Abstract
Background: Optic nerve lymphoma can present a diagnostic challenge because of its confusing clinical features and the difficulty of obtaining lesion tissue for biopsy. The objective of this study was to find some flags of lymphomatous infiltration of optic nerves.Methods: We report two cases of optic nerve lymphoma and conduct a literature review to determine whether a common diagnostic characteristic can be identified.Results: We examined 22 optic nerve lymphoma cases. Thirteen cases were systemic lymphoma infiltration of the optic nerve, five were primary central nervous system lymphoma (PCNSL), and four were primary isolated optic nerve lymphoma. Twenty patients manifested significant enlargement of the lesions in orbital/brain MRI. Seventeen contrast-enhanced MRIs showed abnormal enhancement of the optic nerve. All PCNSL and isolated optic nerve lymphoma patients in the series showed marked enhancement. Moderate and subtle enhancement was found in systemic lymphoma patients only. At the enhancement site, six isolated optic nerve lymphoma and PCNSL patients presented intrinsic enhancement, ten systemic patients showed both optic nerve and sheath enhancement, and one demonstrated sheath enhancement. Cerebrospinal fluid (CSF) tests showed elevated protein levels in six patients, and a neoplasm in one patient. We found abnormality of CSF immunity in both of our patients.Conclusion: Combined characteristics of orbital MRI and CSF tests may facilitate expeditious suspicion establishment of optic nerve lymphoma.
Highlights
Lymphoma can involve any organ in the body and presents with a wide range of symptoms [1]
Sporadic case reports on optic nerve involvement as the initial or secondary manifestation of primary central nervous system lymphoma (PCNSL) or metastatic lymphoma have been published
The aim of our study was to describe magnetic resonance imaging (MRI) and clinical characteristics in two optic nerve lymphoma patients admitted to the neuro-ophthalmology department of the People’s Liberation Army General Hospital (PLAGH; Beijing, China) and to review the literature of optic nerve lymphoma in order to find some flags of lymphomatous infiltration of the optic nerves
Summary
Lymphoma can involve any organ in the body and presents with a wide range of symptoms [1]. Sporadic case reports on optic nerve involvement as the initial or secondary manifestation of primary central nervous system lymphoma (PCNSL) or metastatic lymphoma have been published. According to these reports, optic nerve lymphoma can be confused with a variety of inflammatory and neoplastic infiltrations of the optic nerve in clinical and radiographic examinations. In several case reports, optic nerve lymphoma was successfully diagnosed by optic nerve biopsy [2,3,4], biopsies are challenging due to the considerable risk of loss of visual acuity [2] and the MRI in Optic Nerve Lymphoma difficulty of obtaining enough lesion tissue. The objective of this study was to find some flags of lymphomatous infiltration of optic nerves
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