Primary Central Nervous System Lymphoma Presenting As Chronic Subdural Hematoma: Case Report and Review of the Literature

Abstract

Primary central nervous system lymphoma (PCNSL) rarely manifests in immunocompetent patients. In such cases, these lesions may mimic more common intracranial bleeding or tumors. We present the case of an elderly patient who presented with a presumed chronic subdural hematoma (SDH); upon surgical intervention, an occult mass was discovered with no evidence of associated hematoma. Biopsy and immunohistochemistry demonstrated PCNSL. Literature review identified six other cases of PCNSL in immunocompetent adults that were initially suspected to be SDH but were finally diagnosed with PCNSL. Our literature review highlights the rarity these cases and the importance of distinguishing intracranial bleeds from PCNSL, as the latter can be treated with chemoradiation with good clinical outcomes.

De novo primary malignant lymphoma of the dura following recurrent episodes of subdural abscess presenting as chronic subdural hematoma: illustrative case

“…In the literature, multiple researchers have reported a total of 14 cases of PCNSL that were initially diagnosed as subdural hemorrhage; the characteristics of these cases are presented in Table 1 . 5 – 17 Of these 14 cases, 10 were MALT lymphoma, 2 were DLBCL, 1 was Burkitt lymphoma, and 1 was lymphoplasmacytic lymphoma. Primary dural DLBCL, as in the present case, is rare (2 of 14 cases), and there have been no reports of cases preceded by an intracranial infection.…”

Neoplastic meningitis — a puzzling case with important lessons

“…Liquid biopsy assays to look for circulating tumour cells and tumour DNA are entering the clinical arena, and can facilitate the diagnostic process [2]; 4. Subdural haematomas of uncertain aetiology or unusual clinical course should raise a clinical suspicion for an underlying malignancy [3]; 5. When CNS lymphoma is suspected, prompt diagnostic evaluation is critical, as this disease is highly chemo-and radiosensitive and many patients, even those who are very ill, can be saved with prompt intervention.…”