Artikel
Assessment of the use of H.O.P.E. fixation in vitrectomy specimens in patients with chronic uveitis (Masquerade syndrome)
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Autoren
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S.E. Coupland
- Department of Pathology, University Medicin, Campus Benjamin Franklin
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H. Heimann
- Department of Ophthalmology, University Medicine, Campus Benjamin Franklin
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N. Bechrakis
- Department of Ophthalmology, University Medicine, Campus Benjamin Franklin
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A. Perez-Canto
- Department of Pathology, University Medicin, Campus Benjamin Franklin
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M. Hummel
- Department of Pathology, University Medicin, Campus Benjamin Franklin
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M.H. Foerster
- Department of Ophthalmology, University Medicine, Campus Benjamin Franklin
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H. Stein
- Department of Pathology, University Medicin, Campus Benjamin Franklin
| Veröffentlicht: | 22. September 2004 |
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Gliederung
Text
Objective
Cytological examination of rapidly-transported, unfixed vitreal specimens is considered the gold standard in exclusion of primary intraocular lymphoma (PIOL) in patients with idiopathic steroid resistant chronic uveitis. These specimens are difficult, and reports of "false negatives" or "false positives" are common. Fixation using H.O.P.E. technique (Herpes-Glutamic acid buffer mediated Organic solvent Protection Effect) has been successfully applied in the investigation of cytospin preparations using immunohistochemistry, in situ hybridisation and polymerase chain reaction (PCR). H.O.P.E. fixation of vitrectomy specimens in patients with clinical reactive vitritis and PIOL was performed, to determine its usefulness with these biopsies.
Methods
Pars plana vitrectomy was performed in 12 cases of patients with chronic uveitis. The vitreous samples were halved: one half was fixed in H.O.P.E. solution, the other half remained unfixed. The specimens were assessed blindly by two pathologists, and the corresponding key catalogued by the operating surgeon. Furthermore, immunocytology and, when possible, PCR for the detection of immunoglobulin heavy chain gene rearrangement (IgH-PCR) and GeneScan was performed.
Results
11/12 vitreous samples were diagnosed as reactive vitritis; one sample, a primary intraocular lymphoma of B-cell type. Compared to the unfixed vitreal specimens, the quality of the cytomorphology and immunocytology improved in the H.O.P.E.-fixed specimens. IgH-PCR and GeneScan analysis sequencing demonstrated polyclonal amplification products in the reactive cases, and a monoclonal B-cell population in the B-PIOL.
Conclusions
Our results demonstrate that cytomorphology and immunoreactivity of vitreous specimens are well preserved following H.O.P.E.-fixation. DNA of sufficient quality could be extracted from H.O.P.E.-fixed vitreous specimens, in order to perform clonality analyses. H.O.P.E. fixation appears to be promising in improving the diagnostic reliability of vitreous specimens in patients with masquerade syndrome.
