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Neurochirurgie. 2014 Dec;60(6):312-5. doi: 10.1016/j.neuchi.2014.06.009. Epub 2014 Sep 20.

Isolated primary central nervous system lymphoma arising from the optic chiasm.

Author information

1
Service de neurochirurgie, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France. Electronic address: francois.vassal@chu-st-etienne.fr.
2
Service de neurochirurgie, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
3
Service de neuroradiologie, hôpital Nord, CHU de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France.
4
Service d'anatomie pathologique, hôpital Nord, CHU de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France.
5
Service d'ophtalmologie, hôpital Nord, CHU de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France.

Abstract

A 58-year-old previously healthy woman rapidly developed progressive bilateral visual loss. Magnetic resonance imaging revealed a bulging appearance of the optic chiasm, with homogeneous enhancement after gadolinium administration, which suggested an optic glioma or inflammatory disease. In the absence of (para)clinical clues for a specific diagnosis despite extensive investigation, a biopsy of one optic nerve was performed, resulting in a diagnosis of non-Hodgkin B-cell lymphoma. There was no evidence of any other ocular or systemic involvement, therefore the conclusion was that this immunocompetent patient had a primary central nervous system lymphoma isolated in the anterior visual pathway. Treatment included two cycles of polychemotherapy (rituximab, methotrexate, carmustine, etoposide, methylprednisolone), followed by autologous peripheral blood stem cell transplantation and rituximab plus cytarabine consolidation therapy. Subsequently, the patient exhibited significant improvement in vision, and was still disease-free at the 1-year follow-up examination. The aim of the present paper was to provide well-documented clinical, radiological, and intraoperative features of isolated primary malignant lymphoma arising from the anterior visual pathway. A better recognition of this rare pathological entity is necessary for clinicians who may encounter similar presentations, as prompt management is crucial for both a visual and vital prognosis.

KEYWORDS:

Bandelette optique; Biopsie; Biopsy; Chiasma optique; Lymphome primitif du système nerveux central; Nerf optique; Optic chiasm; Optic nerve; Optic tract; Primary central nervous system lymphoma

PMID:
25245922
DOI:
10.1016/j.neuchi.2014.06.009
[Indexed for MEDLINE]

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