|Year : 2015 | Volume
| Issue : 3 | Page : 648
Primary dural non-hodgkin's lymphoma mimicking meningioma: A case report and review of literature
Jyoti K Kudrimoti1, Manish J Gaikwad1, Shaila C Puranik1, Ashish P Chugh2
1 Department of Pathology, BJ Medical College, Pune, Maharashtra, India
2 Department of Neurosurgery, BJ Medical College, Pune, Maharashtra, India
|Date of Web Publication||9-Oct-2015|
Jyoti K Kudrimoti
Department of Pathology, BJ Medical College, Pune - 411 001, Maharashtra
Source of Support: None, Conflict of Interest: None
A 42-year-old immunocompetent female presented with headache, vomiting and diminished unilateral vision. Computed tomography and magnetic resonance imaging were suggestive of high-grade meningioma. Neurological examination and routine hematological parameters were within normal limits. Craniotomy was performed; the tumor was arising from the dura mater, which was completely resected. Hematoxylin and eosin showed lesion comprising a tumor mass with monomorphic population of tumor cells arranged in sheets and small follicles. The tumor cells were immunoreactive for leukocyte common antigen and CD20 and immunonegative for glial fibrillary acid protein, epithelial membrane antigen, cytokeratin, CD3 and CD30. Rest of the body scan was normal. A diagnosis of primary dural non-Hodgkin's lymphoma was made. We report this exceedingly rare case of primary dural non-Hodgkin's lymphoma, which mimicked clinically and radiologically as meningioma.
Keywords: Meningioma, non-Hodgkins lymphoma, primary dural
|How to cite this article:|
Kudrimoti JK, Gaikwad MJ, Puranik SC, Chugh AP. Primary dural non-hodgkin's lymphoma mimicking meningioma: A case report and review of literature. J Can Res Ther 2015;11:648
|How to cite this URL:|
Kudrimoti JK, Gaikwad MJ, Puranik SC, Chugh AP. Primary dural non-hodgkin's lymphoma mimicking meningioma: A case report and review of literature. J Can Res Ther [serial online] 2015 [cited 2020 May 26];11:648. Available from: http://www.cancerjournal.net/text.asp?2015/11/3/648/146112
| > Introduction|| |
Lymphomas of the central nervous system (CNS) occur mostly due to the secondary spread from a distant non-Hodgkin's lymphoma.  Primary CNS non-Hodgkin's lymphoma is rare, and it comprises 1% of intracranial tumors. Lymphomas involving the dura are mostly secondary, occurring in almost 9% of all patients with non-Hodgkin's lymphoma.  Primary non-Hodgkin's lymphoma of the dura is very rare and its incidence is unknown. We present a rare case of a wide dural based intracranial non-Hodgkin's lymphoma, located over the fronto-parietal convexity that clinically and radiologically resembled a high-grade meningioma.
| > Case report|| |
Clinical features: A 42-year-old female presented with headache and vomiting for 15 days. Headache was aggravated while bending down and sneezing. Patient also complained of decreased right-sided vision since one week. Physical and neurological examinations were normal with no hepatosplenomegaly or any lymphadenopathy. Routine laboratory investigations showed normal results.
A computed tomographic scan of her brain showed an extra-axial broad-based elliptical large mass in the right fronto-parieto-temporal convexity, which was compressing the brain parenchyma causing midline shift and therefore increasing the intracranial tension [Figure 1] and [Figure 2]. The scan showed no evidence of hemorrhage or calcification in the mass. Magnetic resonance imaging (MRI) revealed an intense homogenously enhanced extra-axial dura-based mass suggestive of meningioma, which also showed iso-signal intensity on T1-weighted images and low signal intensity on T2-weighted images.
A right fronto-parieto-temporal craniotomy was performed. The mass was found arising from the dura. The mass was adherent to the surrounding skull bone and to the brain parenchyma making dissection difficult.
| > Mri scan studies|| |
Gross examination of the surgical specimen showed a yellow-white solid lobulated mass with a thickened dura. On histopathology, the tissue showed diffuse proliferation of lymphoplasmacytic cells forming ill-defined nodules and at places having an angiocentric arrangement [Figure 3] and [Figure 4]. Tumor cells were predominantly small, round to oval with high N:C ratio, hyperchromatic nuclei, conspicuous nucleoli and scant cytoplasm [Figure 5]. Focal brisk mitosis was present. Tumor cells were stained for leukocyte common antigen and CD20, but immunonegative for glial fibrillary acid protein, epithelial membrane antigen, cytokeratin, CD3 and immunohistochemistry results. A diagnosis of non-Hodgkin's lymphoma was confirmed.
The patient did not have any neurological deficit at discharge. She was advised both chemotherapy and radiotherapy.
| > Discussion|| |
Non-Hodgkin's lymphoma contributes up to 4% of all neoplasms and is frequently encountered in AIDS patients. CNS is directly involved in up to 2% of patients with lymphoma. , Such lymphomas are most commonly seen in older age group in seventh and eighth decades. , Primary dural lymphomas are extremely rare and only few cases have been reported in the literature. Primary dural lymphomas are known to occur in middle-aged females. Two largest series of primary dural lymphomas had 15 and 8 patients and female/male ratio observed in them was 4:1 and 3:1, respectively indicating high prevalence in females.  There is no direct association between acquired and congenital immunosuppression and primary dural lymphoma.  Our patient was HIV-negative and middle-aged as stated in the literature. The clinical signs and symptoms of intracranial lymphoma are nausea, vomiting, ataxia, changes in vision, confusion, fever, headaches due to damage of bone or meninges by the tumor, leaning to one side when walking, loss of coordination, numbness to hot and cold, pain, and seizures. ,,, In our case, the patient had headache, vomiting and diminished right-sided vision.
In our case the lesion was situated in the fronto-parietal convexity, dura-based with extra axial location, which was highly suggestive of meningioma. On MRI scan, the lesion was seen infiltrating the brain parenchyma as well as eroding the periosteum, which favored a diagnosis of high-grade meningioma. Radiologically and clinically, the tumor highly mimicked meningioma.
Meningioma is the most important differential diagnosis.  Primary dural lymphomas and meningiomas share features like high incidence in women, age of onset and a dural tail on neuroimaging. 
As this tumor is potentially treatable with surgery, chemotherapy and radiotherapy, it is advisable to maintain a high clinical suspicion while dealing with a case of meningioma. The present case was managed with surgery, chemotherapy and radiotherapy. On follow-up, a physical examination with a whole body scan was performed, which was negative for recurrence or distant spread.
| > References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]