Intraocular Lymphoma and Central Nervous System Lymphoma Involving the Hypothalamus: Staging and Evaluation of Response to Therapy With F-18 FDG PET/CT.

摘要

A 77-year-old woman presented with sudden onset of loss of vision in the left eye and bilateral eye inflammation. Biopsy of the vitreous fluid of the right eye revealed large abnormal cells suggestive of lymphoma. A staging F-18 FDG PET/CT showed intense uptake in the hypothalamus, and mild focal uptake in the subcutaneous tissues of the right lower leg, which were biopsied to reveal diffuse large B cell lymphoma. The patient was treated with high dose chemotherapy (methotrexate), and a follow-up PET/CT showed complete resolution of the hypothalamic and right leg lesions. Intraocular-central nervous system lymphoma (also known as oculocerebral lymphoma) is rare, with only 150 cases reported in the literature. This case highlights the utility of PET/CT in the staging and evaluation of response to therapy for this rare lymphoma subtype. We recommend that patients with intraocular-central nervous system lymphoma, who have a staging PET/CT should have total body acquisitions that include the head and neck, and upper and lower extremities, as these may yield unexpected sites of disease, easily accessible for biopsy.