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Pseudotumor associated with CNS lymphoma
H L Hudson1, D R Hinton, D I Friedman
1Department of Ophthalmology, University of Southern California, Los Angeles, Riverside, USA.
Summary
A patient initially treated for orbital pseudotumor experienced a recurrence, which was diagnosed as central nervous system (CNS) lymphoma. This case highlights the importance of considering CNS lymphoma in recurrent orbital inflammatory conditions.
Area of Science:
- Neuro-oncology
- Ophthalmology
- Neuropathology
Background:
- Orbital pseudotumor is a rare idiopathic inflammatory condition that can affect the orbit and surrounding structures.
- Intracranial extension of orbital pseudotumor is uncommon and can mimic other intracranial pathologies.
- High-dose corticosteroids are a standard treatment for orbital pseudotumor.
Observation:
- A 42-year-old immunocompetent woman presented with orbital pseudotumor and presumed intracranial extension into the temporal lobe.
- Initial treatment with high-dose corticosteroids resulted in clinical and radiological improvement.
- Five months later, the patient developed worsening headaches and recurrence of the temporal lobe lesion.
Findings:
- Biopsy of the recurrent temporal lobe lesion revealed a central nervous system (CNS) lymphoma.
- Histopathology showed severe reactive gliosis adjacent to a subarachnoid lymphocytic infiltrate.
- The findings suggest a misdiagnosis of orbital pseudotumor initially, with the underlying pathology being CNS lymphoma.
Implications:
- This case underscores the critical need for thorough diagnostic evaluation in cases of suspected orbital pseudotumor with intracranial involvement.
- Recurrence or lack of sustained response to corticosteroids in such cases should prompt consideration of alternative diagnoses, including CNS lymphoma.
- Accurate and timely diagnosis of CNS lymphoma is crucial for appropriate treatment and improved patient outcomes.