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CASE REPORT article

Front. Oncol.

Sec. Neuro-Oncology and Neurosurgical Oncology

Volume 15 - 2025 | doi: 10.3389/fonc.2025.1553142

Hypothalamic Demyelinating Lesion Preceding Lymphoma Arising Outside the Central Nervous System

Provisionally accepted
Narushi  SugiiNarushi Sugii1*Hiroyoshi  KinoHiroyoshi Kino1Tetsu  SuzukiTetsu Suzuki1Noriaki  SakamotoNoriaki Sakamoto1Makoto  ShibuyaMakoto Shibuya2Ken  AkimotoKen Akimoto1Masahide  MatsudaMasahide Matsuda1Eiichi  IshikawaEiichi Ishikawa1
  • 1University of Tsukuba, Tsukuba, Japan
  • 2Tokyo Medical University Hachioji Medical Center, Tokyo, Japan

The final, formatted version of the article will be published soon.

Nonneoplastic demyelinating brain lesions, known as sentinel lesions, occasionally precede primary central nervous system lymphomas (PCNSL). However, cerebral sentinel lesions associated with lymphoma "outside" the central nervous system (CNS) have not been reported. Here, we describe the case of a 76-year-old female who presented with rapidly progressive visual field disturbances. Magnetic resonance imaging revealed a hypothalamic lesion, and a biopsy demonstrated inflammatory demyelination with T-lymphocyte and macrophage infiltration, but no evidence of lymphoma. Steroid therapy was initiated only after biopsy. The lesions responded well to steroids and almost disappeared, and the patient was discharged with improvement in all symptoms except for diabetes insipidus. Three months later, the patient developed systemic symptoms, including osteolytic bone and skull lesions and multiple organ failure. A second biopsy of a skull lesion revealed diffuse large B-cell lymphoma (DLBCL), a non-germinal center B-cell-like subtype. Despite initiating chemotherapy, the patient died five months after the initial biopsy, although no recurrence of the brain lesion was observed. This case is the first to document a brain sentinel lesion preceding systemic DLBCL without associated cerebral lymphoma. It highlights the similarities with previously reported sentinel lesions in PCNSL, such as inflammatory demyelination and steroid responsiveness, while raising questions regarding the underlying mechanisms and challenges of early diagnosis. We emphasize the importance of considering sentinel lesions in patients with tumefactive inflammatory demyelination characterized by T-lymphocyte-dominant infiltration.

Keywords: case report, demyelinating lesion, diffuse large B-cell lymphoma, outside the central nervous system, sentinel lesion ANCA, antineutrophilic cytoplasmic antibody, AQP, aquaporin, CD, cluster of differentiation, CNS, central nervous system, CSF, cerebrospinal fluid, CT, computed tomography, CVO, circumventricular organ, DI, diabetes insipidus

Received: 14 May 2025; Accepted: 04 Sep 2025.

Copyright: © 2025 Sugii, Kino, Suzuki, Sakamoto, Shibuya, Akimoto, Matsuda and Ishikawa. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Narushi Sugii, University of Tsukuba, Tsukuba, Japan

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