Isolated lymphoma of the optic nerve, chiasm and tract: A case report

Abstract

The current study reports the case of a 68-year-old, previously healthy female who presented with progressive visual impairment leading to blindness bilaterally. Brain imaging features were suggestive of malignant glioma of the anterior visual pathway. Postoperative examination indicated a diagnosis of diffuse malignant lymphoma type B. As no evidence of extracranial lymphoma was observed, the final diagnosis was primary central nervous system lymphoma (PCNSL). Following treatment with surgery and radiotherapy, the patient's symptoms went into remission. At a follow-up examination 12 months after diagnosis, the patient demonstrated no evidence of recurrence. To the best of our knowledge, PCNSL isolated to the optic chiasm has been reported only three times in immunocompetent patients. Therefore, the present case of the lymphoma involving the optic nerve, optic chiasm and optic tract in an immunocompetent patient is unusual. The present case emphasizes the importance of considering the diagnosis of lymphoma in this setting.

Keywords: computed tomography; lymphoma; magnetic resonance imaging; optic nerve.

Figure 1.

Axial brain plain computed tomography. A suprasellar isodensity mass involving (A) the optic chiasm, both optic nerves and (B) the right optic tract with surrounding edema was observed.

Figure 2.

Axial brain magnetic resonance imaging: (A) T2WI; (B) DWI; (C) precontrast T1; (D) postcontrast T1. A suprasellar mass with significant homogenous enhancement involving the optic chiasm and both optic nerves (top row) and right optic tract (bottom row) was observed. The mass exhibited iso-intensity to the cortex on T1WI and T2WI, and slight hyper-intensity on DWI. As on the T2WI, the signal changes (B) were more extensive than the enhancement (D) owing to lesional edema. T2WI, T2-weighted imaging; DWI, diffusion-weighted imaging; T1WI, T1-weighted imaging.

Figure 3.

Coronal brain magnetic resonance imaging: Top row, T2-weighted imaging; bottom row, post-contrast T1-weighted imaging. The suprasellar mass showed significant enhancement involving (A) right optic tract, (B and C) optic chiasm, and (D) both optic nerves.

Figure 4.

Pathological analysis of the resected tumor. (A) The densely cellular tumor showed frequent mitotic figures and surrounded blood vessels (hematoxylin and eosin staining). (B) Cluster of differentiation (CD) 20(+) (hematoxylin staining). (C) CD79a(+) (hematoxylin staining; original magnification, ×400).