17
Eye
cytologic analysis with flow cytometric results of vitreous biopsy
specimens obtained to rule out primary intraocular lymphoma.96
The comparison showed that cytologic examination is essential
and remains the preferred technique for diagnosis of primary
intraocular lymphoma.
Usefulness of immunologic analysis of these specimens is
severely limited. In one study, only one of the nine lympho-
mas expressed monoclonality. This seeming contradiction can
be explained by the frequently observed mixture of benign
Fig. 17.21 Retinoblastoma. A small-cell tumor forms sheets of cells with
suggestions of rosette formation. The cytoplasm is scant. The nuclei are
round with occasional nucleoli and numerous mitotic figures
(May-Grünwald-Giemsa x MP).
inflammatory cells with malignant lymphoid cells. More than
one specimen is frequently necessary to confirm the diagnosis.
It is important to note that, although most studies conclude that
ocular lymphoma is invariably fatal subsequent to CNS spread,
but if diagnosed and treated early, patients can be cured.97
Key features of intraocular neoplasias
Melanoma:
spindle, epithelioid with enlarged nuclei
and prominent nucleoli with accompanying pigment-
filled macrophages;
Retinoblastoma:
small cell tumor with areas of necrosis
and calcification with rare rosettes; and
Lymphoma:
atypical lymphoid cells with prominent
nucleoli.
Diagnostic Accuracy
Table 17.4 features the diagnostic accuracy from several series.56
The series of fine-needle cytology (FNC) of 292 palpable orbital
and eyelid tumors reports a concordant diagnosis of malignancy
and type in 249 cases (87%), false-positive diagnoses in 4 cases
(1.6%), false-negative diagnoses in 5 cases (1.8%), insufficient
specimens in 6.3%, and no complications encountered.98,99
Not every lesion of the eye is an appropriate target for FNA.
Many lesions are accessible to a simple open biopsy, such as
palpable conjunctival and palpebral lesions. Careful physical
examination may reveal a more accessible lesion for diagnosis
than one in the orbit. The pathologist should attempt to obtain
a complete history in cases in which FNA of the orbit is contem-
plated so that unnecessary risk can be avoided. However, in the
Table 17.4 Ascuracy of Orbital Fine-Needle Aspiration in Series with Histologically Verified Cases
First author
Total cases
No. of specimens
histologically
proven
No. of cases
w ith precise
diagnosis
False-positive
diagnoses
False-negative
diagnoses
Insufficient
Zajdela
292
286
249 (87%)
4 (1.4%)
5 (1.8%)
18 (6.3%)
Glasgow
83
43
30 (70%)
0
0
10 (23%)
Tijl
46
26
17 (65%)
0
5 (19%)
0
Char
40
31
22 (71%)
0
1 (3%)
0
Dey
35
18
14 (77%)
0
0
0
Arora
35
15
7 (46%)
0
0
1 (6.7%)
Krohel
34
34
11 (32%)
2
0
11 (32%)
Das
28
9
5 (55%)
0
0
0
Kennerdell
15
13
3 (23%)
0
0
3 (23%)
Czerniak
13
6
6 (100%)
0
0
0
Westman-Naeser
9
5
3 (60%)
0
0
2 (40%)
Meyer
7
3
3 (50%)
0
0
2 (33%)
Kennerdell
7
3
2 (67%)
0
0
0
Kennerdell
7
4
4 (100%)
0
0
0
Kennerdell
43
14
14 (100%)
0
0
3 (0.1%)
Total
644
495
392 (75.2%)
6 (1.2%)
11 (2.2%)
47 (9.5%)
All calculations were performed using only histologically proven cases.
Reproduced from Glasgow BJ, Goldbert RA, Gordon LK, et al. Fine-needle aspiration of orbital masses.
O phthalm ol Clin North Am
1995;8:73-81.
467
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