ROLE OF CYTOPATHOLOGY IN THE DIAGNOSIS OF OCULAR MALIGNANCIES

OBJECTIVE: To determine the positive predictive value of ocular cytolo gic specimens and to describe the cytopathologic findings encountered in ocular samples from patients with intraocular neoplasms. STUDY DESI GN: Intraocular fluids and ocular fine needle aspirates (FNAs) cytolog ically diagnosed as either suspicious or positive for malignancy durin g a 15-year period were reviewed, and follow-up was obtained. RESULTS: Seventeen patients with intraocular samples diagnosed as suspicious o r positive for malignancy (9 vitreous, 6 anterior chamber, 3 FNAs) wer e identified. The mean patient age was 58 years (range, 3-91). Cytolog ic diagnoses included: lymphoma (5), suspicious for lymphoma (2), mela noma (6), suspicious for melanoma (2), carcinoma (2) and retinoblastom a (2). Clinical and/or surgical follow-up teas available in 12 cases a nd was consistent with the presence of malignancy in all but one case, which proved to be fungal endophthalmitis. One of two patients with a cytologic diagnosis of carcinoma had melanoma on follow-up. Cytologic samples suspicious or positive for lymphoma showed single, large cell s with scant cytoplasm and prominent nucleoli. Cytologic samples suspi cious or positive for the epithelioid type of melanoma showed loosely cohesive groups or single cells, marked cellular pleomorphism, large n ucleoli, scant to moderately abundant cytoplasm and variable amounts o f melanin. Cytologic samples from spindle cell melanomas showed spindl e cells without nuclear or cellular pleomorphism, without hyperchromas ia, and with inconspicuous nucleoli and occasional nuclear grooves. Lo ose aggregates of small cells with hyperchromatic nuclei and scant cyt oplasm characterized the retinoblastoma samples. CONCLUSION: The posit ive predictive value of intraocular fluid cytology was 92%. Reactive l ymphoid processes may be difficult to differentiate from lymphoma and epithelioid melanoma from carcinoma in intraocular cytologic specimens .