857. Its sensitivity and specificity were 71.43% and 100.00%. Patients with PIOL had significantly higher vitreous humor IL-10 and IL-10/IL-6 levels than those with uveitis, but no statistically significant difference was found in the IL-6 level between the two groups(<i>P</i>>0.05). ROC curve analysis showed that the AUC of IL-10 was the highest for diagnosis of PIOL. With 170.90pg/mL as the cut-off value, its sensitivity and specificity of IL-10 in diagnosing PIOL were 66.67% and 100.00%, respectively. With 1.95 as the cut-off value, the sensitivity and specificity of IL-10/IL-6 ratio in diagnosing PIOL were 52.40% and 100.00%. The AUC, sensitivity and specificity of gene rearrangement combined with cytokines detection in diagnosing PIOL were 0.893, 95.24% and 83.33%, respectively. <p>CONCLUSION: The sensitivity of gene rearrangement alone is poor in diagnosing PIOL. Combined use of cytokines detection can improve the diagnostic sensitivity and specificity.

Diagnosis and treatment of primary intraocular lymphoma / 眼科新进展

Primary intraocular lymphoma (PIOL) is mostly composed by diffuse large B-cell lymphoma with a high degree of malignancy and often masquerades as uveitis.Moreover,it has a poor prognosis,therefore the early diagnosis and treatment are very important.Cytology,cytokine analysis,immunohistochemistry and genetic testing are often used in combination to improve the diagnosis rate of PIOL,however,eye tissue biopsy is the gold standard for diagnosis of PIOL.Currently,since there is no unified treatment program,the main treatment is given priority to local chemotherapy and orbital radiotherapy,and the use of multiple therapies can improve the efficacy of refractory PIOL.Base on these,this article reviews the current diagnosis and treatment for providing certain reference.

Two Cases of Primary Intraocular Lymphoma: Fine Needle Aspiration Diagnosis and Intravitreal Methotrexate Treatment / 华中科技大学学报（医学）（英德文版）

We described clinical process of two cases of intraocular lymphoma in aspects of early diagnosis by fime needle aspiration (FNA) and biopsy and treatment by intravitreal methotrexate (MTX).Two patients were suspected to have primary intraocular lymphoma (PIOL) with geographic yellow-white infiltrates and vitreous opacity.FNA confirmed malignant intraocular lymphoma in one patient and failed in the other patient due to complication of vitreous hemorrhage.Subsequent vitreous biopsy confirmed malignant intraocular lymphoma in the other patient.Both patients were treated by intravitreal methotrexate.In case 1 the tumor had complete remission and follow-up of 12 months had not found any signs of recurrence.In case 2 the patient died of brain metastasis 22 months after the ocular biopsy.Our findings demonstrate that although cytological examination of vitrectomy specimens remains the gold standard in diagnosis of PIOL,examination of FNA and biopsy increases the reliability of early diagnosing or excluding a PIOL.Individualized intravitreal methotrexate can be used to effectively treat PIOL.More effective integrated program treating primary central nervous system lymphoma/PIOL is worthy of looking forward to.

A Case of Primary Intraocular Lymphoma Confirmed by Endoretinal Biopsy

PURPOSE: To report one case of primary intraocular lymphoma confirmed by endoretinal biopsy and clinical experience. CASE SUMMARY: A 65 year-old man complaining of persistent decreased visual acuity was referred to our hospital. Biomicroscopic examination showed bilateral vitreous cells and small round yellowish inflammatory lesions at the level of the retinal pigment epithelial cells. The disc of the left eye was pale in color. Fluorescein angiographic examination of the left eye showed intermingling round hyperfluorescent and hypofluorescent lesions. We performed diagnostic vitrectomy due to unresponsiveness to oral steroid therapy, but the result was negative. We finally performed an endoretinal biopsy, which showed tumor cells with H&E staining and strong immunoreactivities against CD 20 and CD 79a indicating the presence of B cells. We diagnosed this case as primary intraocular lymphoma and performed multiple-cycle chemotherapy with high-dose methotrexate. The ocular signs and symptoms were improved after chemotherapy. CONCLUSIONS: Endoretinal biopsy could be another diagnostic tool for confirming suspected primary intraocular lymphoma in cases showing negative results with diagnostic pars plana vitrectomy and cytology.

A Case of Primary Intraocular Lymphoma Treated by Intravitreal Methotrexate

A 40-year-old female visited our clinic for visual disturbance of the right eye, in which a few creamy-yellow retinal lesions and visual field constrictions were noted. She had been treated for primary CNS lymphoma and was in complete remission. After failure to follow-up for three months, she lost vision in the right eye, at which time active panuveitis was seen. Decreased vision and field constriction was observed in the left eye. Her left eye showed a granular pattern and dye leakage from the vessels and disc on fluorescein angiography and small RPE humps were seen in optical coherence tomography (OCT). Diffuse large malignant B-cells with strong immunoreactivities with CD20 immunostaining were seen in the epiretinal membrane biopsy specimen. Intravitreal injections of methotrexate (MTX) (800 microgram/0.1 ml in the right eye, 400 microgram/0.05 ml in the left eye) were performed twice weekly for one month, once weekly for the following month, once every two weeks for the next month, followed by nine monthly injections. Both eyes were free from malignant cells on vitreous biopsy six months later. There was no leakage seen by angiography, but the granular pattern persisted. Visual field constriction was slightly improved, and the small RPE humpsdetachments seen in OCT disappeared. EOG Arden ratio was decreased in both eyes, and b wave amplitude of scotopic ERG was decreased in the left eye. She was free from recurrence until six months later. No ocular complications except minimal opacity of the crystalline lenses were noted in both eyes.

Clinical Manifestations of Intraocular Lymphoma

PURPOSE: To investigate the clinical features and prognosis of primary intraocular lymphoma (PIOL). METHODS: A retrospective review of medical records was performed in 9 patients who were diagnosed and treated as PIOL in the Department of Ophthalmology, Seoul National University Hospital. RESULTS: Among patients who were enrolled in the study, 14 eyes were examined. Thirteen eyes (92.9%) showed yellowish subretinal or choroidal infiltrates which is a characteristic finding of PIOL in fundus examination and fluorescein angiography. Three patients presented with ocular symptoms initially, and 5 patients later presented with central nerve system (CNS) involvement. Only 1 patient showed PIOL without CNS involvement. Among 6 patients (9 eyes) that received systemic chemotherapy or ocular irradiation, 5 patients (7 eyes, 77.8%) responded. Among those patients, 3 patients (4 eyes) showed relapse of PIOL. Five patients died during the mean follow-up period of 43.3 months, and the median survival time was 47 months. CONCLUSIONS: The most common characteristic fundus finding of PIOL is subretinal or choroidal infiltration. Ocular irradiation combined with systemic chemotherapy is the first method of treatment, although long-term prognosis is poor.