Use of the Polymerase Chain Reaction to Detect B- and T-Cell Gene Rearrangements in Vitreous Specimens From Patients With Intraocular Lymphoma

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Abstract
THE DIAGNOSIS of large-cell lymphoma involving the vitreous in the absence of central nervous system (CNS) disease can be difficult. Typically, the clinical picture is characterized by initial misdiagnosis and treatment for inflammatory uveitis, delaying definitive diagnosis. Diagnosis requires an invasive procedure, and often sufficient material is received to only perform routine cytological examination. Procedures such as immunohistochemical analysis, which might aid in diagnosis, cannot often be used. The major diagnostic difficulties with vitreous washings are in the distinction of inflammatory lymphoid infiltrates from intraocular lymphoma or, when only a few atypical cells are present, being confident of the diagnosis of lymphoma. The polymerase chain reaction (PCR) method for the detection of immunoglobulin heavy chain (IgH) gene rearrangements, T-cell receptor gene rearrangements, and the bcl-2 translocation has been used for several years to confirm the diagnosis of lymphoma at other sites.1 Recently, PCR has been found to be useful in the diagnosis of lymphomatous meningitis in cerebrospinal fluid specimens.2 We sought to determine whether PCR could be applied to vitreous samples in a similar manner for diagnosis.