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Yagisawa T, Ibayashi K, Kuroda R, Koyama S, Kanda Y, Fukuda Y, Shirai K, Kawata H, Kunii N, Kawai K. De novo primary malignant lymphoma of the dura following recurrent episodes of subdural abscess presenting as chronic subdural hematoma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE24153. [PMID: 39038372 DOI: 10.3171/case24153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/12/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Chronic inflammation of the thorax, as in tuberculosis-related pyothorax, can cause secondary malignant lymphomas. However, primary malignant lymphoma of the central nervous system, specifically of the dura mater, developing after intracranial infection or inflammation has rarely been reported. Herein, the authors describe a case of primary dural lymphoma that developed secondary to subdural empyema, with an initial presentation mimicking a chronic subdural hematoma. OBSERVATIONS A 51-year-old man had undergone single burr hole drainage for subdural empyema 2 years prior. The patient subsequently underwent multiple craniotomy and drainage procedures, with successful remission of the subdural empyema. He was subsequently referred to the authors' hospital approximately a year after his initial treatment because of a recollection of subdural fluid, which was suspected to be recurrent empyema. After another single burr hole drainage, which revealed only a subdural hematoma, a histopathological diagnosis of B-cell lymphoma of the dural/subdural membrane was made. Subsequent radiation therapy was completed, with good local control and no recurrence of the subdural hematoma confirmed at 2 months posttreatment. LESSONS Intracranial lymphoma triggered by chronic inflammation is rare but should be considered a differential diagnosis in subdural hematomas for which the background pathology is unclear. https://thejns.org/doi/10.3171/CASE24153.
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Affiliation(s)
- Tomoya Yagisawa
- Departments of Neurosurgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kenji Ibayashi
- Departments of Neurosurgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Rintaro Kuroda
- Departments of Neurosurgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shunsuke Koyama
- Department of Medicine, Division of Hematology, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Yoshinobu Kanda
- Department of Medicine, Division of Hematology, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
- Department of Medicine, Division of Hematology, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan
| | - Yukiko Fukuda
- Departments of Radiology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Katsuyuki Shirai
- Departments of Radiology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hirotoshi Kawata
- Department of Diagnostic Pathology, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Naoto Kunii
- Departments of Neurosurgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kensuke Kawai
- Departments of Neurosurgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Singh R, Chaturvedi S, Pant I, Singh G. Primary Dural Non-Hodgkin's Lymphoma as a Diagnostic Pitfall: Report of a Rare Presentation with Review of Literature. J Microsc Ultrastruct 2023; 11:196-198. [PMID: 38025184 PMCID: PMC10679825 DOI: 10.4103/jmau.jmau_110_20] [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: 10/28/2020] [Revised: 11/15/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
Primary central nervous system lymphomas (PCNSLs) account for 2%-3% of all primary brain tumors. Lymphomas arising from the dura, without brain and other systemic involvement, constitute a tiny fraction of this rare group. Most dural lymphomas present as dural-based masses and an acute presentation as a subdural hematoma is exceptional, with only five such cases reported previously in the literature. We present the case of a 65-year-old female who was admitted with complaints of slurring of speech, visual disturbances, and reduced appetite for 2 days. Computerized tomography scan showed a crescentic hyperdense area in the left fronto-temporo-parietal region with no bony or extracranial involvement suggestive of acute subdural hematoma. There was a history of a similar episode 3 months back, wherein she was operated upon and followed up conservatively. Craniotomy for drainage was performed, and histopathology revealed a non-Hodgkin's Lymphoma. Primary lymphoma of the dura is a rare subtype of PCNSL. This case is being reported for its unusual presentation as a common entity-an acute subdural hematoma.
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Affiliation(s)
- Ritika Singh
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, Delhi, India
| | - Sujata Chaturvedi
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, Delhi, India
| | - Ishita Pant
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, Delhi, India
| | - Gurbachan Singh
- Department of Neurosurgery, Guru Teg Bahadur Hospital, Delhi, India
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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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Yu T, Yin J, Huo H, Zhao H, Wang Z, Jiang J. Subdural anaplastic large-cell lymphoma presenting as a subacute epidural hematoma on imaging: A case report. Medicine (Baltimore) 2022; 101:e30012. [PMID: 35945716 PMCID: PMC9351866 DOI: 10.1097/md.0000000000030012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Subdural anaplastic large-cell lymphoma (SALCL) is an extremely rare subtype of primary central nervous system (CNS) lymphoma. Here, we report a very rare subdural lymphoma case, which was misdiagnosed as a subacute epidural hematoma based on the radiological examination. PATIENT CONCERNS We present the case of an 82-year-old patient who presented with a 2-day history of headache and consciousness disorder following head injury. Computed tomography of the head revealed a fusiform isodense/slightly dense shadow under the right temporoparietal occipital cranial plate, suggesting a subacute epidural hematoma. It was initially misdiagnosed as a right traumatic subacute epidural hematoma with hemiplegia of the left limb. According to the patient's condition, an emergency craniotomy was performed to remove the hematoma. However, it was found that the lesion was located under the dura mater and was yellowish-brown with yellowish-brown liquid inside. The appearance of the lesion looked like bean curd residue. Histopathological examination diagnosed ALCL. DIAGNOSIS SALCL presenting as a subacute epidural hematoma on imaging. INTERVENTIONS Operation. OUTCOMES The patient died 1 month after being discharged automatically. CONCLUSIONS This report shows a rare radiography presentation of SALCL. SALCL can mimic the appearance of an epidural hematoma and should be regarded as a differential diagnosis even in patients with a history of craniocerebral injury and the "typical" imaging appearance of an epidural hematoma. The report is hoped to provide a scientific reference for the clinical diagnosis of subdural lymphoma.
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MESH Headings
- Aged, 80 and over
- Craniocerebral Trauma/complications
- Craniotomy/adverse effects
- Hematoma, Epidural, Cranial/surgery
- Hematoma, Epidural, Spinal/surgery
- Humans
- Lymphoma, Large-Cell, Anaplastic/diagnosis
- Lymphoma, Large-Cell, Anaplastic/diagnostic imaging
- Subdural Space
- Tomography, X-Ray Computed/adverse effects
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Affiliation(s)
- Tingting Yu
- Graduate School of Dalian Medical University, Lvshunkou Kou District, Dalian, Liaoning, China
- Department of Neurosurgery, Taizhou People’s Hospital affiliated to Nanjing Medical University, Hailing District, Taizhou, Jiangsu, China
- Department of Neurology, Taizhou People’s Hospital, Hailing District, Taizhou, Jiangsu, China
| | - Jibo Yin
- Department of Neurosurgery, Lufeng People’s Hospital, Chuxiong State, Yunnan Province, China
| | - Hongyue Huo
- Graduate School of Dalian Medical University, Lvshunkou Kou District, Dalian, Liaoning, China
- Department of Neurosurgery, Taizhou People’s Hospital affiliated to Nanjing Medical University, Hailing District, Taizhou, Jiangsu, China
- Department of Neurosurgery, Taizhou People’s Hospital, Hailing District, Taizhou, Jiangsu, China
| | - Haixue Zhao
- Department of Neurosurgery, Lufeng People’s Hospital, Chuxiong State, Yunnan Province, China
| | - Zhongwen Wang
- Department of Neurosurgery, Lufeng People’s Hospital, Chuxiong State, Yunnan Province, China
| | - Jianxin Jiang
- Department of Neurosurgery, Taizhou People’s Hospital affiliated to Nanjing Medical University, Hailing District, Taizhou, Jiangsu, China
- Department of Neurosurgery, Taizhou People’s Hospital, Hailing District, Taizhou, Jiangsu, China
- *Correspondence: Jinxing Jiang, Department of Neurosurgery, Taizhou People’s Hospital affiliated to Nanjing Medical University, Hailing District, Taizhou, Jiangsu, China; Department of Neurosurgery, Taizhou People’s Hospital, Hailing District, Taizhou, Jiangsu, China (e-mail: )
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Neeley OJ, Al-Hreish KM, Aoun SG, El Ahmadieh TY, Plitt A, Vance AZ, Jaso JM, Hatanpaa KJ, White JA. Tumoral Mimics of Subdural Hematomas: Case Report and Review of Diagnostic and Management Strategies in Primary B-Cell Lymphoma of the Subdural Space. World Neurosurg 2020; 133:49-54. [DOI: 10.1016/j.wneu.2019.09.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 10/26/2022]
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Lyndon D, Lansley JA, Evanson J, Krishnan AS. Dural masses: meningiomas and their mimics. Insights Imaging 2019; 10:11. [PMID: 30725238 PMCID: PMC6365311 DOI: 10.1186/s13244-019-0697-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/15/2019] [Indexed: 02/08/2023] Open
Abstract
Meningiomas are the most common dural tumour. They are regularly being seen as an incidental finding on brain imaging and treated conservatively. However, there are many other dural masses which mimic their appearances, including primary neoplastic processes, metastases, granulomatous diseases and infection. While some of these are rare, others such as metastases and tuberculosis arise relatively frequently in practice. Although not pathognomonic, key features which increase the probability of a lesion being a meningioma include intralesional calcifications, skull hyperostosis, local dural enhancement and increased perfusion. It is important to have an awareness of these entities as well as their main imaging findings, as they have a wide range of prognoses and differing management strategies. This review outlines several of the most important mimics along with their imaging findings on both standard and advanced techniques with key features which may be used to help differentiate them from meningiomas.
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Affiliation(s)
- Daniel Lyndon
- Department of Neuroradiology, St Bartholomew's and the Royal London Hospitals, Whitechapel, London, E1 1BB, UK.
| | - Joseph A Lansley
- Department of Neuroradiology, St Bartholomew's and the Royal London Hospitals, Whitechapel, London, E1 1BB, UK
| | - Jane Evanson
- Department of Neuroradiology, St Bartholomew's and the Royal London Hospitals, Whitechapel, London, E1 1BB, UK
| | - Anant S Krishnan
- Department of Neuroradiology, St Bartholomew's and the Royal London Hospitals, Whitechapel, London, E1 1BB, UK
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Intracranial multiple myeloma may imitate subdural hemorrhage: How to overcome diagnostic limitations and avoid errors in treatment. Neurol Neurochir Pol 2017; 51:252-258. [DOI: 10.1016/j.pjnns.2017.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
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Franzini A, Gribaudi G, Pirola E, Pluderi M, Goldaniga MC, Marfia G, Rampini PM. Waldenstrom macroglobulinemia presenting as a bilateral subdural chronic hematoma. J Clin Neurosci 2017; 40:89-91. [PMID: 28262409 DOI: 10.1016/j.jocn.2017.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Andrea Franzini
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giulia Gribaudi
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Elena Pirola
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Mauro Pluderi
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | | | - Giovanni Marfia
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Paolo Maria Rampini
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
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Catana D, Koziarz A, Cenic A, Nath S, Singh S, Almenawer SA, Kachur E. Subdural Hematoma Mimickers: A Systematic Review. World Neurosurg 2016; 93:73-80. [PMID: 27268313 DOI: 10.1016/j.wneu.2016.05.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND A variety of subdural pathologies that may mimic hematomas are reported in the literature. We aimed to identify the atypical clinical and radiologic presentations of subdural masses that may mimic subdural hematomas. METHODS A systematic review of MEDLINE and Embase was conducted independently by 2 reviewers to identify articles describing subdural hematoma mimickers. We also present a patient from our institution with a subdural pathology mimicking a subdural hematoma. We analyzed patient clinical presentations, underlying pathologies, radiologic findings, and clinical outcomes. RESULTS We included 43 articles totaling 48 patients. The mean ± SD patient age was 55.7 ± 16.8 years. Of the 45 cases describing patient history, 13 patients (27%) had a history of trauma. The underlying pathologies of the 48 subdural collections were 10 metastasis (21%), 14 lymphoma (29%), 7 sarcoma (15%), 4 infectious (8%), 4 autoimmune (8%), and 9 miscellaneous (19%). Findings on computed tomography (CT) scan were 18 hyperdense (41%), 11 hypodense (25%), 9 isodense (20%), 3 isodense/hyperdense (7%), and 3 hypodense/isodense (7%). Thirty-four patients (71%) were treated surgically; among these patients, 65% had symptom resolution. Neither the pathology (P = 0.337) nor the management strategy (P = 0.671) was correlated with improved functional outcomes. CONCLUSIONS Identification of atypical history and radiologic features should prompt further diagnostic tests, including magnetic resonance imaging (MRI), to elucidate the proper diagnosis, given that certain pathologies may be managed nonsurgically. A subdural collection that is hyperdense on CT scan and hyperintense on T2-weighted MRI, along with a history of progressive headache with no trauma, may raise the suspicion of an atypical subdural pathology.
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Affiliation(s)
- Dragos Catana
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Alex Koziarz
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Aleksa Cenic
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Siddharth Nath
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Sheila Singh
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Saleh A Almenawer
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
| | - Edward Kachur
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
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