[A case of malignant lymphoma in the skull base]

A case of malignant lymphoma located in the clivus, sella and cavernous sinus is reported. A 46-year-old female was hospitalized with a 3-week history of diplopia. Neurological examination showed left oculomotor, trochlear, abducens and hypoglossal nerve palsy. Improvement of cranial nerve palsy was achieved with the administration of prednisolone but it was only transient. Laboratory studies and endocrinological examination showed almost no abnormal findings. Skull x-ray film revealed a widely damaged base. MR studies showed a homogeneously enhanced mass lesion in the clivus, sella and bilateral cavernous sinus. Partial removal of the lesion was performed via the transsphenoidal route. The histopathological diagnosis of the mass was consistent with diffuse, medium sized cell, B-cell type malignant lymphoma. A postoperative systemic evaluation by tumor scan with 67Ga disclosed no abnormal uptake except in the skull base. Postoperatively, the patient was treated with radiation, a total of 50 Gy, followed by chemotherapy every 3 week consistent of cyclophosphamide, vincristine, pirarubicin, bleomycin, procarbazine and prednisolone. The cranial nerve symptoms disappeared during radiation therapy. The MR studies after three courses of chemotherapy revealed almost complete remission. The patient died of acute progression of pneumonia without any evidence of the recurrence of malignant lymphoma 10 months after the operation. Skull base involvement of malignant lymphoma is unusual. Five cases of malignant lymphoma invading the skull base have been reported since 1987. In most cases, the lesion originated from paranasal sinuses and was usually accompanied with intradural extensions. In the case we have reported there was no intradural invasion of the tumor.(ABSTRACT TRUNCATED AT 250 WORDS)