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[Follicular dural lymphoma. Case report]
J Peltier1, A Fichten, M Lefranc
1Service de neurochirurgie, centre hospitalier universitaire d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 1, France. peltier.johan@chu-amiens.fr
Abstract:
A case of a meningeal B-cell lymphoma is described. A 48-year-old man presented with an episode of grand mal seizure following a brain injury. An initial diagnosis of extradural hematoma was made based on the results of the cerebral computerized tomography scan. Magnetic resonance images demonstrated an enhanced mass with a dural tail attached to the meningeal layer of the temporal bone, suggesting a meningioma "en plaque". The mass was surgically excised. Tumoral removal was subcomplete (Simpson 2). Operative inspection also suggested a meningioma, but histological analysis and electron microscopy revealed a grade IV follicular B-cell lymphoma. Biological studies were normal. An extensive workup found an external iliac adenopathy with several osseous locations on PET. The patient underwent chemotherapy and radiotherapy. Three years after the first symptoms appeared, the patient is alive and free of symptoms. The clinicopathological features and treatments were discussed.
Insights
This case study describes a rare meningeal B-cell lymphoma initially misdiagnosed as a meningioma. Prompt chemotherapy and radiotherapy led to a favorable outcome, with the patient remaining symptom-free.
Area of Science:
- Neurology
- Oncology
- Pathology
Background:
- Meningeal B-cell lymphoma is a rare condition.
- Accurate diagnosis can be challenging due to overlapping imaging features with meningiomas.
Observation:
- A 48-year-old male presented with seizures after head trauma.
- Initial imaging suggested extradural hematoma, followed by suspicion of meningioma based on MRI findings.
- Histological and electron microscopy analysis confirmed grade IV follicular B-cell lymphoma.
Findings:
- The patient had external iliac adenopathy and osseous metastases.
- Subtotal tumor resection (Simpson 2) was performed.
- The patient responded well to chemotherapy and radiotherapy.
Implications:
- This case highlights the importance of histological confirmation in diagnosing dural masses.
- Multimodal treatment including chemotherapy and radiotherapy can be effective for meningeal lymphoma.
- Early diagnosis and treatment are crucial for favorable prognosis in rare dural malignancies.
