Vitreoretinal Lymphoma as the Initial Presentation of a Breast Diffuse Large B-cell Lymphoma

PURPOSE

We report a case of vitreoretinal lymphoma as the initial presentation of diffuse large B-cell lymphoma of the breast.

METHODS

A case report is presented.

RESULTS

A 72-year-old woman was referred for evaluation of vitritis in both eyes. Diagnostic vitrectomy and pathology workup demonstrated atypical lymphoid cells consistent with the presence of diffuse large B-cell lymphoma. Brain magnetic resonance imaging and lumbar puncture findings were negative for central nervous system lymphoma. Positron emission tomography/computed tomography imaging showed a mass in the left breast, and breast biopsy confirmed aggressive B-cell lymphoma.

CONCLUSIONS

When vitreoretinal lymphoma is diagnosed, it is important to evaluate for other forms of systemic lymphoma in addition to central nervous system lymphoma.

Single B-Cell Genomic Analyses Differentiate Vitreoretinal Lymphoma from Chronic Inflammation

PURPOSE

To test whether analyzing DEPArray (Menarini Silicon Biosystems) isolated single B cells from the vitreous fluid can reveal crucial genomic and clinicopathological features to distinguish patients with vitreoretinal lymphoma (VRL) from those with chronic inflammation using immunoglobulin heavy chain (IGH), disease biomarker myeloid differentiation primary response 88 (MYD88)^L265P mutation, and copy number profiling.

DESIGN

A single-center, retrospective study.

PARTICIPANTS

Remnant vitreous biopsies from 7 patients with VRL and 4 patients with chronic inflammation were acquired for molecular analysis.

METHODS

Vitreous fluid samples were prefixed in PreservCyt (Hologic) and underwent cytologic analysis and immunohistochemistry examination. Single cells were isolated using the DEPArray NxT system, followed by downstream genomic analysis.

MAIN OUTCOME MEASURES

The frequencies of the dominant IGH and MYD88^L265P mutation and the genome-wide copy number aberration (CNA) profiles of individual vitreous-isolated B cells were characterized.

RESULTS

An average of 10 to 13 vitreous B cells were used in the single-cell IGH and MYD88 analyses. Higher frequencies of dominant IGH (88.8% ± 13.2%) and MYD88^L265P mutations (35.0% ± 31.3%) were detected in patients with VRL than in patients with chronic inflammation (65.9% ± 13.4% and 1.5% ± 2.6% for IGH and MYD88^L265P, respectively). In a cytology-proven VRL case, all 15 vitreous isolated B cells were derived from the same clone with 100% paired IGH: immunoglobulin light chain (IGK) sequences. Genome-wide copy number profiling revealed a high degree of similarity between B cells from the same patient with VRL, with extensive gains and losses at the same areas across the whole genome. In addition, 14 of 15 B cells showed a BCL2/JH t(14;18) translocation, confirming cellular malignancy with a clonal origin. Clustering analysis of the copy number profiles revealed that malignant B cells derived from different patients with VRL had no common genome-wide signatures.

CONCLUSIONS

Single B-cell genomic characterization of the IGH, MYD88^L265P mutation, and copy number profile enables VRL diagnosis. Because our study involved only a small cohort, these meaningful proof-of-concept data now warrant further investigation in a larger patient cohort.

The importance of cytokines analysis in the diagnosis of vitreoretinal lymphoma

PURPOSE

To evaluate the efficacy of the different diagnostic tests for vitreoretinal lymphoma (VRL).

METHODS

A cohort of 150 patients with a presumed diagnosis of VRL. Vitrectomy samples were analysed for cytology, monoclonality [polymerase chain reaction (PCR)] and cytokine levels, and anterior chamber taps were analysed for cytokine levels. Vitreoretinal lymphoma (VRL) was diagnosed after confirming the clinical suspicion with vitreal or brain cytology.

RESULTS

Vitreoretinal lymphoma (VRL) was diagnosed in 78 patients. Vitreal cytology was positive for 53/132 patients (40.2%), 36/53 had positive cytology from both the eye and the brain. Additional 25 patients had positive brain cytology. Vitreal PCR for monoclonality was positive for 32/91 patients (35.2%). Vitreal cytokine levels of interleukin (IL)-10/IL-6 were >1 for 47/110 patients (43.1%). For cytology, PCR and cytokine analysis, the respective sensitivity was 73.6%, 46.0% and 81.4%, and the accuracy of the tests was 85.6%, 60.4% and 80.9%, respectively. All three tests were available for 79 patients. In this subset, for cytology, PCR and cytokine analysis the respective sensitivity was 79.5%, 41.0% and 82.1%, respectively, and the accuracy of the tests was 89.9%, 60.8% and 81.0%, respectively.

CONCLUSION

Cytokines analysis has an important role in the diagnosis of VRL. We suggest analysing cytokines levels in all cases suspected of VRL along with cytology and PCR analysis.