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Hamamoto R, Kawasaki T, Oda M, Sumiyoshi S, Hayashi K, Kobayashi T, Ioroi Y, Uchiyama T, Takayama M, Saiki M. Primary extranodal marginal zone mucosa-associated lymphoid tissue-type B-cell lymphoma involving the dura: A case report. Surg Neurol Int 2024; 15:113. [PMID: 38628522 PMCID: PMC11021089 DOI: 10.25259/sni_792_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/09/2024] [Indexed: 04/19/2024] Open
Abstract
Background Primary extranodal marginal zone mucosa-associated lymphoid tissue-type B-cell lymphoma (EMZMBCL), which presents as a dural mass, is a rare intracranial tumor that mimics a subdural hematoma or meningioma. Case Description A 49-year-old woman presented to our hospital with transient right upper limb paresis, dysarthria for 10 min, and ongoing right upper-limb numbness. Computed tomography (CT) of the head revealed extra-axial lesions in the left frontal and parietal lobes. Based on the initial CT findings in the emergency room, an acute subdural hematoma was suspected. However, meningiomas and other intracranial tumors were also listed as differential diagnoses because there was no history of head trauma or coagulation abnormalities on blood examination, and further imaging studies were performed. Imaging findings suggested a subdural neoplastic lesion. A partial resection was performed for the lesion. Based on histopathological and immunohistochemical examinations, the patient was diagnosed with EMZMBCL. Whole-brain and intensity-modulated radiation therapies were administered as adjuvant therapies. The patient was discharged without neurological deficits. Conclusion EMZMBCL is a rare disease that should be considered in the differential diagnosis of subdural lesions, especially when there is no history of trauma or abnormalities in the coagulation system. The patient had a favorable outcome after selecting radiotherapy as the adjuvant therapy.
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Affiliation(s)
- Ryo Hamamoto
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Toshinari Kawasaki
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masashi Oda
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Sosuke Sumiyoshi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Kosuke Hayashi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Tamaki Kobayashi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Yoshihiko Ioroi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Tatsuki Uchiyama
- Department of Hematology Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Motohiro Takayama
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masaaki Saiki
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
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Flospergher E, Marino F, Calimeri T, Cangi MG, Ferreri AJM, Ponzoni M, Bongiovanni L. Primary central nervous system marginal zone lymphoma. Br J Haematol 2024; 204:31-44. [PMID: 38054330 DOI: 10.1111/bjh.19238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
Marginal zone lymphoma (MZL) is the most common indolent lymphoma primarily arising in the central nervous system (CNS). To date, 207 cases of primary CNS MZL (PCNSMZL) were published, mostly as single case reports or small case series. It most commonly presents as extra-axial dural-based masses, more frequently in middle-aged women, displaying an insidious onset, with a long history of symptoms preceding the diagnosis. PCNSMZL can be radiographically mistaken for meningioma. PCNSMZL consists of CD20+ , CD3- small B lymphocytes with varying degrees of plasmacytic differentiation and low proliferation index. Trisomy 3, but not MALT1 or IgH translocation, is a common genetic abnormality. Other recurrent genetic abnormalities involve TNFAIP3 and NOTCH2. Ethiopathogenesis was poorly investigated. Due to its rarity, standard of care remains to be defined; it exhibits an excellent prognosis after varied treatments, such as surgery, radiotherapy, chemotherapy or their combinations. Nevertheless, each treatment should be considered after an accurate analysis of overtreatment risk. Short follow-up is a major limitation in reported PCNSMZL cases, which restrains our knowledge on long-term results and iatrogenic sequels. This review was focussed on presentation, differential diagnoses, pathological findings, treatment options and clinical outcomes of PCNSMZL; recommendations for best clinical practice are provided.
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Affiliation(s)
- Elena Flospergher
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Marino
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Teresa Calimeri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrés José María Ferreri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
| | - Maurilio Ponzoni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
| | - Lucia Bongiovanni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
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La Rocca G, Auricchio AM, Mazzucchi E, Ius T, Della Pepa GM, Altieri R, Pignotti F, Gessi M, De Santis V, Zoia C, Sabatino G. Intracranial dural based marginal zone MALT-type B-cell lymphoma: a case - Based update and literature review. Br J Neurosurg 2023; 37:1480-1486. [PMID: 34180316 DOI: 10.1080/02688697.2021.1941760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Dural based Marginal Zone MALT-type B-Cell Lymphoma (MZBCL) is an intracranial tumor that can mimicking meningioma both from a clinical and a radiological point of view. A standard treatment protocol is still lacking. Aim of the present work is to provide an update of the present literature regarding this rare neoplasia. PATIENTS AND METHODS We report the case of a patient with a dural-based lesion mimicking a meningioma of the tentorium. After surgical treatment, the diagnosis was of MZBCL. A literature review is performed to highlight the typical characteristics of this rare intracranial lesion and to define the best therapeutic approach. RESULTS Literature review included 38 articles describing 126 cases of intracranial dural-based MZBCL. No clinical trial has been found. Clinical and histopathological features are properly collected to provide a guide for future cases. Different treatment options have been attempted. Combination of surgery with adjuvant radiation therapy is the most used option. CONCLUSIONS MZBCL should be considered in differential diagnosis for dural-based intracranial lesion. Surgery followed by radiation therapy is the most reported treatment. As a consequence of the rarity of this disease, of its indolent progression and of the lack of adequate follow-up, it is not possible to define it is the best treatment option.
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Affiliation(s)
- G La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - A M Auricchio
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - E Mazzucchi
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - T Ius
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia, University Hospital, Italy, Udine
| | - G M Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - R Altieri
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G.Rodolico" University Hospital, Catania, Italy
| | - F Pignotti
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - M Gessi
- Department of Neuro-Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - V De Santis
- Institute of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
- Unit of Orthopedics, Mater Olbia Hospital, Olbia, Italy
| | - C Zoia
- Unit of Neurosurgery, Fondazione Policlinico San Matteo Pavia IRCCS, Pavia, Italy
| | - G Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
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Fiorentino V, Pizzimenti C, Pierconti F, Lentini M, Ieni A, Caffo M, Angileri F, Tuccari G, Fadda G, Martini M, Larocca LM. Unusual localization and clinical presentation of primary central nervous system extranodal marginal zone B‑cell lymphoma: A case report. Oncol Lett 2023; 26:408. [PMID: 37600340 PMCID: PMC10436157 DOI: 10.3892/ol.2023.13994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Primary central nervous system (CNS) extranodal marginal zone B-cell lymphoma (MZBL) is a rare low-grade non-Hodgkin lymphoma, characterised predominantly by small B cells, plasma cells, monocytoid cells and scattered large immunoblasts. Primary CNS MZBL is a slow-growing tumour that remains localised and is characterised by an excellent clinical prognosis. The present study describes the case of a 48-year-old HIV-negative female patient with a history of head trauma 1 year prior, who presented with worsening neurological symptoms and a magnetic resonance imaging finding of a ~3-cm extra-axial mass within the left lateral ventricle. From histopathology and immunohistochemistry, the lesion was diagnosed as a CNS MZBL; as no other primary lesions were found, the base of the choroid plexuses of the left lateral ventricle was considered the primary site. To the best of our knowledge, the current case is the first study to report on primary CNS MZBL arising in this anatomical site and paves the way for further studies on the role of chronic inflammation (in the present case resulting from trauma) in the pathogenesis not only of primary CNS MZBL but also of lymphoma in general. Additionally, this report could serve as a starting point for studies analysing the role of meningothelial cells in the pathogenesis of primary CNS MZBL.
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Affiliation(s)
- Vincenzo Fiorentino
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Cristina Pizzimenti
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Francesco Pierconti
- Institute of Pathology, Division of Anatomic Pathology and Histology, A. Gemelli-Scientific Institute for Research, Hospitalization and Healthcare University Hospital Foundation, I-00168 Rome, Italy
| | - Maria Lentini
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Maria Caffo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Neurosurgery, University Hospital ‘G. Martino’, I-98125 Messina, Italy
| | - Filippo Angileri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Neurosurgery, University Hospital ‘G. Martino’, I-98125 Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Guido Fadda
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Maurizio Martini
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Luigi Maria Larocca
- Department of Medicine and Surgery, Unicamillus, Saint Camillus International University of Health Sciences, International Medical University in Rome, I-00131 Rome, Italy
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Facchinelli D, Mazzai L, Parisi C, Novello M. Intracranial MALT lymphomas of the dura mater: two case reports. Acta Neurol Belg 2023:10.1007/s13760-023-02214-0. [PMID: 36964304 DOI: 10.1007/s13760-023-02214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/13/2023] [Indexed: 03/26/2023]
Affiliation(s)
- Davide Facchinelli
- Hematology Unit, Department of Clinical Oncology, San Bortolo Hospital, Vicenza, Italy.
| | - Linda Mazzai
- Neuroradiology Unit, Department of Neuroscience, San Bortolo Hospital, Vicenza, Italy
| | - Cristiano Parisi
- Neurosurgery Unit, Department of Neuroscience, San Bortolo Hospital, Vicenza, Italy
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Kwok HM, Li KY, Chan RLS, Chan CH, Wong SKH, Lee CM, Cheng LF, Ma JKF. Different facets of intracranial central nervous system lymphoma and its imaging mimics. J Clin Imaging Sci 2022; 12:4. [PMID: 35242450 PMCID: PMC8888189 DOI: 10.25259/jcis_135_2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 02/18/2022] [Indexed: 12/12/2022] Open
Abstract
Lymphomas of the central nervous system (CNS) are broadly classified into primary CNS lymphoma (PCNSL) and secondary CNS lymphoma (SCNSL). PCNSL refers to lymphoma restricted to the brain, leptomeninges, spinal cord, or eyes without evidence of it outside the CNS at primary diagnosis, while SCNSL refers to secondary CNS involvement by systemic lymphoma. The brain is the most common site of involvement and intracranial CNS lymphoma has a highly variable imaging appearance and varies according to the patient’s clinical profile and immunity. This pictorial essay aims to illustrate the different facets of intracranial CNS lymphomas on neuroimaging. This enables radiologists to be familiarized with their key diagnostic features and differentiate from their differential diagnoses, leading to early diagnosis, and treatment.
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Affiliation(s)
- Hoi Ming Kwok
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Kowloon, Hong Kong, China,
| | - Kwok Yan Li
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Kowloon, Hong Kong, China,
| | - Rois L. S. Chan
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Kowloon, Hong Kong, China,
| | - Chi Hin Chan
- Department of Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Kowloon, Hong Kong, China,
| | - Stephen Ka Hon Wong
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Kowloon, Hong Kong, China,
| | - Chiu Man Lee
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Kowloon, Hong Kong, China,
| | - Lik Fai Cheng
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Kowloon, Hong Kong, China,
| | - Johnny Ka Fai Ma
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Kowloon, Hong Kong, China,
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Ariani R, Ballas L. Primary CNS Extranodal Marginal Zone B-Cell Lymphoma: A Case Series of 2 Patients Treated with External Beam Radiation Therapy. Case Rep Oncol 2021; 14:725-732. [PMID: 34177522 PMCID: PMC8216028 DOI: 10.1159/000515780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/19/2022] Open
Abstract
Primary CNS extranodal marginal zone B-cell lymphoma (MZBL) is a rare low-grade non-Hodgkin lymphoma characterized predominantly by small B cells, plasma cells, monocytoid cells, and scattered large immunoblasts. As a slow-growing tumor that remains localized, primary CNS MZBL carries an excellent clinical prognosis. Here, we report two cases of primary CNS MZBL successfully treated using external beam radiation therapy along with a literature review.
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Affiliation(s)
- Rojine Ariani
- Department of Radiation Oncology, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Leslie Ballas
- Department of Radiation Oncology, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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