Pediatric suprasellar primary CNS lymphoma with cavernous sinus invasion and ischemic stroke: a case report and systematic review.
Fatimah A AlShakhs, Asayel A Alruwaili, Thana S Namer et al.
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Case in brief
A 12-year-old immunocompetent girl presented with high fever, severe headache, and diplopia, followed by rapid neurological deterioration. MRI showed a rim-enhancing sellar-suprasellar lesion invading the cavernous sinus and critically narrowing the internal carotid artery, with bilateral watershed infarctions. Emergency endoscopic endonasal decompression was performed, and pathology identified anaplastic diffuse large B-cell lymphoma of the non-germinal center B-cell subtype. Despite surgery and systemic chemotherapy, she developed central diabetes insipidus and severe hemodynamic instability and died within a few months.
What made this case unusual
The lesion caused critical internal carotid artery stenosis and bilateral watershed infarctions through cavernous sinus invasion, an exceptionally aggressive presentation compared with the previously reported pediatric cases reviewed.
Diagnostic / clinical pearl
In a child with a rapidly progressive suprasellar mass, vascular complications such as carotid stenosis and watershed infarction should heighten concern for an aggressive process and support early histopathological confirmation.