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NEUROLOGY 2009;73:e84-e85
© 2009 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImages: Primary diffuse large B-cell lymphoma of the cranial vault

D. Renard, MD, C. Campello, MD, O. Beraru, MD, P. Bouillot, MD and P. Labauge, MD, PhD

From the Department of Neurology (D.R., C.C., O.B., P.L.), CHU Nîmes, Hôpital Caremeau; and Department of Neurosurgery (P.B.), Clinique des Franciscaines, Nîmes, France.

Address correspondence and reprint requests to Dr. Dimitri Renard, Department of Neurology, CHU Nîmes, Hôpital Caremeau, Place du Pr Debré, 30029 Nîmes Cedex 4, France dimitrirenard{at}hotmail.com

A 67-year-old woman presented with a painful right-sided scalp swelling. Brain imaging showed an intracranial and extracranial frontal mass lesion associated with local cranial bone destruction (figure). The radiologic differential diagnosis included malignant meningioma, primary bone tumor, and bone metastasis. Thoracic, abdominal, pelvic, and orbital CT scan, bone scintigraphy, whole-body fluorodeoxyglucose PET, bone marrow biopsy, lumbar puncture, and ophthalmologic examination (including slit lamp examination) showed no other lesions. Open lesion biopsy revealed a diffuse malignant large B-cell non-Hodgkin lymphoma of the dura mater and cranial bone. Six cycles of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen was started. Primary bone (most frequently non-Hodgkin) lymphoma are rare.1,2 In our case, associated dura mater involvement (which seemed to be secondary) was seen on both brain imaging and histology. Primary bone tumors often have a favorable outcome, especially when treated by combined modality therapy. Clinical stage is the most important prognostic variable in predicting overall survival.


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  		Figure Brain images showing an intracranial and extracranial frontal mass lesion associated with local cranial bone destruction

Brain CT showing a slightly hyperintense intracranial and extracranial frontal mass lesion (A) with homogeneous enhancement after contrast injection (B), associated with local cranial bone destruction (C). This lesion was isointense on T1-weighted (D) and T2-weighted (E) MRI. Gadolinium-enhanced T1 sequences showed strong, slightly heterogeneous enhancement (F).

 

Disclosure: The authors report no disclosures.


   REFERENCES
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 REFERENCES
 

  1. Aquilina K, O’Brian DF, Phillips JP. Diffuse primary non-Hodgkin’s lymphoma of the cranial vault. Br J Neurosurg 2004;18:518–523.[Medline]
  2. Agbi CB, Bannister CM, Turnbull IW. Primary cranial vault lymphoma mimicking a meningioma. Neurochirurgia 1983;26:130–132.[Medline]




This Article
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