Primary dural-based MALT lymphoma mimicking falx meningioma: a case report

Authors

  • Oleg Andrushkevich Federal neurosurgical center

Keywords:

MALT, marginal zone lymphoma, central nervous system, dura mater, MRI, case report

Abstract

Abstract

Introduction

Primary dural lymphoma (PDL) is very rare and often misdiagnosed as meningioma based on neuroimaging characteristics.

Case report

A 36-year-old woman presented with headache, behaviour changes and ataxia. She had no history of oncology or immunodeficiency. Magnetic resonance imaging showed a solitary mass lesion in the anterior and middle thirds of the falx cerebri with bilateral growth and a moderate mass effect, which was interpreted as a falx meningioma. Gross total resection of the lesion involving the dura mater of the falx cerebri was performed by bilateral parasagittal craniotomy. Surprisingly, histological examination showed no meningothelial components. Instead, there was diffuse lymphocytic and plasma cell infiltration. Immunohistochemistry was positive for B-cell antigens. The final histopathological diagnosis was primary dural mucosa-associated lymphoid tissue lymphoma. Systemic screening examination was then performed and did not reveal additional tumor foci or lymphadenopathy. Follow-up brain MRI at 3 months did not reveal tumor progression. Neither chemotherapy nor radiotherapy were given, and the patient is under observation.

Conclusion

Diagnostic errors can cause delays in pathogenetic treatment of primary dural lymphoma. Thus, PDL should be considered in the differential diagnosis of meningiomas.

Keywords: MALT, marginal zone lymphoma, central nervous system, dura mater, MRI, case report

 

Declarations

 

Ethics approval and consent to participate

Data acquisition and publication were in accordance with the principles outlined in the Declaration of Helsinki. The local ethics committee (Federal Neurosurgical Center of Novosibirsk Ethics Committee) has confirmed that no ethical approval is needed.

Consent for publication

Written informed consent was taken from the patient. The identity of the patient is not revealed in the pictures or in the manuscript.

Availability of data and material

Data can be provided by the corresponding authors upon request.

Competing interests

The authors declare that they have no competing interests.

Funding

No funding.

Authors’ contributions

OA: acquisition of the data, analysis and research of the literature, and preparation of the manuscript.  EF: conception and design of the manuscript, analysis and research of the literature, and preparation of the manuscript. AK: revision of the manuscript. JR: administrative support and supervision. All authors read and approved the final manuscript.

Acknowledgements

None

References

Bayraktar, S., Stefanovic, A., Montague, N., Davis, J., Murray, T., & Lossos, I. S. (2010). Central nervous system manifestations of marginal zone B-cell lymphoma. Annals of Hematology, 89(10), 1003–1009. https://doi.org/10.1007/S00277-010-0976-3

Chojak, R., Koźba-Gosztyła, M., Polańska, K., Rojek, M., Chojko, A., Bogacz, R., Skorupa, N., Więcław, J., & Czapiga, B. (2022). Surgical resection versus biopsy in the treatment of primary central nervous system lymphoma: a systematic review and meta-analysis. Journal of Neuro-Oncology, 160(3), 753–761. https://doi.org/10.1007/S11060-022-04200-7

de Azevedo Rosas, F., Favareto, S. L., Vieira, G. M. M., de Oliveira, M. N., D’Almeida Costa, F., & de Castro, D. G. (2021). Marginal zone lymphoma of the dura — two case reports with long-term follow-up. Reports of Practical Oncology and Radiotherapy, 26(1), 138. https://doi.org/10.5603/RPOR.A2021.0011

Deng, X., Xu, X., Lin, D., Zhang, X., Yu, L., Sheng, H., Yin, B., Zhang, N., & Lin, J. (2020). Real-World Impact of Surgical Excision on Overall Survival in Primary Central Nervous System Lymphoma. Frontiers in Oncology, 10, 515153. https://doi.org/10.3389/FONC.2020.00131/BIBTEX

Di, N., Cheng, W., Chen, H., Zhai, F., Liu, Y., Mu, X., Chu, Z., Lu, N., Liu, X., & Wang, B. (2019). Utility of arterial spin labelling MRI for discriminating atypical high-grade glioma from primary central nervous system lymphoma. Clinical Radiology, 74(2), 165.e1-165.e9. https://doi.org/10.1016/J.CRAD.2018.10.003

Dobran, M., Paracino, R., Mancini, F., & Nasi, D. (2020). Primary Dural Lymphoma: Clinical Cases and Literature Review. Case Reports in Medicine, 2020. https://doi.org/10.1155/2020/2812487

Eisenhut, F., Schmidt, M. A., Putz, F., Lettmaier, S., Fröhlich, K., Arinrad, S., Coras, R., Luecking, H., Lang, S., Fietkau, R., & Doerfler, A. (2020). Classification of Primary Cerebral Lymphoma and Glioblastoma Featuring Dynamic Susceptibility Contrast and Apparent Diffusion Coefficient. Brain Sciences 2020, Vol. 10, Page 886, 10(11), 886. https://doi.org/10.3390/BRAINSCI10110886

Ferguson, S. D., Musleh, W., Gurbuxani, S., Shafizadeh, S. F., & Lesniak, M. S. (2010). Intracranial mucosa-associated lymphoid tissue (MALT) lymphoma. Journal of Clinical Neuroscience, 17(5), 666–669. https://doi.org/10.1016/j.jocn.2009.10.001

Gocmen, S., Gamsizkan, M., Onguru, O., Sefali, M., & Erdogan, E. (2010). Primary dural lymphoma mimicking a subdural hematoma. Journal of Clinical Neuroscience, 17(3), 380–382. https://doi.org/10.1016/j.jocn.2009.02.014

Karschnia, P., Batchelor, T. T., Jordan, J. T., Shaw, B., Winter, S. F., Barbiero, F. J., Kaulen, L. D., Thon, N., Tonn, J. C., Huttner, A. J., Fulbright, R. K., Loeffler, J., Dietrich, J., & Baehring, J. M. (2020). Primary dural lymphomas: Clinical presentation, management, and outcome. Cancer, 126(12), 2811–2820. https://doi.org/10.1002/CNCR.32834

Kumar, S., Kumar, D., Kaldjian, E. P., Bauserman, S., Raffeld, M., & Jaffe, E. S. (1997). Primary low-grade B-cell lymphoma of the dura: a mucosa associated lymphoid tissue-type lymphoma. The American Journal of Surgical Pathology, 21(1), 81–87. https://doi.org/10.1097/00000478-199701000-00009

La Rocca, G., Auricchio, A. M., Mazzucchi, E., Ius, T., Della Pepa, G. M., Altieri, R., Pignotti, F., Gessi, M., De Santis, V., Zoia, C., & Sabatino, G. (2021). Intracranial dural based marginal zone MALT-type B-cell lymphoma: a case - Based update and literature review. British Journal of Neurosurgery. https://doi.org/10.1080/02688697.2021.1941760

Lopetegui-Lia, N., Delasos, L., Asad, S. D., Kumar, M., & Harrison, J. S. (2020). Primary central nervous system marginal zone B-cell lymphoma arising from the dural meninges: A case report and review of literature. Clinical Case Reports, 8(3), 491–497. https://doi.org/10.1002/CCR3.2680

Lv, Z. W., Cheng, K. L., Tian, H. J., & Han, X. M. (2016). Primary diffuse large B-cell lymphoma of the dura with skull and scalp involvement: A case report and brief review of the literature. Oncology Letters, 11(6), 3583–3588. https://doi.org/10.3892/OL.2016.4455

Meyer, H. J., Wienke, A., & Surov, A. (2020). ADC values of benign and high grade meningiomas and associations with tumor cellularity and proliferation - A systematic review and meta-analysis. Journal of the Neurological Sciences, 415. https://doi.org/10.1016/J.JNS.2020.116975

Partovi, S., Karimi, S., Lyo, J. K., Esmaeili, A., Tan, J., & Deangelis, L. M. (2014). Multimodality imaging of primary CNS lymphoma in immunocompetent patients. The British Journal of Radiology, 87(1036). https://doi.org/10.1259/BJR.20130684

Pavlou, G., Pal, D., Bucur, S., Chakrabarty, A., & Van Hille, P. T. (2006). Intracranial non-Hodgkin’s MALT lymphoma mimicking a large convexity meningioma. Acta Neurochirurgica, 148(7), 791–793. https://doi.org/10.1007/S00701-006-0761-1

Raguž, M., Mudrovčić, Y., Dlaka, D., Almahariq, F., Romić, D., Tomasović-Lončarić, Č., Müller, D., Marčinković, P., Kaštelančić, A., & Chudy, D. (2018). Primary dural lymphoma mimicking meningioma: a clinical and surgical case report. Journal of Surgical Case Reports, 2018(8), 1–4. https://doi.org/10.1093/JSCR/RJY189

Schellekes, N., Barbotti, A., Abramov, Y., Sitt, R., Di Meco, F., Ram, Z., & Grossman, R. (2021). Resection of primary central nervous system lymphoma: impact of patient selection on overall survival. Journal of Neurosurgery, 135(4), 1016–1025. https://doi.org/10.3171/2020.9.JNS201980

Sebastián, C., Vela, A. C., Figueroa, R., Marín, M. Á., & Alfaro, J. (2014). Primary intracranial mucosa-associated lymphoid tissue lymphoma. A report of two cases and literature review. The Neuroradiology Journal, 27(4), 425–430. https://doi.org/10.15274/NRJ-2014-10074

Surov, A., Gottschling, S., Mawrin, C., Prell, J., Spielmann, R. P., Wienke, A., & Fiedler, E. (2015). Diffusion-Weighted Imaging in Meningioma: Prediction of Tumor Grade and Association with Histopathological Parameters. Translational Oncology, 8(6), 517. https://doi.org/10.1016/J.TRANON.2015.11.012

TAKEUCHI, I., TANEI, T., KUWABARA, K., KATO, T., NAITO, T., KOKETSU, Y., HIRAYAMA, K., & HASEGAWA, T. (2022). Primary Dural Mucosa-associated Lymphoid Tissue Lymphoma Mimicking Falx Meningioma: A Case Report. NMC Case Report Journal, 9(0), 123. https://doi.org/10.2176/JNS-NMC.2021-0426

Thibodeau, R., Li, H. K., Babu, H., Jafroodifar, A., Ramovic, M., & Hahn, S. S. (2022). Dural lymphoma misdiagnosed as subdural hematoma following head trauma after an episode of syncope. Radiology Case Reports, 17(12), 4774–4779. https://doi.org/10.1016/J.RADCR.2022.09.044

Wallace, E. W. (2004). The Dural Tail Sign1. Https://Doi.Org/10.1148/Radiol.2331021332, 233(1), 56–57. https://doi.org/10.1148/RADIOL.2331021332

MALT Lymphoma

Published

2025-01-17

How to Cite

Andrushkevich, O. (2025). Primary dural-based MALT lymphoma mimicking falx meningioma: a case report. Neurohirurgija - The Serbian Journal of Neurosurgery, 4(1). Retrieved from https://neurohirurgija.com/neurohirurgija/article/view/59