Abstract
IntroductionWe 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 presentationA 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.ConclusionThe 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.
Highlights
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
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 malignant lymphoma is relatively frequent among orbital tumors [1] and is usually not difficult to detect because it forms a mass lesion that causes changes such as proptosis [2]
Summary
The possibility of orbital lymphoma should be considered in patients with an early recurrence of optic neuropathy after corticosteroid pulse therapy, even when there are no abnormal findings on CSF examination or MRI. MRI: magnetic resonance imaging; OS: oculus sinister (Latin for "left eye"); RAPD: relative afferent pupil defect. Tumor biopsy was carried out six months after presentation. The tumor cells are large, polygonal, or round and the nuclei are folded, cleaved, or kidneyshaped. Mitoses and prominent nuclear abnormalities can be seen. The pathological diagnosis was diffuse large B cell lymphoma (hematoxylin-eosin, × 50). The atypical lymphocytes expressed the B cell markers CD20 and CD79a (data not shown). On July 28th, the patient was referred to another hospital for chemotherapy and radiotherapy. The succeeding 42 months showed no evidence of local recurrence or systemic metastasis of the lymphoma
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