Brain Tumor Res Treat.  2013 Apr;1(1):32-35. 10.14791/btrt.2013.1.1.32.

Primary Malignant Lymphoma of the Cranial Vault with Extra- and Intracranial Extension

• Ko MJ
• Hwang SN
• Park YS
• Nam TK

• KMID: 2165220
• DOI: http://doi.org/10.14791/btrt.2013.1.1.32

Abstract

Bone involvement is a common finding in many types of lymphomas, particularly in advanced stages. However, cranial vault affliction has been regarded as an exceedingly rare presentation. Here, we report the case of a patient with cranial vault lymphoma who presented with a scalp mass. An 81-year-old woman presented with a gradually growing and non-painful frontal scalp mass that she noticed one month before admission. It was a flatly elevated, round mass measuring about 6x4x4 cm. Computed tomography and magnetic resonance imaging of the brain revealed a contrast-enhancing intracranial extradural mass at the counter-location of the scalp mass. The superior sagittal sinus was involved at the tumor site. Cerebral angiography showed that the tumor feeding vessels originated from the bilateral external carotid arteries. An operation was performed and the tumors were removed together with the involved bone. The pathologic diagnosis was malignant diffuse large B-cell type lymphoma. The patient was transferred to the Hemato-Oncology department for chemotherapy. Primary lymphoma of the cranial vault with scalp mass is very rare but it should be considered in the differential diagnosis of scalp masses. Although the results of reported cases are variable, the combination of surgery, radiation, and chemotherapy appears to offer favorable outcomes.

Keyword

Primary lymphoma; Cranial vault; Scalp mass

MeSH Terms

Aged, 80 and over
B-Lymphocytes
Brain
Carotid Artery, External
Cerebral Angiography
Diagnosis
Diagnosis, Differential
Drug Therapy
Female
Humans
Lymphoma*
Magnetic Resonance Imaging
Scalp
Superior Sagittal Sinus

Figure

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  Fig. 1 Preoperative X-ray and computed tomography (CT) imaging. A: The skull X-ray shows an irregular inner cortical margin of the involved frontal bone. B: The sagittal view of the CT scan shows a permeative extra- and intracranial isodense mass. C: The bone window has moderately well-defined borders and shows some osteolysis of the inner table of the frontal bone.

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  Fig. 2 Preoperative magnetic resonance imaging and digital subtraction angiography. A: The sagittal T1-weighted image shows an iso-signal intensity mass in the frontoparietal region. B: The sagittal T2-weighted image shows an iso-signal intensity mass in the same region. C: Diffuse contrast enhancement of the tumor and the dura. D: Feeding arteries from the right superficial temporal artery. E: Feeding arteries from the left superficial temporal artery. F: The superior sagittal sinus is occluded.

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  Fig. 3 Pathologic findings. The histologic features show diffusely invading round nuclear immature cells. A: Diffuse infiltration of round vesicular cells without an organoid pattern (HE stain, ×100). B: The tumor cells stained strongly positively for CD20, CD79a, and Bcl-2. The proliferating index (Ki-67) was over 90% (immunohistochemical stain, ×100).

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  Fig. 4 Postoperative follow-up magnetic resonance imaging. A: The contrast-enhanced sagittal T1-weighted image taken 8 weeks after surgery shows good resection of the tumor. B: The contrast-enhanced sagittal T1-weigthed image taken 9 months after surgery shows that there is no tumor recurrence.

Reference

1. El Asri AC, Akhaddar A, Baallal H, et al. Primary lymphoma of the cranial vault: case report and a systematic review of the literature. Acta Neurochir (Wien). 2012; 154:257–265.

2. Paige ML, Bernstein JR. Transcalvarial primary lymphoma of bone. A report of two cases. Neuroradiology. 1995; 37:456–458.

3. Tanimura A, Adachi Y, Tanda M, Yuasa H, Ishii Y, Katou Y. Primary peripheral B cell lymphoma, Burkitt-like, of the cranial vault. Acta Haematol. 2005; 113:258–261.

4. Fukushima Y, Oka H, Utsuki S, Nakahara K, Fujii K. Primary malignant lymphoma of the cranial vault. Acta Neurochir (Wien). 2007; 149:601–604.

5. Oberling C. Les reticulosarcomes et les reticuloendotheliosarcomes de la moelle osseuse (sarcomas d'Ewing). Bull Assoc Fr Etude Cancer. 1928; 17:259–296. (in French).

6. Parker F, Jackson H. Primary reticulum cell sarcoma of bone. Surg Gynecol Obstet. 1939; 68:45–53.

7. Dai MS, Ho CL, Chen CY, Chen TM, Yu CP, Chao TY. Lymphoma of bone with initial presentation as a calvarial mass. Ann Hematol. 2000; 79:700–702.

8. Fadoukhair Z, Lalya I, Amzerin M, et al. Successful management of primary non Hodgkins lymphoma of the cranial vault. Pan Afr Med J. 2011; 8:50.

9. Mohindra S, Gupta R, Sharma T, Das A, Radotra BD. Calvarial lymphoma. Br J Neurosurg. 2007; 21:629–630.

10. Maruyama D, Watanabe T, Beppu Y, et al. Primary bone lymphoma: a new and detailed characterization of 28 patients in a single-institution study. Jpn J Clin Oncol. 2007; 37:216–223.