Epstein‐Barr virus‐positive diffuse large B‐cell primary central nervous system lymphoma associated with organized chronic subdural hematoma: A case report and review of the literature

Abstract

We here report on a rare case of Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) detected in both brain parenchyma and in an organized chronic subdural hematoma (OCSH). A 96-year-old man diagnosed with asymptomatic OCSH in the left frontal convexity was referred to our hospital because of a de novo mass lesion just beneath the OCSH on contrast-enhanced magnetic resonance imaging. The size of the OCSH remained stable. We diagnosed the lesion as a malignant tumor. At surgery, the organized hematoma and the soft fragile tumor were removed. Histological examinations revealed pleomorphic lymphoid cells not only in the brain tissue but also in the OCSH component with tumor necrosis, and these were immunopositive for B-cell markers. In situ hybridization revealed positive signals for EBV-encoded small RNAs, consistent with EBV-positive DLBCL. Since the membranes of the subdural hematoma were fibrous and the tumor progression resulted in necrosis of the tumor, the DLBCL may have originally developed in the OCSH and infiltrated into the brain parenchyma. We believe that this rare case provides crucial information for the understanding of DLBCLs associated with OCSH.

Single Burr Hole and Drainage in Chronic Subdural Hematoma: Outcome in Consecutive 333 Cases

“…7,8 Coagulopathy and intracranial tumors have been associated with spontaneous CSDH. 4,13,19,21 In this study we also found the association of hypertension, diabetes, previous surgery and Parkinson's disease associated with CSDH but they were all statistically insignifi cant causes. The presenting symptoms are depending on the site and size, confusion or coma, altered memory, speaking or swallowing problems, gait abnormalities, decreased mentation, headache, seizures and bowel or bladder incontinence.…”

“…Epidemiological and demographical data like age, sex, mode of injury if recorded, alcohol intake, comorbid conditions, side of hematoma, admission Glasgow coma scale (GCS) and GCS at discharge were noted. The outcome of surgery for CSDH is good and therefore the GCS was dichotomized into good (GCS-15) or poor prognosis (GCS- [12][13][14] and this was used to calculate the fi nal outcome and interrelationship between variables.…”

“…The cases were divided into two groups on the basis of GCS as either poor outcome (GCS- [12][13][14] or good outcome (GCS>15) and interrelated variables calculated. Statistical analysis did not show any signifi cant p value between the Age group, Sex, Side of CSDH or chronic alcoholism as independent variables affecting outcome.…”

A Malignant Lymphoma Growing Inside a Cardiac Mixoma: A Case Report

“…Most importantly, despite aggressive histologic features (large cell morphology, high proliferation index), FA-DLBCL is a localized disease with an indolent behaviour and a favourable outcome even with surgical excision alone. The rare event of relapse and the associated risk of local invasion [3,9,21], however, reinforces the need for a complete surgical excision.…”

Fibrin-associated diffuse large B-cell lymphoma in a hemorrhagic cranial arachnoid cyst

“…As reviewed by Boyer et al, three cases of fibrin-associated DLBL have been documented in SDH found in patients with a median age of 66.5 years and a male: female ratio of 4:0. An additional new case was reported by Boyer et al All except one of these cases showed similar histology, prognosis and an EBV-association [ 1 , 2 , 6 ]. One of the cases was considered a primary lymphoma presenting as a chronic subdural hematoma [ 2 ].…”