Higashida Taichi, Mori Sotaro, Katanazaka Kimitaka, Kurata Keiji, Ashizaki Risa, Tanaka Takeshi, Nakamura Makoto
Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, JPN.
Division of Neurology, Kobe University Graduate School of Medicine, Kobe, JPN.
Cureus. 2025 Mar 25;17(3):e81191. doi: 10.7759/cureus.81191. eCollection 2025 Mar.
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.
本文旨在报告一例通过全身CT诊断的眶尖恶性淋巴瘤病例，强调诊断中的挑战以及及时进行检查和治疗的重要性。一名69岁女性，有类风湿性关节炎和高血压病史，出现头痛一周，并新出现左眼上睑下垂。初始检查显示视力20/20，左眼上睑下垂，向上眼球运动受限。一周后进行的眼眶MRI检查发现一个肿块，从左直肌延伸至眶尖。可溶性白细胞介素-2受体水平升高，全身CT显示肝脏和胰腺有多个肿块以及心脏病变。对这些部位进行活检后诊断为弥漫性大B细胞淋巴瘤。尽管立即开始化疗，但视神经损伤持续存在，导致严重视力障碍。全身CT成像通过识别适合活检的原发或转移部位，在诊断具有挑战性的眶尖病变病例中起着关键作用。该病例强调了在疑似恶性淋巴瘤时迅速进行全面诊断评估和及时开始治疗的必要性，以防止如视神经损伤等不可逆转的并发症。
