[Primary malignant lymphoma of the skull presenting a huge mass lesion: case report]

A rare case of primary malignant lymphoma of the skull presenting a huge mass lesion is reported. A 65-year-old male was admitted complaining of a huge scalp mass (largest 13 x 9 x 4 cm) which was growing rapidly. On admission he showed hemiparesis. The craniogram revealed a large osteolytic lesion of the right parietal bone. Computed tomography and magnetic resonance images revealed a huge tumoral mass lesion expanding from the epidural to the subcutaneous space at the frontoparietal region. The angiogram showed marked tumor stain feeding from the bilateral middle meningeal artery and the superficial temporal artery. On operation, the tumor was shown to be elastic soft, and existed in the epidural and subcutaneous space. It was invading the diploic, with infiltration into the dura. The tumor was detached from the dura matter and totally resected. The histological diagnosis was malignant lymphoma (B cell type). After the operation, the patient's left hemiparesis improved without additional neurological deficit. Bone and tumor scintigraphy disclosed no uptake other than that of the head. The tumor was diagnosed at primary malignant lymphoma of the skull. After 50-Gy radiation and chemotherapy, the postoperative course was uneventful. Although the number of reports on malignant lymphoma has increased recently, there are only 15 case reports concerning those in the skull. The neuroradiological findings and differential diagnosis of malignant lymphoma in the skull were mainly discussed.