Primary Dural Mucosa-associated Lymphoid Tissue Lymphoma Mimicking Falx Meningioma: A Case Report

Abstract

An 85-year-old woman presented with ataxia and deterioration of cognitive functions. She had no history of autoimmune diseases or viral infections. Magnetic resonance imaging showed a solitary mass lesion at the cerebral falx on contrast-enhanced T1-weighted imaging. Gross total resection of the lesion involving the dura mater was performed by bifrontal craniotomy. Histological examination showed diffuse infiltration of small lymphocytes and plasma cells. There was also some proliferation of large lymphocytes with folded nuclei, high-density chromatin, and inconspicuous nucleoli. The large atypical B lymphocytes did not demonstrate diffuse dense sheet findings. Meningothelial components were not detected. Immunohistochemistry was positive for pan B-cell antigens. The analysis of the kappa/lambda ratio indicated kappa immunoglobulin light chain-restricted B-cell proliferation. The final histopathological diagnosis was mucosa-associated lymphoid tissue lymphoma. Systemic screening examinations were then performed. Histological findings of the bone marrow showed normal findings without atypical lymphocytes. A chromosomal study of the bone marrow showed 46, XX. 18F fluoro-2-deoxyglucose positron emission tomography showed high accumulations at the left pterygoid muscle and the right transverse processes of the thoracic vertebrae, and mild accumulation at the right ilium bone, which indicated disseminated lesions. One year later, thickening of the dura mater was detected. Therefore, gamma knife surgery was performed. Two years later, she was alive without neurological deterioration, and magnetic resonance imaging showed no evidence of recurrence.

Primary extranodal marginal zone mucosa-associated lymphoid tissue-type B-cell lymphoma involving the dura: A case report

“…[ 3 ] EMZMBCLs are highly radiosensitive, and surgery followed by focal low-dose radiotherapy has shown good outcomes. [ 10 ] In the present case, whole-brain (21 Gy in 14 fractions) and intensity-modulated radiation therapy (9 Gy in 6 fractions) were administered as adjuvant therapies, resulting in favorable tumor control with no recurrence of EMZMBCL. Although chemotherapy may expose patients to various risks, it may be necessary in cases of secondary or recurrent EMZMBCL.…”

Mucosa-Associated Lymphoid Tissue Lymphoma With Lymphomeningothelial Lesion of the Dura

“…It is characterized as a slowly growing dural mass that is not infiltrative or has systemic involvement. 4 Although the pathogenesis of dura-origin MALT lymphoma is not known, the hypothesis has been suggested that monoclonal expansion resulting from subclinical inflammation in the dura could originate from the accumulation of lymphocytes in the region. As there is a predominance of female population, it has also been suggested that there could be a hormonal role in the pathophysiology.…”

“…It is characterized as a slowly growing dural mass that is not infiltrative or has systemic involvement. 4…”

“…It has been assumed that arachnoid membrane meningothelial cells are similar to the epithelial cells in other regions where MALT lymphoma develops. [3][4][5] Primary gastric MALT lymphoma is the most common and the most well-studied, but the histological characteristics of extranodal marginal zone lymphoma are largely similar whatever the origin. The most striking characteristic of MALT lymphoma is the presence of lymphoepithelial lesions in varying numbers, defined by partial destruction and significant invasion of the mucosal glands by tumor cells.…”

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue of the dura mimicking meningioma: a case report and literature review

“…An especially rare location is the central nervous system (CNS) and the dura mater. Little more than 100 cases of dural MALT lymphoma have been reported in the past [2,13,16]. Generally, most MALT lymphoma cases occur in adults, with a median patient age in the seventh decade of life.…”