Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
E-JCRT CORRESPONDENCE
Year : 2015  |  Volume : 11  |  Issue : 3  |  Page : 648

Primary dural non-hodgkin's lymphoma mimicking meningioma: A case report and review of literature


1 Department of Pathology, BJ Medical College, Pune, Maharashtra, India
2 Department of Neurosurgery, BJ Medical College, Pune, Maharashtra, India

Date of Web Publication9-Oct-2015

Correspondence Address:
Jyoti K Kudrimoti
Department of Pathology, BJ Medical College, Pune - 411 001, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.146112

Rights and Permissions
 > Abstract 

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 2019 Nov 11];11:648. Available from: http://www.cancerjournal.net/text.asp?2015/11/3/648/146112


 > Introduction Top


Lymphomas of the central nervous system (CNS) occur mostly due to the secondary spread from a distant non-Hodgkin's lymphoma. [1] 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. [2] 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 Top


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.

Radio-Imaging

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.
Figure 1: A large enplaque lesion of 9.3 x 3.6 cm

Click here to view
Figure 2: Tumor mass infiltrating through the meninges

Click here to view



 > Mri scan studies Top


Pathology

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.
Figure 3: Ill-defined nodular pattern of cells

Click here to view
Figure 4: Tumour cells arranged in small follicular pattern

Click here to view
Figure 5: Tumour cells with high N:C ratio

Click here to view


The patient did not have any neurological deficit at discharge. She was advised both chemotherapy and radiotherapy.


 > Discussion Top


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. [3],[4] Such lymphomas are most commonly seen in older age group in seventh and eighth decades. [5],[6] 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. [7] There is no direct association between acquired and congenital immunosuppression and primary dural lymphoma. [7] 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. [5],[8],[9],[10] In our case, the patient had headache, vomiting and diminished right-sided vision.

Neuroimaging

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.

Differential diagnosis

Meningioma is the most important differential diagnosis. [7] Primary dural lymphomas and meningiomas share features like high incidence in women, age of onset and a dural tail on neuroimaging. [7]

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 Top

1.
Hochberg FH, Baehring JM, Hochberg EP. Primary CNS lymphoma. Nat Clin Pract Neurol 2007;3:24-35.  Back to cited text no. 1
    
2.
Dural marginal zone lymphoma confused with meningioma en plaque. J Korean Neurosurg Soc 2007;42:220-3.  Back to cited text no. 2
    
3.
Baleydier F, Galambrun C, Manel AM, Guibaud L, Nicolino M, Bertrand Y. Primary lymphoma of the pituitary stalk in an immunocompetent 9- year-old child. Med Pediatr Oncol 2001;36:392-5.  Back to cited text no. 3
    
4.
Jamjoom ZA, Naim-Ur-Rahman, Cheema MA. Primary mid-line cranial vault lymphoma simulating parasagittal meningioma: The role of angiography in preoperative diagnosis. Neurosurg Rev 1998;21:202-5.  Back to cited text no. 4
[PUBMED]    
5.
Aquilina K, O′Brien DF, Phillips JP. Diffuse primary non-Hodgkin′s lymphoma of the cranial vault. Br J Neurosurg 2004;18:518-23.  Back to cited text no. 5
    
6.
Tanimura A, Adachi Y, Tanda M, Yuasa H, Ishii Y, Katou Y. Primary peripheral B cell lymphoma, Burkitt-like, of the cranial vault. Acta Heamatol 2005;113:258-61.  Back to cited text no. 6
    
7.
Fawbio M, Iwamoto, Lauren E, Abrey. Primary dural lymphomas: A review. Neurosurg Focus 2006;21.  Back to cited text no. 7
    
8.
Tu PH, Giannianoi C, Judkins AR, Schwalb JM, Burack R, O′ Neill BP, et al. Clinicopathologic and genetic profile of intracranial marginal zone lymphoma: A primary low-grade CNS lymphoma that mimics meningioma. J Clin Oncol 2005;23:5718-27.  Back to cited text no. 8
    
9.
Parekh HC, Sharma RR, Keogh AJ, Prabhu SS. Primary malignant non-Hodgkin′s lymphoma of the cranial vault: A case report. Surg Neurol 1993;39:286-9.  Back to cited text no. 9
    
10.
Holtas S, Monajati A, Utz R. Computed tomography of malignant lymphoma involving the skull. J Comput Assist Tomogr 1985;9:725-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

Top
 
 
  Search
 
Similar in PUBMED
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Case report>Mri scan studies>Discussion>Article Figures
  In this article
>References

 Article Access Statistics
    Viewed2663    
    Printed64    
    Emailed0    
    PDF Downloaded122    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]