Progressive loss of vision in patients with high-grade non-Hodgkin's lymphoma

Optic neuropathy in the context of leukemia or lymphoma: diagnostic approach to a neuro-oncologic emergency

Background

Optic neuropathy in the context of leukemia or lymphoma has a broad differential diagnosis, including infiltration, infection, inflammation, compression, and medication effects. Confirming the underlying etiology in a timely manner is crucial as, while infiltration carries a poor prognosis, treatment modalities can have serious consequences themselves.

Methods

A review of the literature was conducted for cases of isolated optic neuropathy in the context of leukemia or lymphoma, in which the underlying etiology remained unclear following initial clinical examination and neuroimaging. Clinical, radiological, and pathological characteristics of the cases are summarized.

Results

Ninety-two cases meeting inclusion criteria were identified. Leukemic or lymphomatous infiltration was the presumed diagnosis in 72% of the reports, indicating this is the most likely etiology in such cases. The remaining reports were attributed to inflammation, infection, or drug toxicity. For illustrative purposes, the previously unpublished case of an 11-year-old girl with remitted T lymphoblastic lymphoma is presented. She suffered recurrence in the form of isolated left optic nerve infiltration that required transconjunctival biopsy to confirm diagnosis.

Conclusions

Optic nerve infiltration by leukemia or lymphoma requires both diagnostic certainty and urgent management. Recommendations are made for a step-wise, yet rapid investigative approach that may ultimately require biopsy of the optic nerve.

Bilateral retrobulbar neuritis in an adolescent boy with lymphoma

A 13-year-old boy presented with bilateral retrobulbar neuritis. Three months later he presented with unilateral proptosis and cervical lymphadenopathy. Lymph node biopsy confirmed non-Hodgkin's lymphoma, B-cell type. To the best of our knowledge, this is the first reported case of bilateral retrobulbar neuritis as the presumptive initial presentation of non-Hodgkin's lymphoma.

Unusual orbital lymphoma undetectable by magnetic resonance imaging: a case report

Introduction

We report the case of a patient with orbital malignant lymphoma that was not detected by imaging studies when she presented with impaired vision, which lead to her eventual loss of sight.

Case presentation

A 71-year-old Japanese woman complained of deteriorating vision in her left eye. On examination, papilledema was detected, but magnetic resonance imaging only showed slight thickening and enhancement of the left optic nerve. A diagnosis of idiopathic optic neuritis was made and corticosteroid pulse therapy was administered. During the next four months, the patient received a total of four courses of corticosteroid pulse therapy, but she still suffered from bilateral loss of vision. A second magnetic resonance imaging procedure revealed tumors in both orbits and a biopsy showed diffuse large B-cell malignant lymphoma.

Conclusion

The possibility of malignant lymphoma should be considered in patients with recurrent optic neuropathy despite administration of corticosteroid pulse therapy, even when there are no abnormalities on cerebrospinal fluid examination or magnetic resonance imaging.

Primary central nervous system lymphoma involving the optic chiasm in AIDS

OBJECTIVE

To report visual loss resulting from chiasmal involvement by primary central nervous system lymphoma (PCNSL).

MATERIALS AND METHODS

Case report.

RESULTS

A patient with the acquired immune deficiency syndrome (AIDS) presented with visual loss resulting from PCNSL involving the optic chiasm. The clinical findings, neuroimaging, pathology, and treatment of this patient are described.

CONCLUSIONS

Although rare, clinicians should consider PCNSL in the differential of a hypothalamic/chiasmal mass, especially in a patient with AIDS.

Anterior visual system involvement in non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma may have ocular involvement but optic nerve and chiasmal disease is unusual. Determining the cause of the neuropathy in this group of patients presents major difficulties despite modern neuroimaging and immunocytochemistry. Two patients with NHL are presented; one had an anterior chiasmal syndrome and the other bilateral optic nerve involvement. The first patient was thought to have lymphomatous infiltration and the second a concomitant infection (progressive multifocal leucoencephalopathy). Toxic effects of therapy were considered but finally rejected. The importance of modern neuroimaging and the role of optic nerve biopsy are discussed.