DIAGNOSIS OF SYSTEMIC METASTATIC RETINAL LYMPHOMA

　　曹晓光 Defen Shen David G.Callanan Manabu Mochizuki Chi-Chao Chan

　　Immunopathology Section Laboratory of Immunology National Eye Institute National Institutes of Health Bethesda Maryland Department of Ophthalmology People’s hospital Peking university Beijing China Texas Retina Associates Arlington Texas USA Department of Ophthalmology Tokyo Medical and Dental University School of Medicine Tokyo Japan 100044

　　Introduction and objectives：Metastatic systemic lymphoma to the retina is extremely rare，as they often metastasize to the uvea.We present 12 cases of metastatic systemic retinal lymphoma(MSRL)，which were diagnosed via vitreous evaluation.

　　Method:Twelve patients with systemic lymphoma and chronic vitritis underwent diagnostic vitrectomy.Specimens were performed for cytology，cytokine analysis(ELISA for IL-10 and IL-6 levels)，and microdissection and polymerase chain reaction for IgH and TCR genes rearrangements.

　　Results:The mean age of the 12 MSRL patients(6 males，6 females)was 64.The original sites of the systemic lymphomas were nasopharynx(3)，testis(2)，skin(2)，breast(1)，blood(1)and unknown(3).All patients manifested chronic vitritis that did not respond to corticosteroid.The most common clinical findings included vitreous cells and subretinal lesions，similar to primary retinal lymphoma.Cytology of vitreous samples illustrated atypical lymphoma cells，which either harbored B-or T-monoclonality(in general，B-MSRL cells were large and T-MSRL cells were in variable sizes).Molecular pathology demonstrated identical PCR products of the systemic lymphoma cells that had either IgH gene rearrangements in B-MSRL(9 cases)or TCR gene rearrangements in T-MSRL(3 cases).Interestingly，the T-MSRL did not have an elevation of vitreal IL-10，while the B-MSRL demonstrated mild elevation of vitreal IL-10 levels.

　　Conclusions:MSRL is extremely rare.It frequently presents similar features as primary retinal lymphoma and may masquerade as uveitis.The key diagnosis of MSRL includes clinical history of systemic lymphoma(particularly from nasopharynx，testis，and skin)and identification of atypical lymphoma cells in the vitreous.Molecular analysis is more helpful than vitreal cytokine measurement in making the diagnosis of MSRL.