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Garg S, Gude G, Chatterjee D, Tewari MK, Singla R, Ahuja C. Primary Dural Acute Lymphoblastic Leukaemia/Lymphoma Masquerading Meningioma: Report of a Case and Review of Literature. Neurol India 2023; 71:987-990. [PMID: 37929440 DOI: 10.4103/0028-3886.388108] [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] [Indexed: 11/07/2023]
Abstract
Acute lymphoblastic leukaemia/lymphoma (ALL) is a systemic disease which primarily involves bone marrow or lymphoid organs. Extranodal presentation of ALL is uncommon, and ALL presenting as a dural mass is exceedingly rare. Here we present a case of primary dural B-cell ALL which was preoperatively diagnosed as meningioma on clinico-radiological grounds. A 27-year-old female patient presented with left hemicranial headache for one month's duration along with progressive vision loss of in both eye and altered behaviour. Contrast enhanced magnetic resonance imaging (CE-MRI) suggest dural based mass with dural tail sign. Histopathological examination of the resected specimen revealed B-cell ALL. Further systemic investigations didn't suggest any peripheral blood, bone marrow or lymph node involvement. To the best of our knowledge, only two cases of primary dural ALL have been reported in the literature so far. This report highlights the diagnostic difficulty in extramedullary precursor lymphoid neoplasm.
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Affiliation(s)
- Sumit Garg
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Geethanjali Gude
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj K Tewari
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghav Singla
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag Ahuja
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Patel NS, Van Abel KM, Link MJ, Driscoll CLW, Van Gompel JJ, Neff BA, Lane JI, Carlson ML. Prevalence and Surgical Implications of Dural Enhancement at the Porus Acusticus in Vestibular Schwannomas. Otolaryngol Head Neck Surg 2016; 155:1021-1027. [PMID: 27703093 DOI: 10.1177/0194599816670144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/12/2016] [Accepted: 08/30/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Demonstrate the association of radiographic dural enhancement with increased tumor adherence at the porus acusticus, which may influence completeness of resection and facial nerve outcome. STUDY DESIGN Case series with chart review. SETTING Academic referral center. SUBJECTS AND METHODS A total of 205 consecutive patients with histopathologically confirmed vestibular schwannoma (VS) were evaluated. Patients with tumors exhibiting dural enhancement on postgadolinium T1-weighted magnetic resonance imaging were identified and compared with matched controls. Completeness of resection, intraoperative details, and facial nerve outcomes were analyzed. RESULTS Excluding strictly intracanalicular tumors (n = 32, 16%) and those with NF2 (n = 10, 4.9%), the presence of dural enhancement was radiographically confirmed in 16 (9.8%) cases. Paired analysis did not reveal significant baseline differences between cases and controls. Subtotal resection was performed in 5 (31%) of the 16 patients with tumors exhibiting dural enhancement, in contrast to 1 (3%) of the matched controls (P = .01). Four (25%) demonstrated increased tumor adherence at the porus acusticus intraoperatively, compared with 1 control (3%, P = .04). Long-term facial nerve function was similar between cases and controls (81% vs 84% House-Brackmann I-II function, P = 1.00). CONCLUSION Dural enhancement is present in approximately 10% of extracanalicular VS. Dural enhancement at the porus acusticus may represent hypervascularity, dural reaction, or infiltration, and portends increased tumor adherence and greater likelihood of subtotal resection to preserve facial nerve function. To our knowledge, this is the first series that reports the prevalence of this phenomenon in VS and the potential surgical implications. Recognition preoperatively may be valuable toward patient counseling.
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Affiliation(s)
- Neil S Patel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Colin L W Driscoll
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian A Neff
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - John I Lane
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew L Carlson
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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de la Fuente MI, Haggiagi A, Moul A, Young RJ, Sidani C, Markoe A, Vega F, DeAngelis LM, Lossos IS. Marginal zone dural lymphoma: the Memorial Sloan Kettering Cancer Center and University of Miami experiences. Leuk Lymphoma 2016; 58:882-888. [PMID: 27649904 DOI: 10.1080/10428194.2016.1218006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Dural lymphoma (DL) is a rare type of primary CNS lymphoma arising from the dura mater. The optimal treatment is uncertain. A retrospective review was performed on 26 DL patients. Seventeen patients underwent resection and nine had a biopsy. Twenty three patients could be assessed for a response to treatment after surgery. Thirteen received focal radiotherapy (RT), six whole brain RT (WBRT), three chemotherapy alone and one chemotherapy followed by WBRT. Twenty two achieved complete response (CR) and one a partial response (PR). Four patients relapsed (two local and two systemic). Median follow up was 64 months, with median progression free survival (PFS) and OS not reached. Three year PFS was 89% (95% CI 0.64-0.97). All patients are alive at last follow-up, demonstrating that DL is an indolent tumor with long survival. CR is achievable with focal therapy in the majority of cases, but there is a risk for relapses and long-term follow-up is recommended.
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Affiliation(s)
- Macarena I de la Fuente
- a Departments of Neurology and Sylvester Comprehensive Cancer Center , University of Miami , Miami , FL , USA
| | - Aya Haggiagi
- b Department of Neurology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Adrienne Moul
- c Department of Hematopathology, Pathology and Laboratory Medicine , University of Miami/Sylvester Comprehensive Cancer Center , Miami , FL , USA.,g Division of Hematology-Oncology, Department of Medicine , Sylvester Comprehensive Cancer Center, University of Miami , Miami , FL , USA
| | - Robert J Young
- d Department of Radiology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Charif Sidani
- e Department of Radiology , University of Miami , Miami , FL , USA
| | - Arnold Markoe
- f Department of Radiation Oncology , University of Miami , FL , USA
| | - Francisco Vega
- c Department of Hematopathology, Pathology and Laboratory Medicine , University of Miami/Sylvester Comprehensive Cancer Center , Miami , FL , USA
| | - Lisa M DeAngelis
- b Department of Neurology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Izidore S Lossos
- g Division of Hematology-Oncology, Department of Medicine , Sylvester Comprehensive Cancer Center, University of Miami , Miami , FL , USA.,h Department of Molecular and Cellular Pharmacology , Sylvester Comprehensive Cancer Center, University of Miami , Miami , FL , USA
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Primary dural lymphoblastic B-cell lymphoma: a rare subtype of aggressive dural lymphoma. J Hematop 2016. [DOI: 10.1007/s12308-015-0257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ramnarayan R, Anilkumar T, Nayar R. An unusual extra-axial hypodense lesion mimicking a chronic subdural haematoma. J Neurosci Rural Pract 2013; 4:216-9. [PMID: 23914111 PMCID: PMC3724313 DOI: 10.4103/0976-3147.112774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 59-year-old man was found on the road with multiple injuries. CT scan showed a hypodense extra axial lesion in the left fronto-temporal region suggestive of chronic subdural haematoma. He was treated conservatively but did not improve. He underwent craniectomy after lesion was shown to be increasing in size, only solid tissue was seen which was not biopsied. Patient made good recovery after steroids were put on. He deteriorated again 6 weeks later and radiology showed the frontal lesion without involvement of the brain and with minimal enhancement and mass effect. He underwent biopsy decompression of the lesion with steroids, post-operatively he improved well, but deteriorated when the steroids were tapered. Histopathology report was Non-Hodgkin's lymphoma. No primary was found and the patient died during oncology treatment. This illustrates manifestation of primary dural lymphoma radiologically mimicking chronic subdural haematoma, another common disorder.
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Affiliation(s)
- R Ramnarayan
- Department of Neurosurgery, Apollo Hospital, Chennai, India
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Reis F, Schwingel R, Queiroz LDS, Zanardi VDA. Primary dural lymphoma: a rare subtype of primary central nervous system lymphoma (PCNSL). ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:264-5. [DOI: 10.1590/s0004-282x2011000200025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Matmati K, Matmati N, Hannun YA, Rumboldt Z, Patel S, Lazarchick J, Stuart R, Giglio P. Dural MALT lymphoma with disseminated disease. Hematol Rep 2010; 2:e10. [PMID: 22184513 PMCID: PMC3222263 DOI: 10.4081/hr.2010.e10] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/30/2010] [Accepted: 12/01/2010] [Indexed: 12/16/2022] Open
Abstract
Central nervous system (CNS) lymphoma involving the dura mater is very rare and histologically is usually a subtype of non-Hodgkin's lymphoma (NHL) termed mucosa-associated lymphoid tissue (MALT) lymphoma. We present a case of a 46-year old woman with dural MALT lymphoma that was found to also involve a lacrimal gland, inguinal lymph nodes, and bone marrow. Magnetic resonance imaging of the brain showed an extra-axial enhancing mass approximately 6 cm in maximum diameter along the right frontotemporal convexity. Histopathology of the resected dural mass showed MALT lymphoma expressing CD20, CD52, CD19, and CD38. Molecular studies of the B-cell receptor heavy chain demonstrated monoclonality at the involved sites. The patient was treated with four cycles of fludarabine, mitoxantrone, and rituximab with complete remission. She had recurrence in the subcutaneous tissue of the back at 12 months but has remained free of intracranial disease for 31 months. A review of the literature reveals 57 cases of dural MALT lymphoma. Only 4 had extra-CNS involvement at presentation, and only 3 had local recurrence of the dural tumor. Because of the indolent behavior of this tumor, the intracranial portion can be treated conservatively after resection with or without chemotherapy. Deferral of brain radiation can be considered with close clinical and neuroimaging follow up.
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Affiliation(s)
- Kelly Matmati
- Medical University of South Carolina, Charleston, SC, USA
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Giordano A, Perrone T, Guarini A, Ciappetta P, Rubini G, Ricco R, Palma M, Specchia G, Liso V. Primary intracranial dural B cell small lymphocytic lymphoma. Leuk Lymphoma 2009; 48:1437-43. [PMID: 17613779 DOI: 10.1080/10428190701387021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Primary meningeal CNS lymphoma treated with intra-arterial chemotherapy and blood-brain barrier disruption. J Neurooncol 2008; 90:329-33. [PMID: 18758913 DOI: 10.1007/s11060-008-9667-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
Abstract
Diffuse large B-cell lymphoma of the meninges is a particularly rare form of primary CNS lymphoma. We report a case of a 63-year-old woman found to have primary meningeal lymphoma (PML) with dural and leptomeningeal involvement whom we treated with multiple cycles of intra-arterial (IA) methotrexate, intravenous (IV) etoposide phosphate, and IV cyclophosphamide after reversible osmotic blood-brain barrier disruption (BBBD). Improvement was evident on gadolinium-enhanced brain MRI one month into therapy. At 67 months post-diagnosis there is no evidence of CNS disease. After completing her therapy regimen, she remained disease-free for 34 months, when stage IV diffuse large B-cell lymphoma was discovered in her left adrenal gland and right thigh. Following six cycles of rituximab and CHOP treatment, she is presently in complete remission. IA methotrexate and reversible osmotic BBBD without radiation therapy may be an effective therapy for treating PML.
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Kiewe P, Dallenbach FE, Fischer L, Hoecht S, Kombos T, Thiel E, Korfel A. Isolated B-cell lymphoproliferative disorder at the dura mater with B-cell chronic lymphocytic leukemia immunophenotype. ACTA ACUST UNITED AC 2008; 7:594-6. [PMID: 18186969 DOI: 10.3816/clm.2007.n.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lymphoma manifestations of the dura mater are extremely rare and have mostly been attributed to extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type. We report a patient with an isolated meningeal tumor, identified as a B-cell lymphoproliferative disorder with typical B-cell chronic lymphocytic leukemia immunophenotype. Because of the subclinical detection of trisomy 3 in the bone marrow by cytogenetic analysis and interphase fluorescence in situ hybridization, CD5(+) MALT is an important differential diagnosis; however, to our knowledge, this entity has never been reported in the context of dural lymphoma.
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Affiliation(s)
- Philipp Kiewe
- Department of Hematology, Oncology and Transfusion Medicine, Charité Campus Benjamin Franklin, Berlin, Germany.
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Abstract
✓Primary dural lymphoma (PDL) is a rare subtype of primary central nervous system lymphoma (PCNSL) that arises from the dura mater and differs biologically from other CNS lymphomas. The PDL is usually a low-grade marginal zone lymphoma (MZL), whereas other types of PCNSLs are usually high-grade, diffuse, large B-cell lymphomas. A PDL usually presents with single or multiple extraaxial masses that enhance diffusely with addition of contrast material and can be confused with meningioma. The MZLs respond well to local therapy such as surgery and radiation treatment. Most patients attain complete response and have good local disease control. Nevertheless, the risk of systemic relapse appears to be high, probably because the dura mater is outside of the blood–brain barrier.
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Affiliation(s)
- Fabio M Iwamoto
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, USA
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