Metastatic Malignant Lymphoma of the Skull with Extradural and Extracranial Extension

Abstract

A 72-year-old male was hospitalized because of a steadily growing mass (4 x 4 x 2 cm) in the frontal region, noticed following head injury. Six months earlier, he had declined treatment for malignant lymphoma (small non-cleaved cell type), discovered upon evaluation of a subcutaneous mass in his forearm. Neurological examination on admission was negative. Plain skull films revealed a large, osteolytic lesion with an irregular margin. Bone scintigraphy disclosed no uptake other than in the frontal bone. Computed tomography (CT) showed a large, homogeneously enhanced mass with both extradural and extracranial extension, which had destroyed the left frontal bone. The skull tumor was totally resected, and the diagnosis was malignant lymphoma, large cell, immunoblastic and plasmacytoid type. Postoperative combined chemotherapy with vincristine, cyclophosphamide, prednisolone, and adriamycin resulted in the complete disappearance of liver metastases. The patient was readmitted 2 months later, however, because of headache and gradually progressive impairment of consciousness. A CT scan disclosed brain metastasis in the paraventricular region. Radiation therapy (20 Gy) was administered but no further treatment was given. Skull metastasis is not uncommon in cases of malignant lymphoma, but a large mass with both extradural and extracranial extension is rare. Although aggressive chemotherapy was effective, prophylactic irradiation of the brain should have been considered in this case.