Isolated primary central nervous system lymphoma arising from the optic chiasm

Area of Science:

• Neuro-oncology
• Ophthalmology
• Hematology

Background:

• Primary central nervous system lymphoma (PCNSL) is rare, with anterior visual pathway involvement being exceptionally uncommon.
• Optic nerve compromise can present with progressive visual loss, mimicking other optic neuropathies.

Observation:

• A previously healthy 58-year-old woman presented with rapid, bilateral visual decline.
• MRI revealed optic chiasm thickening with homogeneous enhancement, suggesting glioma or inflammatory processes.
• Biopsy confirmed non-Hodgkin B-cell lymphoma, isolated to the anterior visual pathway.

Findings:

• The patient received intensive polychemotherapy, autologous stem cell transplant, and consolidation therapy.
• Significant visual improvement was observed post-treatment.
• The patient remained disease-free at one-year follow-up.

Implications:

• This case highlights the importance of considering rare diagnoses like isolated PCNSL in the anterior visual pathway.
• Early recognition and prompt, multimodal treatment are critical for favorable visual and oncological outcomes.
• Enhanced understanding of this rare entity can improve diagnostic accuracy and patient management.