Intracerebral presentation of Hodgkin’s disease mimicking meningioma

Abstract

12533 A 23-year-old woman presented with headaches, diplopia, nausea and vomiting. CT scan revealed frontal extradural mass consistent with meningioma. After excision of the mass light microscopic evaluation revealed a polymorphous variably cellular neoplasm with a background of normal small lymphocytes, eosinophils, histiocytes with large, atypical, often multinucleated cells. Immunohistochemical studies demonstrated large cell strongly positive for CD 30 and focally positive for CD 15 and negative for EMA and ALK1. The morphology, architectural features, and immunohistochemical findings were consistent with Hodgkin disease, the nodular sclerosing type. Systemic work up revealed stage IV disease. Patient was successfully treated with chemotherapy for Advance Stage HD and involved field RT, involving brain. The patient remains disease free 4 years after completion of treatment. Intracranial involvement (IC) of the Hodgkin disease (HD) is a rare entity. In the majority of cases intracranial involvement has been seen during relapsed and progressive disease. Until now nine cases of initial presentation of the HD as a brain tumor with appropriate morphological and histochemical confirmation were reported. Among those patients six patients had isolated primary IC HD and three patients after further investigation were found to have extracranial involvement. Seven of the nine patients had nodular sclerosing histology, one had mixed cellularity and in one case histology was not reported. All patients following resection of the IC mass received cranial RT. Two patients also received intrathecal chemotherapy. Patients with the extracranial involvement received systemic chemotherapy. All patients responded to the treatment and were disease free on the subsequent follow up 6–48 months after the completion of the therapy. No significant financial relationships to disclose.