Orbital Apex Malignant Lymphoma Diagnosed Using Whole-Body Computed Tomography

TL;DR

A rare case of orbital apex lymphoma was diagnosed using whole-body CT, highlighting the need for timely and comprehensive evaluation to prevent severe complications.

Contribution

Demonstrates the diagnostic utility of whole-body CT in identifying metastatic sites for biopsy in complex orbital apex lesions.

Findings

Whole-body CT identified multiple masses in the liver, pancreas, and heart, guiding biopsy for lymphoma diagnosis.

Prompt chemotherapy failed to reverse optic nerve damage, underscoring the importance of early intervention.

Orbital MRI and elevated soluble IL-2 receptor levels supported the diagnosis of diffuse large B-cell lymphoma.

Abstract

This article aims to report a case of orbital apex malignant lymphoma diagnosed using whole-body CT, emphasizing the challenges in diagnosis and the importance of timely investigation and treatment. A 69-year-old female with a history of rheumatoid arthritis and hypertension presented with a one-week history of headache and newly developed left eye ptosis. Initial examination revealed 20/20 visual acuity, left eye ptosis, and impaired upward eye movement. A subsequent orbital MRI, performed one week later, identified a mass extending from the left superior rectus muscle to the orbital apex. Elevated soluble IL-2 receptor levels were noted, and whole-body CT revealed multiple liver and pancreatic masses, as well as cardiac lesions. Biopsies from these sites led to a diagnosis of diffuse large B-cell lymphoma. Despite prompt initiation of chemotherapy, the optic nerve damage persisted, resulting in significant visual impairment. Whole-body CT imaging plays a crucial role in diagnosing challenging cases of orbital apex lesions by identifying primary or metastatic sites suitable for biopsy. This case emphasizes the necessity of prompt and comprehensive diagnostic evaluations and timely treatment initiation in suspected malignant lymphoma to prevent irreversible complications such as optic nerve damage.

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