Primary dural lymphoma mimicking meningioma: a clinical and surgical case report

Abstract

Introduction: Primary central nervous system lymphoma and its subtype, primary dural lymphoma, are types of non-Hodgkin's lymphoma that only occur in the central nervous system without any dissemination. They are extremely rare cases of extra nodal lymphomas accounting for 1--5% of intracranial tumors. Case report: We present a patient diagnosed with primary dural lymphoma in right frontal brain region who underwent surgical resection. Histopathological analysis revealed diffuse B-type large cell non-Hodgkin lymphoma. Patient underwent four cycles of R-CHOP and intrathecal methotrexate protocol. Six months postoperative, no signs of newly onset infiltration were present. Discussion: Primary dural lymphoma most likely presents with unusual radiological signs, which can easily be mistaken for meningioma, the main differential diagnosis. A thorough immunological, histopathological and clinical patients profile should be conducted in order to establish the certainty of diagnosis. Although there are few treatment options: surgery, radiotherapy or chemotherapy, there is no established treatment protocol.

A cerebral lymphoma mimicking a meningioma: case report

“…It should be noted that ADC values are inversely correlated with cytopathological progression of PCNSL cell density and may be a prognostic factor 7 . Several data suggest that pretherapeutic ADC measurements in the contrast-taking lesion are predictive of overall survival in immunocompetent patients treated with a combination of high-dose MTX and rituximab 8 .…”

Dural lymphoma misdiagnosed as subdural hematoma following head trauma after an episode of syncope

“…Diagnosis is often delayed as PCNSL may resemble other pathological conditions such as subdural hematomas (on nonenhanced CT) or en plaque meningiomas (on enhanced CT) [5] , [6] , [7] , [8] , [9] , [10] . Most patients will receive neuroradiologic imaging shortly after presentation given their neurologic symptomatology.…”

“…Most patients will receive neuroradiologic imaging shortly after presentation given their neurologic symptomatology. CT of the brain will commonly reveal a single or multifocal irregularly- or crescent-shaped, extra-axial, vividly enhancing, high-density mass compared to the brain parenchyma [5 , 6 , 11 , 12] . The hyperdensity is often attributed to the highly cellular nature of the lesions [12] .…”

“…The hyperdensity is often attributed to the highly cellular nature of the lesions [12] . There is often an associated hypodense area adjacent to the lymphoma which represents vasogenic edema [5 , 6 , 11 , 12] .…”

Primary Dural Lymphoma Mimicking En Plaque Cerebellopontine Angle Meningioma

“…Due to the fact that the majority of PDLs are low-grade marginal zone B-cell lymphomas, the prognosis tends to be much more favorable, especially in comparison to bona fide PCNSLs. Its clinical and radiographic features mostly mimic meningioma so that diagnosis of meningioma is often made clinically prior to the pathological findings [ 8 ]. Given the accumulating reports for the past decades, PDL histopathology is much more defined.…”