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Year : 1984  |  Volume : 32  |  Issue : 6  |  Page : 528-530

Aqueous humour cytology in retinoblastoma

Dr. Rajendra Prasad Centre for Ophthalmic Sciences & Department of Pathology, A.I.I.M.S., New Delhi, India

Correspondence Address:
Y Dayal
Dr. Rajendra Prasad Centre for Ophthalmic Sciences A.I.I.M.S., New Delhi
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Source of Support: None, Conflict of Interest: None

PMID: 6599898

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How to cite this article:
Dayal Y, Goyal J L, Verma K, Agarwal H C. Aqueous humour cytology in retinoblastoma. Indian J Ophthalmol 1984;32:528-30

How to cite this URL:
Dayal Y, Goyal J L, Verma K, Agarwal H C. Aqueous humour cytology in retinoblastoma. Indian J Ophthalmol [serial online] 1984 [cited 2022 Jun 29];32:528-30. Available from: https://www.ijo.in/text.asp?1984/32/6/528/30861

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Table 1

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Table 1

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Misdiagnosis in retinoblastoma has always been a problem for ophthalmologist [1],[2]. Al­though the diagnostic techniques like ultraso­nography, computerised tomography and routine radiological examination of the orbit have considerably helped in establishing the diagnosis of retinoblastoma yet there is no fool proof method for diagnosing a case of retinoblastoma. Aqueous humour cytology, an important diagnostic adjunct in this malig­nancy, has been rarely used. As far as we are aware only 14 cases of retinoblastoma have been reported in the world literature where the aqueous humour cytology has been car­ried out [3],[4],[5],[6],[7] Even though a few reports of positive cytology in cases of retinoblastoma exist but the sensitivity of this test as a diag­nostic tool in these cases has not yet been evaluated in a study involving a large number of cases. This study was aimed at evaluating aqueous humour cytology as a diagnostic tool in cases of retinoblastoma.

  Material and methods Top

Twenty two eyes of 17 patients of retino­blastoma in intraocular stage were the sub­jects of this study. Detailed funduscopic examination was carried out under general anaesthesia in each case to see the stage, extent and type of lesion (Exophytic or Endo­phytic). 0.1 ml of aqueous sample was with­drawn using a 26 gauge needle with a tuberculin syringe. Polysone solution was added and the sample was cytocentrifuge. Smear was prepared and stained with papanicolau's stain. Confirmation of the diagnosis was achieved by enucleation and histological examination of the same or the fellow eye (in bilateral cases).

  Observations Top

Clinical data of the twenty two eyes inves­tigated and their correlation with positive cytology are given in [Table - 1][Table - 2][Table - 3]. The malignant cells were darkly stained and arranged in clumps with prominent hyperch­romatic nuclei with scanty or occasionally no cytoplasm. Typical Flexner-Winter Steiner rosettes were not seen in any of the smears. Pigment laden cells were also present in two of the 4 cytologically positive smears. Three of the smears showed only inflammatory cells and no malignant cells.

  Discussion Top

Aqueous humour cytology in retinoblas­toma was first reported in 1960 by Schofield [3]. He reported malignant cells on aqueous hum­our paracentesis in four cases of hypopyon non responding to treatment. A diagnosis of diffuse infiltrating retinoblastoma was subse­quently confirmed histopathologically. He observed the malignant cells with large hyperchromatic nuclei arranged in clumps on cytological study. Later on a number of other investigators reported isolated case reports of positive aqueous humour cytology in retino­blastoma [4],[5],[6],[7]. Typical true rosettes in aque­ous humour cytology were also seen of these cases [3],[5],[6]

Stroma in retinoblastoma is sparse and the tumour cells show little cohesion [8]. This might be the reason for seedlings which may also be seen in the anterior chamber in an advanced stage of the tumour. Aqueous humour cyto­logy is particularly useful in cases with opa­que media and particularly in those centres where ultrasonography is not available or is unsatisfactory. [7]

The fact that only 18.2% of the cases of retinoblastoma showed positive aqueous cyto­logy shows that although a positive result proves the diagnosis, a negative result is not of much significance. It was observed that in those cases where the lesions involved a total area of less than a quadrant of retina (localised lesions) this investigation was of little value. However, in advanced cases present­ing with a large retrolental mass this investi­gation showed a positivity rate of 28.6%. Amongst the advanced cases endophytic type of lesions showed a higher positivity rate (42.9%) as compared to the exophyte type (14.3%), This might be due to the absence of retinal barrier in endophytic lesions which exists in glioma exophytum. Also predictably enough, cases in stage II were associated with positive aqueous cytology more commonly (25%) than with stage I tumours (14;0) but correlation seemed to be related more to the extent of the tumour than to the stage. The observation of only inflammatory cells in three of the cases may be explained by the inflammatory response to the toxins released by the tumour cells or the irritation by the products of the tumour necrosis. Source of the pigment laden cells was probably the Iris pigment epithelium.

  Summary Top

Aqueous humour cytology was studied in twenty two eyes of 17 patients of retinoblast. toma (intraocular stage). Only 18.2% of the cases showed malignant cells in aqueous smears. Cytology was observed to be positive only in cases with extensive lesions (28.6%). Endophytic type of tumours showed a higher positivity rate (42.9%) as compared to the exophytic type (14.3%). Although a positive result proves the diagnosis of retinoblastoma, a negative result is not of much significance.

  References Top

Kaneko, A., Bibl. Ophthal. No. 83,119-124, (Karger. Basel, 1975).  Back to cited text no. 1
Stafford, W. R., Yanoff, M., Parnell, B. L. 1969, Arch. Ophthalmol. 82:771.  Back to cited text no. 2
Schofield, P. B., 1960, Brit. J. Ophthalmol. 44, 35-41.  Back to cited text no. 3
Wotter, J. R.. Naylor, B., 1968. J. Paed. Oph­thalmol 5 : 36.  Back to cited text no. 4
Zuper, M., Naib., 972, Acta Cytologica, 16; 178-85.  Back to cited text no. 5
Sagiroglue. N.; Ozgomul, T. Muderris, S. 1975. Acta Cytologica 19 (1), 32-37.  Back to cited text no. 6
Rodriguez, A„ 1977, Mod. Probl. Ophthalmol. 18; 142-148.  Back to cited text no. 7
Reese, A. B., 1976, Tumours of the eye. Ed. 3 Hagerstown, Md. Harper and Row.  Back to cited text no. 8


  [Figure - 1], [Figure - 2], [Figure - 3]

  [Table - 1], [Table - 2], [Table - 3]


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