Follicular lymphoma of the dura associated with meningioma: A case report and review of the literature

Abstract

A 70-year-old immunocompetent woman who had been radiologically diagnosed with a left parasagittal meningioma 5 years previously developed a palpable subgaleal mass and underwent neurosurgery. Histologically the tumor was composed of thickened fibrotic dural tissue, infiltrated by a follicular lymphoma, of grade IIIB. A coexistent transitional meningioma had been infiltrated by the neoplastic lymphoid tissue. Two months after surgery, the patient developed evidence of extracranial dissemination of the lymphoma to the cervical lymph nodes and was treated with polychemotherapy plus Rituximab and intrathecal methotrextate. The patient is alive and recurrence-free at 1-year follow up. A review of the literature indicates that lymphomas developing primarily in the meninges, have an indolent course and tend to be localized in areas rich in meningothelial cells.

Primary dural lymphoma: A novel concept of heterogeneous disease

“…In contrast to cerebral PDL, where the vast majority of the reported cases are MZL (98 of 126 cases, 77.7%), only two (5%) of the spinal PDL cases were diagnosed as such . This suggests a difference in predilection of lymphoma type for the anatomical site of dural involvement, which may be related to different pathogenesis.…”

“…Our literature review investigated ‘dural’, ‘epidural’ and ‘meningeal’ lymphomas, and identified many PDL cases, including 166 well‐documented cases . Particularly, PDLs diagnosed prior to the Revised European American Lymphoma (REAL) classification (1994), and where more recent reclassification was not possible, were not included.…”

“…Most cases of dural lymphoma consist of secondary dural involvement in the context of systemic or other organs' primary lymphomas, and well‐documented cases of primary dural lymphoma (PDL) are less common. Primary dural lymphomas are distinct from primary lymphomas of the central nervous system (CNS) that encompasses brain, spinal cord and subarachnoid space .…”

A Rare Presentation of Follicular Lymphoma: Cerebellar Involvement, Successfully Treated with a Combination of Radiotherapy and Chemotherapy

“…Very few reports of patients with low-grade follicular lymhoma spreading to the CNS have been presented to date (Table 1) [5,7-10,15]. Four of the patients in these reported cases were in good condition after treatment, but one had progressive disease.…”

Dural MALT Lymphoma with Disseminated Disease

“…Of these, 67 (72%) were described as MALT or marginal zone lymphoma, 6,9,10,12,15,16,20–25,28–35,41,44,62–70 9 were diffuse large B-cell lymphoma, 11,14,18,27,36,37,42,71 and 6 were follicular lymphoma. 3,17,26,38,40,72 Six were described as small lymphocytic lymphoma 13,14,73,74 or B-cell lymphoproliferative disorder of CLL type, 75 but the four of these that were described prior to the establishment of the REAL-WHO criteria may have actually been MALT/Marginal zone lymphoma since immunophenotypical analysis was not performed. 15,74 The remaining 5 cases were described in various ways, including large-cell immunoblastic T-cell lymphoma, 14 monocytoid malignant B-cell lymphoma, 76 centroblastic/ centrocytic lymphoma, 19 precursor B-cell lymphoblastic lymphoma, 77 and diffuse large cell non-Hodgkin lymphoma due to Richter's transformation.…”