Comprehensive diagnostics of intraocular lymphomas: the role of optical coherence tomography and fine-needle aspiration biopsy

Purpose of the study: to evaluate the capabilities of optical coherence tomography (OCT) and fine-needle aspiration biopsy (FNAB) in the diagnosis of intraocular lymphoma. Material and methods. 9 patients aged 39 до 67 (ave 51.0 ± 8.7) yrs with suspected intraocular neoplasm were examined. OCT, FNAB, cytologic and immunocytochemical (ICC) examination with the use of monoclonal antibodies CD19, CD20 were performed. Results. An amorphous light-gray protruding diffuse formation with pigmented hyperreflective small foci was diagnosed ophthalmoscopically. According to OCT data, were determined the following biomarkers: wave-like changes in the choroidal profile, point hyperreflective clusters at the level of the inner choroid. In addition, pronounced disorganization of the retinal pigment epithelium and wave-like changes in the inner and outer layers of the retina, extensive diffuse detachment of the neuroepithelium, multiple hyperreflective foci at the level of the photoreceptor layer, small hyperreflective foci in the posterior layers of the vitreous body, hyperreflective infiltrates in the outer layers of the retina were diagnosed. The results of organ-preserving diagnostics (FIAB and imprint) showed an abundance of diffusely located lymphoid elements of small and medium sizes, among which small lymphocytes, prolymphocytes, cells with a round nucleus and characteristic “spotting” of chromatin, a narrow rim of cytoplasm prevailed. According to the ICC data, positive expression of specific markers CD19 and CD20 was revealed, manifested by a brown color of the cell cytoplasm, which confirmed the B-cell nature of the tumor. Conclusion. Among all clinical and instrumental examination methods, OCT and FNAB are of decisive importance in intraocular lymphoma. In addition to ultrasound, the examination complex should include OCT to identify morphometric biomarkers of lymphoma. In opaque optical media, organ-preserving diagnostics (FNAB and imprint) makes it possible to obtain a diagnosis of lymphoma and determine its belonging to the most malignant B-cell type. The above measures allow for early patient referral to a hematologist to determine further treatment tactics.

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