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Sreenivasan S, Solanki R, Kancharla P, Khan C, Samhouri Y. A Meningioma Mimic and Distinct Subtype of Primary Central Nervous System Lymphoma: Primary Dural Lymphoma. J Hematol 2023; 12:87-91. [PMID: 37187500 PMCID: PMC10181329 DOI: 10.14740/jh1113] [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: 03/11/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is an aggressive form of extranodal non-Hodgkin lymphoma that arises in the brain parenchyma, eyes, meninges, or spinal cord in the absence of systemic disease. Primary dural lymphoma (PDL), in contrast, arises from the dura mater of the brain. PDL is usually a low-grade B-cell marginal zone lymphoma (MZL), whereas other types of PCNSL are usually high-grade large B-cell lymphoma. This specific pathological subtype has important therapeutic and prognostic implications, making PDL a distinct subtype of PCNSL. Herein, we report a case of PDL in an African American patient, in her late thirties, who presented to our emergency room with chronic headaches. An emergent magnetic resonance imaging (MRI) of the brain showed a dural-based homogeneously enhancing extra-axial mass along the left hemisphere, which was contained within the anterior and parietal dural mater. A surgical specimen was collected after an emergency debulking procedure. The flow cytometry, done on the surgical specimen obtained, was positive for CD19+, CD20+, and CD22+, but negative for CD5- and CD10-. These findings were consistent with a clonal B-lymphoproliferative disorder. The surgical pathology specimen immunohistochemistry was positive for CD20+ and CD45+, but negative for Bcl-6Cyclin D1- and CD56-. The Ki67 was 10-20%. These findings were consistent with extranodal MZL. Given the location and pathology, the patient was diagnosed with PDL. Due to MZL's indolent nature, location outside the blood-brain barrier, and known efficacy to bendamustine-rituximab (BR), we decided to treat our patient with BR. She completed six cycles without major complications, and her post-therapy brain MRI showed complete remission (CR). Our case adds to the sparse literature about PDL and highlights the efficacy of BR systemic chemotherapy on MZLs.
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Affiliation(s)
- Sushanth Sreenivasan
- Department of Internal Medicine, West Penn Hospital, Pittsburgh, PA, USA
- Corresponding Author: Sushanth Sreenivasan, Department of Internal Medicine, West Penn Hospital, Pittsburgh, PA, USA.
| | - Risha Solanki
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Pragnan Kancharla
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Cyrus Khan
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Yazan Samhouri
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
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Thibodeau R, Li HK, Babu H, Jafroodifar A, Ramovic M, Hahn SS. Dural lymphoma misdiagnosed as subdural hematoma following head trauma after an episode of syncope. Radiol Case Rep 2022; 17:4774-4779. [PMID: 36238205 PMCID: PMC9550849 DOI: 10.1016/j.radcr.2022.09.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/19/2022] Open
Abstract
Primary dural lymphoma is a rare subtype of primary central nervous system lymphoma. Primary dural lymphoma may be radiologically misdiagnosed as it shares similar imaging characteristics with several pathologies, including meningiomas and subdural or epidural hematomas. We present a patient who was originally diagnosed with a subdural hematoma following a syncopal episode on computed tomography. Follow-up magnetic resonance imaging of the brain demonstrated heterogeneously enhancing dural-based mass overlying the left frontoparietal convexity associated with bidirectional dural tails, suggestive of a malignant meningioma. Neurosurgical histopathology revealed marginal zone B-cell lymphoma. This case represents the potential difficulty in diagnosing primary dural lymphoma, especially in the setting of uncertain clinical history and obscured imaging features.
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Key Words
- 18F-FDG PET/CT, 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography
- ADC, Apparent diffusion coefficient
- CNS, Central nervous system
- CT, Computed tomography
- DWI, Diffusion-weighted imaging
- Dural lymphoma
- ED, Emergency department
- FLAIR, Fluid-attenuated inversion recovery
- MR, Magnetic resonance
- MZBCL, Marginal zone B-cell lymphoma
- Meningioma
- Neuroradiology
- Neurosurgery
- PCNSL, Primary central nervous system tumor
- PCP, Primary care physician
- PDL, Primary dural lymphoma
- Radiation oncology
- SPECT, single-photon emission computed tomography
- Subdural hematoma
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Affiliation(s)
- Ryan Thibodeau
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Radiology, Albany Medical Center, Albany, NY, USA
| | - Hsin Kwung Li
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Harish Babu
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Abtin Jafroodifar
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Merima Ramovic
- Department of Medical Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Seung Shin Hahn
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
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Nitta N, Moritani S, Fukami T, Nozaki K. Characteristics of cranial vault lymphoma from a systematic review of the literature. Surg Neurol Int 2022; 13:231. [PMID: 35855149 PMCID: PMC9282819 DOI: 10.25259/sni_28_2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Cranial vault lymphomas are rare and their clinical features are often similar to those of cranial vault meningiomas. The objective of this review was to identify the features helpful for differentiating lymphomas of the cranial vault, from meningiomas which were the most common diagnosis before the definitive pathological diagnosis. Methods: The inclusion criterion was a histologically proven malignant lymphoma initially appearing in the calvarium. We conducted a literature search of the electronic PubMed and Ichushi-Web databases up to June 1, 2020. Cranial vault lymphoma that was diagnosed after an original diagnosis of lymphoma in a nodal or soft-tissue site was excluded from the study. Descriptive analyses were used to present the patient characteristics. Results: A total of 111 patients were found in 98 eligible articles. Almost all studies were case reports. The most common symptom was a growing subcutaneous scalp mass (84%) present for a mean duration of 5.9 months before the patient presented for treatment in analyzable cases; this fast growth may distinguish lymphomas from meningiomas. The tumor vascularization was often inconspicuous or poor, unlike well-vascularized meningiomas. A disproportionately small amount of skull destruction compared with the soft-tissue mass was observed in two-thirds of the analyzable cases. Conclusion: This qualitative systematic review identified several features of cranial vault lymphomas that may be useful in differentiating them from meningiomas, including a rapidly growing subcutaneous scalp mass, poor vascularization, and limited skull destruction relative to the size of the soft-tissue mass.
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Affiliation(s)
- Naoki Nitta
- Departments of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Suzuko Moritani
- Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tadateru Fukami
- Departments of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kazuhiko Nozaki
- Departments of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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Primary Dural Lymphoma Mimicking En Plaque Cerebellopontine Angle Meningioma. Case Rep Pathol 2021; 2021:2845995. [PMID: 34341695 PMCID: PMC8325585 DOI: 10.1155/2021/2845995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Primary dural lymphoma (PDL) usually arises from the calvarial dura without the brain parenchyma or systemic involvement and thus may not be considered as a typical form of primary CNS lymphoma (PCNSL). It is exceedingly rare. When it occurs, it might not be suspected as a primary diagnosis on clinical and radiologic findings. We present a PDL case that occurs at the cerebellopontine (CP) angle mimicking en plaque meningioma. The tumor histopathology showed a lymphoproliferative disorder immunophenotypically consistent with a low-grade marginal zone lymphoma. Bone marrow and systemic involvements were not identified, and a diagnosis of PDL was established. As a residual tumor at the CP angle was inaccessible to surgery, postoperative radiation therapy was performed. No recurrence was found at 15-month follow-up. PDLs are mostly indolent and have a good prognosis. There is no doubt that the most important differential diagnosis is meningioma. Furthermore, the present case emphasizes the necessity of an intraoperative consultation and knowledge of this rare yet essential form of PCNSL so that appropriate studies can be ordered.
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Dural based tumor causing cognitive decline: Answer. J Clin Neurosci 2020; 72:493-494. [PMID: 32780690 DOI: 10.1016/j.jocn.2019.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kiessling JW, Whitney E, Cathel A, Khan YR, Mahato D. Primary Cranial Vault Non-Hodgkin's Lymphoma Mimicking Meningioma With Positive Angiography. Cureus 2020; 12:e8856. [PMID: 32754397 PMCID: PMC7386091 DOI: 10.7759/cureus.8856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Primary non-Hodgkin’s lymphoma of the bone remains an uncommon presentation of non-Hodgkin’s lymphoma. Primary lymphoma of the cranial vault is exceptionally rare. Here, we present a 62-year-old immunocompetent male presenting with the rapid growth of a left parietal scalp lesion and new-onset seizure. In addition to his imaging, which showed an extracranial, cranial, and intracranial mass with bony destruction, sagittal sinus involvement, and parenchymal invasion, his diagnostic angiogram demonstrated extensive vascular supply from both the right and left external carotid branches. Intraoperatively, we confirmed a frank invasion of the posterior sagittal sinus. After subtotal resection followed by R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, the patient continues to be disease-free at the 10-month follow-up. We report here a case of primary cranial vault lymphoma that very closely mimicked meningioma in many ways, with positive angiography and intraoperatively confirmed venous sinus invasion.
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Affiliation(s)
| | - Eric Whitney
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | | | - Yasir R Khan
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
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Lopetegui‐Lia N, Delasos L, Asad SD, Kumar M, Harrison JS. Primary central nervous system marginal zone B-cell lymphoma arising from the dural meninges: A case report and review of literature. Clin Case Rep 2020; 8:491-497. [PMID: 32185043 PMCID: PMC7069868 DOI: 10.1002/ccr3.2680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/26/2019] [Accepted: 12/16/2019] [Indexed: 12/26/2022] Open
Abstract
Primary central nervous system (CNS) marginal zone B-cell lymphoma (MZBCL) arising from the dural meninges is a rare but indolent disease. This malignancy can present in various ways, hence making it difficult to diagnose. Biopsy results dictate an appropriate treatment plan, which commonly consists of a combination of surgical resection, whole brain radiotherapy and systemic therapy.
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Affiliation(s)
| | - Lukas Delasos
- Department of MedicineUniversity of Connecticut SystemFarmingtonCTUSA
| | - Syed Daniyal Asad
- Department of MedicineUniversity of Connecticut SystemFarmingtonCTUSA
| | - Manish Kumar
- Department of MedicineUniversity of Connecticut SystemFarmingtonCTUSA
| | - Jonathan S. Harrison
- Department of Hematology/Oncology, Carole and Ray Neag Comprehensive Cancer CenterUniversity of Connecticut SystemFarmingtonCTUSA
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Quinn ZL, Zakharia K, Schmid JL, Schmieg JJ, Safah H, Saba NS. Primary Dural Diffuse Large B-cell Lymphoma: A Comprehensive Review of Survival and Treatment Outcomes. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e105-e112. [PMID: 31902733 DOI: 10.1016/j.clml.2019.09.600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/09/2019] [Accepted: 09/21/2019] [Indexed: 11/20/2022]
Abstract
Primary dural diffuse large B-cell lymphoma (PD-DLBCL) is a rare and aggressive B-cell non-Hodgkin lymphoma that can present in intracranial or intraspinal locations. Although the optimal management is unknown, PD-DLBCL therapy is often mirrored after primary central nervous system lymphoma therapy and aggressive treatment with a high dose methotrexate-based regimen is frequently used. Our comprehensive, retrospective study of 24 reported cases of PD-DLBCL provide the most complete analysis of this rare disease including data on biology, treatment outcomes, and survival. Our findings demonstrate good outcomes following induction treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), suggesting that these cases can be treated as DLBCL rather than primary central nervous system lymphoma, obviating the need for more aggressive and toxic approaches. The durable responses following R-CHOP also confirm that PD-DLBCL is not protected by the blood brain barrier.
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Affiliation(s)
- Zachary L Quinn
- Deming Department of Medicine, Tulane University, New Orleans, LA
| | - Karam Zakharia
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University, New Orleans, LA
| | - Janet L Schmid
- Department of Pathology, Tulane University, New Orleans, LA
| | - John J Schmieg
- Department of Pathology, Tulane University, New Orleans, LA
| | - Hana Safah
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University, New Orleans, LA
| | - Nakhle S Saba
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University, New Orleans, LA.
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Raguž M, Mudrovčić Y, Dlaka D, Almahariq F, Romić D, Tomasović-Lončarić Č, Müller D, Marčinković P, Kaštelančić A, Chudy D. Primary dural lymphoma mimicking meningioma: a clinical and surgical case report. J Surg Case Rep 2018; 2018:rjy189. [PMID: 30093991 PMCID: PMC6077807 DOI: 10.1093/jscr/rjy189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/17/2018] [Accepted: 07/13/2018] [Indexed: 01/13/2023] Open
Abstract
Introduction: Primary central nervous system lymphoma and its subtype, primary dural lymphoma, are types of non-Hodgkin's lymphoma that only occur in the central nervous system without any dissemination. They are extremely rare cases of extra nodal lymphomas accounting for 1--5% of intracranial tumors. Case report: We present a patient diagnosed with primary dural lymphoma in right frontal brain region who underwent surgical resection. Histopathological analysis revealed diffuse B-type large cell non-Hodgkin lymphoma. Patient underwent four cycles of R-CHOP and intrathecal methotrexate protocol. Six months postoperative, no signs of newly onset infiltration were present. Discussion: Primary dural lymphoma most likely presents with unusual radiological signs, which can easily be mistaken for meningioma, the main differential diagnosis. A thorough immunological, histopathological and clinical patients profile should be conducted in order to establish the certainty of diagnosis. Although there are few treatment options: surgery, radiotherapy or chemotherapy, there is no established treatment protocol.
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Affiliation(s)
- Marina Raguž
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Yannick Mudrovčić
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Domagoj Dlaka
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Fadi Almahariq
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Dominik Romić
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | | | - Danko Müller
- Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia
| | - Petar Marčinković
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Anđelo Kaštelančić
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
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Prasad SN, Lal H, Jaiswal S, Das KK. Primary dural diffuse large B cell lymphoma mimicking parafalcine meningioma. BMJ Case Rep 2017; 2017:bcr-2016-219126. [PMID: 28978572 PMCID: PMC5652401 DOI: 10.1136/bcr-2016-219126] [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] [Accepted: 09/15/2017] [Indexed: 11/04/2022] Open
Abstract
A 58-year-old immunocompetent woman presented with complaints of recent onset recurrent generalised tonic-clonic seizures and left hemiparesis. On MRI a dural-based heterogeneously enhancing mass was seen along the falx cerebri mimicking parafalcine meningioma, causing brain parenchymal compression and vasogenic oedema in the right frontal and parietal lobes. The tumour was completely excised and on subsequent investigation it was diagnosed as diffuse large B cell type primary dural lymphoma. Chemotherapy with CHOP (cyclophosphamide, hydroxyl doxorubicin, vincristine and prednisone) regimen was started; however, the patient later died from episodes of acute pulmonary thromboembolism, aspiration pneumonia and septic shock.
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Affiliation(s)
- Surya Nandan Prasad
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sushila Jaiswal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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