Primary Cranial Vault Non-Hodgkin’s Lymphoma Mimicking Meningioma With Positive Angiography

Abstract

Primary non-Hodgkin's lymphoma of the bone remains an uncommon presentation of non-Hodgkin's lymphoma. Primary lymphoma of the cranial vault is exceptionally rare. Here, we present a 62-year-old immunocompetent male presenting with the rapid growth of a left parietal scalp lesion and new-onset seizure. In addition to his imaging, which showed an extracranial, cranial, and intracranial mass with bony destruction, sagittal sinus involvement, and parenchymal invasion, his diagnostic angiogram demonstrated extensive vascular supply from both the right and left external carotid branches. Intraoperatively, we confirmed a frank invasion of the posterior sagittal sinus. After subtotal resection followed by R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, the patient continues to be disease-free at the 10-month follow-up. We report here a case of primary cranial vault lymphoma that very closely mimicked meningioma in many ways, with positive angiography and intraoperatively confirmed venous sinus invasion.

Hyaluronic Acid-Modified and Doxorubicin-Loaded Gold Nanoparticles and Evaluation of Their Bioactivity

“…Therefore, PEG has been widely studied in the fields of controlled drug release, wound healing, and drug delivery [ 48 , 49 , 50 , 51 , 52 ]. Doxorubicin (Dox) is an anti-tumor drug that is clinically used for the treatment of acute myelogenous leukemia, acute lymphoblastic leukemia, Hodgkin’s and non-Hodgkin’s lymphoma, breast cancer, and other malignant tumors [ 53 , 54 , 55 , 56 , 57 , 58 ]. However, it displays a low utilization rate, causes severe adverse reactions, and an inability to effectively reach the sites of tumors [ 59 , 60 , 61 , 62 ].…”

COVID19-induced immunosuppression and aggressive progression of primary cranial vault lymphoma presenting as a management challenge, a case report, and a literature review

“…[ 1 , 2 ] Not more than 50 cases have been reported to date. Primary cranial vault lymphoma had been defined as localized lymphoma not involving other than the primary site for more than 6 months, once we made the initial diagnosis [ 3 ]. In primary calvaria lymphoma, the most common histopathology reported is NHL large B-cell type (39–78%), and in primary Dural lymphoma most common pathology reported is marginal B cell lymphoma which is low grade.…”

“…On DSA tumor was being fed from bilateral ECA with tumor blush present suggesting vascular lesion, and left transverse sinus was also not visualized. Angiographic findings favor meningioma as lymphomas are not reported to have vascular blush on angiography except in 2–3 reported patients in the literature [ 3 , 6 ].…”

“…Such selective permeation of malignant lymphomatous cells was reported in the study by Ochiai et al and Galarza et al [ 7 , 8 ]. In the study by Kissling et al, the lymphomatous mass resembling meningioma has diffuse osteolytic features with thrombosis of the posterior third sagittal sinus [ 3 ].…”

“…Once it converts to a high-grade lesion, it presents as an osteolytic lesion, uncommonly as an osteoblastic lesion, and rarely with permeative transmission through the cortex [ 1 ]. Among these cases, concomitant calvaria and the epidural lesion are few and far between (5–6) [ 2 , 3 ]. We did not find any study which could suggest its association with COVID 19, although it is commonly associated with other immunosuppressive conditions.…”