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Primary diffuse large B cell lymphoma of the optic chiasm in an immunocompetent patient
  1. Orlando De Jesus1,
  2. Christian Rios-Vicil1,
  3. Frances M Gómez-González2 and
  4. Román Vélez2
  1. 1Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
  2. 2Pathology and Laboratory Medicine, University of Puerto Rico School of Medicine, Río Piedras, Puerto Rico
  1. Correspondence to Dr Orlando De Jesus; drodejesus{at}


Primary lymphoma of the visual pathway is rare, especially at the chiasm. Very few cases have been reported. The lesion is frequently confused with an optic–hypothalamic glioma. A 55-year-old man was found disoriented at his home by a friend and evaluated with a brain MRI which demonstrated an expansile mass located at the optic chiasm and hypothalamus level. The principal differential was a high-grade hypothalamic glioma due to the contrast enhancement. A biopsy of the chiasmal lesion was performed. Histological diagnosis of the lesion was compatible with a diffuse large B cell lymphoma. He was started on methotrexate and rituximab; however, his clinical course kept deteriorating, and he died 64 days after his presentation. All prior cases of primary lymphoma of the chiasm are reviewed.

  • Malignant and Benign haematology
  • Neuroimaging
  • Neuro-oncology
  • CNS cancer
  • Neurosurgery

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  • Contributors Acquiring data—ODJ and CR-V. Drafting manuscript—ODJ, CR-V, FMG-G and RV. Approval of the final version—ODJ, CR-V, FMG-G and RV.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.