Generalisiertes hochmalignes Non-Hodgkin-Lymphom mit Infiltration des linken Vorhofs und der Nervi optici mit bilateraler Amaurosis

Abstract

Zentralarterienverschluss – kirschroter Fleck – Amaurosis – Papillenatrophie Non-Hodgkin(cid:29)s Lymphoma Originating from the Left Atrium with Infiltration of Both Optic Nerves. A 48-year-old man was admitted because of an intracardiac tumor originating from the left atrium detected by chance. The patient had no symptoms associated with heart failure or arrhythmias. Transesophageal echocardiography revealed a large tumor mass probably encompassing the pulmonary veins. Due to this obstruction, a surgical exstirpation of the tumor was tried under cardiopulmonary bypass. But a resection of the tumor was not possible because of its large extension with diffuse cardiac infiltration. The histological diagnosis was non-Hodgkin(cid:29)s lymphoma of B-cell origin. Further lymphomatous lesions were detected in the abdomen. Combined chemotherapy was startet with partial remission at first. But the patient experienced a sudden bilateral visual loss. The funduscopy showed papilledema, hemorrhages of various types, and a cherry-red macula in association with tumoral optic nerve involvement. The retinal vessels were markedly narrowed or obliterated. The lumbar puncture revealed marked pleocytosis. The patient received whole brain irradiation together with intrathecal chemotherapy. However, there was no improvement in vision due to optic nerve atrophy. 5 months after admission, the patient died. Thus, even large cardiac tumors are often asymptomatic and detected by chance. Acute bilateral blindness caused by non-Hodgkin(cid:29)s lymphoma is a very rare disorder.