Primary Dural Lymphoma Research Articles

NCMP-17. SPHENOID WING DIFFUSE LARGE B-CELL LYMPHOMA MIMICKING A MENINGIOMA: A RARE DIFFERENTIAL DIAGNOSIS

Abstract BACKGROUND Meningioma is the most frequent dural lesion and in most cases have a benign course and surgery usually is curative. Nevertheless, there are several dural lesions, neoplastic and non-neoplastic that may mimic meningiomas. Radiological features could help to perform this differentiation. Primary dural lymphoma (PDL) is a rare entity in which adjuvant therapy is required for proper therapeutic approach. CASE PRESENTATION A 67-year-old female patient presented with a clinical complaint of left exophthalmos and headache. During investigation, it was noticed the presence of a hyperintense left sphenoid wing lesion with orbital invasion. The diagnosis of meningioma was initially considered and she underwent neurosurgical approach aiming maximal extension. However, histopathological investigation disclosure that was a primary dural lymphoma (diffuse large B type) and she was referred to adjuvant therapy with a proper control of the disease. CONCLUSIONS Dural lesions could have neoplastic and non-neoplastic origin. Although meningiomas have a high prevalence, it must be considered other pathologies during evaluation and consideration of the differential diagnosis. This help to improve therapeutic management of the patients.

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

Chronic inflammation of the thorax, as in tuberculosis-related pyothorax, can cause secondary malignant lymphomas. However, primary malignant lymphoma of the central nervous system, specifically of the dura mater, developing after intracranial infection or inflammation has rarely been reported. Herein, the authors describe a case of primary dural lymphoma that developed secondary to subdural empyema, with an initial presentation mimicking a chronic subdural hematoma. A 51-year-old man had undergone single burr hole drainage for subdural empyema 2 years prior. The patient subsequently underwent multiple craniotomy and drainage procedures, with successful remission of the subdural empyema. He was subsequently referred to the authors' hospital approximately a year after his initial treatment because of a recollection of subdural fluid, which was suspected to be recurrent empyema. After another single burr hole drainage, which revealed only a subdural hematoma, a histopathological diagnosis of B-cell lymphoma of the dural/subdural membrane was made. Subsequent radiation therapy was completed, with good local control and no recurrence of the subdural hematoma confirmed at 2 months posttreatment. Intracranial lymphoma triggered by chronic inflammation is rare but should be considered a differential diagnosis in subdural hematomas for which the background pathology is unclear. https://thejns.org/doi/10.3171/CASE24153.

A Meningioma Mimic and Distinct Subtype of Primary Central Nervous System Lymphoma: Primary Dural Lymphoma

Primary central nervous system lymphoma (PCNSL) is an aggressive form of extranodal non-Hodgkin lymphoma that arises in the brain parenchyma, eyes, meninges, or spinal cord in the absence of systemic disease. Primary dural lymphoma (PDL), in contrast, arises from the dura mater of the brain. PDL is usually a low-grade B-cell marginal zone lymphoma (MZL), whereas other types of PCNSL are usually high-grade large B-cell lymphoma. This specific pathological subtype has important therapeutic and prognostic implications, making PDL a distinct subtype of PCNSL. Herein, we report a case of PDL in an African American patient, in her late thirties, who presented to our emergency room with chronic headaches. An emergent magnetic resonance imaging (MRI) of the brain showed a dural-based homogeneously enhancing extra-axial mass along the left hemisphere, which was contained within the anterior and parietal dural mater. A surgical specimen was collected after an emergency debulking procedure. The flow cytometry, done on the surgical specimen obtained, was positive for CD19+, CD20+, and CD22+, but negative for CD5- and CD10-. These findings were consistent with a clonal B-lymphoproliferative disorder. The surgical pathology specimen immunohistochemistry was positive for CD20+ and CD45+, but negative for Bcl-6Cyclin D1- and CD56-. The Ki67 was 10-20%. These findings were consistent with extranodal MZL. Given the location and pathology, the patient was diagnosed with PDL. Due to MZL's indolent nature, location outside the blood-brain barrier, and known efficacy to bendamustine-rituximab (BR), we decided to treat our patient with BR. She completed six cycles without major complications, and her post-therapy brain MRI showed complete remission (CR). Our case adds to the sparse literature about PDL and highlights the efficacy of BR systemic chemotherapy on MZLs.

A Case of Primary Dural Lymphoma Treated with Bendamustine and Rituxan

Background Primary CNS lymphoma (PCNSL) is an aggressive form of extranodal non-Hodgkin lymphoma that arises in the brain parenchyma, eyes, meninges, or spinal cord in the absence of systemic disease. Primary dural lymphoma (PDL) arises from the dura mater of the brain. It differs biologically from other CNS lymphomas. It is usually a low-grade B-cell marginal zone lymphoma (MZL), whereas other types of PCNSL are usually high-grade large B-cell lymphoma. This specific pathological subtype has important therapeutic and prognostic implications, making PDL a distinct subtype of PCNSL. Herein, we report a case of PDL in an African American patient who was treated with bendamustine and rituximab. Case Presentation A 38-year-old African American female patient presented with chronic intermittent headaches. MRI of the brain showed a dural-based homogeneously enhancing extra-axial mass along the left hemisphere with extension to the anterior interhemispheric falx and anterior right frontal lobe measuring up to 11 cm. This was found to have a significant mass effect and 1-2 cm left-to-right midline shift on the underlying brain parenchyma with vasogenic edema. The patient underwent an emergent craniotomy and debulking of the mass. The tumor was contained within the anterior and parietal dural matter. The malignant cells stained diffusely positive for CD19, CD20, and CD22 but negative for CD5, CD10, Cyclin D1, and CD56. Ki67 was 10-20%, consistent with extranodal marginal zone lymphoma. Given the location and pathology, the patient was diagnosed with PDL. She was started on treatment with bendamustine and rituximab. She completed six cycles, and post-therapy MRI brain showed complete remission. She continues to do well two years after finishing treatment. Discussion The Dura mater is devoid of lymphoid tissue; however, it is hypothesized that chronic inflammation of the dura due to chronic infection or autoimmune disorder may attract polyclonal lymphocytes from which monoclonal lymphoma could arise. PDL has not been definitively associated with any infectious or autoimmune disease, but patients with hepatitis C, scleroderma, Graves' disease, and Sjogren disease have been reported. Developmentally, the dura originates from the mesoderm. In contrast, the CNS originates from the ectoderm, which leads to the presence of the dura outside the blood-brain barrier and is easily exposed to systemic therapies. So, HDMTX regimens are excessive for PDL, where MZL is the most common pathology. Because of this and the known efficacy of bendamustine-rituximab in extranodal MZL, we decided to treat our patient with this regimen. Tsutsumi et al. reported 2 cases of dural MZL that were treated successfully with bendamustine-rituximab. However, those two cases also had evidence of systemic disease, not only dural disease like our patient. Because of its indolent pathology, surgery and/or radiation have also been used as treatment modalities, although complete resection of dural lymphomas can be technically difficult Conclusion Our case adds to the sparse literature about primary dural lymphoma. It emphasizes the importance of recognizing it as a separate entity from parenchymal PCNSL, an aggressive disease with a poor prognosis. Surgery, radiation, and/or chemoimmunotherapy used for other extranodal MZL are appropriate treatments for PDL. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Primary dural lymphoma: a comprehensive literature review and report of a case

Primary dural lymphoma (PDL) is a subtype of primary central nervous system (CNS) lymphoma (PCNSL) with only an extra-axial dural location. It accounts for less than 1% of all CNS lymphomas. PDL is a sporadic CNS tumor, and in the preoperative period, because of imaging characteristics, it is usually mimicking a meningioma. Usually, PDL is a low-grade B-cell lymphoma with a relatively good response to surgical resection with or without radiotherapy. Here we reviewed 102 case reports of PDL in the literature. Then, we present the case of our patient with PDL and explain the complexity of our treatment approach.

Diagnostic Difficulties and Management of Childhood Lymphoma: A Case Report

Primary dural lymphoma is a rare pathology, it is part of the malignant lymphoma of the central nervous system and it can reach the extradural or subdural space. We report a case of a little boy of three years and two months admitted to the Department of Neurosurgery CHU JRA for multiple swellings in the scalp associated with an altered general condition. The CT scan revealed a multiple extra-axial expansive process with retro-orbital extension responsible for an important exophthalmos as well as at the scalp level. Anatomopathological examination of the dura mater biopsy revealed a malignant non-Hodgkin's small cell lymphoma. The patient underwent chemotherapy of 05 sessions and the evolution was marked by the persistence of the symptoms. The post chemotherapy brain scan showed considerable extension of the lesions. The next step would be radiotherapy.

Primary Dural Diffuse Large B-Cell Lymphoma Is Associated with Good Prognosis and Is Effectively Treated with CHOP-R Alone

Introduction: Primary dural diffuse large B-cell lymphoma (PD-DLBCL) is a rare and aggressive B-cell non-Hodgkin lymphoma that arises in the dura mater, mimicking primary central nervous system lymphoma (PCNSL). While the optimal management is unknown, PD-DLBCL therapy is often mirrored after PCNSL, and aggressive therapy is frequently used. Combining data collected at our institution along with a review of the literature, we provide the most complete analysis of this rare disease entity including data on biology, treatment outcomes, and survival to assist in clinical management.Patients and Methods: A comprehensive review of the literature was conducted on pathologically confirmed intra-cranial and intra-spinal cases of PD-DLBCL reported from Jan 1st 1992 to July 1st 2017 in PubMed. Key words used (single or in combination) included: primary dural lymphoma, PDL, diffuse large B-cell lymphoma, DLBCL, and primary diffuse large B-cell lymphoma dura mater. Data were tabulated regarding the following 16 variables: tumor location (cranial vs. spinal), age, gender, disease stage, cell of origin (germinal center B-cell like (GCB)-DLBCL vs. activated B-cell like (ABC)-DLBCL), CD20, CD10, CD79a, CD30, BCL2, BCL6, MUM1, Ki-67 (above or below 70%), type of chemotherapy, use of radiation therapy, and overall survival (OS). Data were reported as percent and total number of cases with available information of each variable.Results and Discussion: Out of 235 screened cases, 47 cases of PD-DLBCL were detected from 26 distinct sources. Two cases were excluded for unclear definition about site of origin (dural vs. subdural). In total 45 cases were included in our analysis. Sixteen of these cases were intra-cranial and 29 were intra-spinal. Median age was 59 years at the time of diagnosis. Incidence was nearly equal between women (22/45) and men. When tested, CD20 was positive in each instance (21/21). Using Hans criteria when possible to determine cell of origin, 3 cases were classified as ABC-DLBCL and 5 as GCB-DLBCL, confirming the representation of both subtypes in PD-DLBCL. Ki-67 fraction was given in 9 cases, 6 of which were less than 70%, reflecting an overall less aggressive tumor behavior. The remainder of studied markers are detailed in Figure 1A. Interestingly, all cases were stage IE. Survival data available from 40 cases showed an OS of 84% at 1 year, and 81% at 5 years (Figure 1B), which compares favorably to PCNSL and matches early-stage DLBCL. Tumor location (intra-cranial vs. intra-spinal) did not impact OS (P=0.82; Figure 1C). Significant heterogeneity existed in regards to treatment choices. Initial chemotherapy regimen was reported in 19 cases with available survival data. Eleven patients received a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), 6 of which additionally received rituximab (CHOP-R). Eight patients received high-dose methotrexate (MTX) based therapy. Interestingly, no difference in OS was observed between CHOP vs. MTX-based therapy (P=0.97; Figure 1D), suggesting that PD-DLBCL should be treated as DLBCL rather than PCNSL. Moreover, all patients who received rituximab in addition to CHOP remained disease free and alive. Radiation therapy was given often (25/29) in treatment of spinal disease, but rarely (4/16) when treating cranial disease. Three patients received whole brain radiation therapy, twice following CHOP and once following MTX. The use of radiation therapy did not impact OS (data not shown).Conclusion: PD-DLBCL is an exceedingly rare subtype of DLBCL, GCB- or ABC-derived, and equally seen in both genders. The good outcomes seen with CHOP-R suggest that these cases should be treated like DLBCL rather than PCNSL, obviating the need for the more toxic high-dose MTX-based regimens or radiation therapy. The durable responses following CHOP-R also confirm that PD-DLBCL is not protected by the blood brain barrier. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Giant primary dural lymphoma with vault involvement

A 52-year-old immunocompetent man presented with frontal headaches. Physical examination showed a painful frontal hump (A). Computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed a giant bifrontal extra-axial tumor (B, C). He benefited from total removal of the tumor. Pathological examination of the resected mass led to the diagnosis of anaplastic large B-cell lymphoma (cell immunopositivity for CD30 and anaplastic lymphoma kinase) (D). He was transferred to the oncology unit for chemo and radiotherapy with good clinical evolution. Primary dural lymphoma (PDL) is extremely rare, accounting for 7% of all primary central nervous system lymphomas. PDL usually involves sites that are rich in meningothelial cells, and results in a localized mass or plaque-like thickening of the dura that radiologically resembles a number of other diseases, such as meningioma or subdural hematomas. Although there is as yet no optimal treatment for PDL, surgical excision followed by radiotherapy and chemotherapy are recommended.

Primary dural lymphomas: Clinical presentation, management, and outcome

Clinical experience is limited for primary central nervous system (CNS) lymphoma that arises from the dura mater, which is denoted with the term primary dural lymphoma (PDL). This study was aimed at determining the relative incidence, presentation, and outcomes of PDL. The institutional databases of the Divisions of Neuro-Oncology at the Massachusetts General Hospital and the Yale School of Medicine were retrospectively searched for patients with primary CNS lymphoma. Patients with pathologically confirmed dural lymphoma and no evidence of primary cerebral or systemic involvement were identified. Clinical data, diagnostic findings, treatments, and outcomes were recorded. A total of 20 patients with PDL were identified, and they represented 6.3% of the individuals with primary CNS lymphomas (20 of 316). Histopathological examination of PDL revealed the following underlying subtypes: diffuse large B-cell lymphoma (10 of 20 patients), marginal zone lymphoma (6 of 20), follicular lymphoma (2 of 20), undefined B-cell non-Hodgkin lymphoma (1 of 20), and T-cell non-Hodgkin lymphoma (1 of 20). On imaging, all tumors appeared as extra-axial masses with avid contrast enhancement and mostly mimicked meningioma. The median apparent diffusion coefficient value was 667±26mm2 /s. Cerebrospinal fluid analyses and symptoms were nonspecific, and the diagnosis rested on tissue analysis. Therapeutic approaches included surgery, radiotherapy, and chemotherapy. The median overall survival was not reached after 5years. Three patients were deceased at database closure because of tumor progression. The extent of tumor resection correlated positively with overall survival (P=.044). PDL is a rare variant of primary CNS lymphoma that can be radiographically mistaken for meningioma. The outcome is excellent with multimodality treatment, and aggressive surgery may convey a survival advantage in select cases.

Primary Dural Lymphoma Masquerading as a Meningioma: A Rare Clinical Entity

Abstract Primary dura mater–based lymphomas are extremely uncommon and when detected are often clinically and radiologically misidentified. As per literature search, they account for <0.1% of all non-Hodgkin lymphomas; however, a precise incidence is unknown since only a few cases have been described in the literature. Here we report a case of a 64-year-old female who presented for evaluation of a newly diagnosed left tentorial tumor, diagnosed as “consistent with meningioma” on imaging studies with significant mass effect on the left occipital lobe and left cerebellum with effacement of the fourth ventricle. She had been experiencing disabling headaches, balance dysfunction, and reduced vision. On examination, the patient had right visual field defect with wide-based gait. No evidence of systemic lymphoma or clinically suspicious lymphadenopathy was documented. An intraoperative consultation revealed sheets of lymphocytes, rather highly concerning for lymphoma. H&E sections showed dense fibroconnective tissue heavily infiltrated by mature small- to intermediate-sized lymphocytes with irregular nuclei and condensed chromatin without a discernible architecture. Only sparse and scattered larger lymphocytes were seen. Flow cytometry identified a subset of B cells with lambda-restricted immunophenotype expressing CD19+, CD20+, CD10+, CD5–, and CD23–. On tissue sections, Ki-67 showed an overall proliferation index of 10% to 20%. However, no residual follicular dendritic cell meshwork was detected by CD21 or CD23. PCR analysis detected clonal B-cell IgH and IgKappa gene rearrangements. A diagnosis of low-grade CD10-positive B-cell lymphoma (likely follicle center-cell origin) was made and the patient was discharged after 3 days of surgery for outpatient follow-up and treatment. In conclusion, low-grade dural-based lymphomas are extremely rare and often misdiagnosed as meningiomas clinically and radiologically. Additionally, it is important distinguish lymphomas of the dura mater, which are excluded from the definition of primary CNS lymphomas and may have a different clinical management and outcome.

Primary dural lymphomas: clinical presentation, management, and outcome in a bi-institutional study (S14.008)

Primary dural lymphomas: clinical presentation, management, and outcome in a bi-institutional study (S14.008)

Primary dural diffuse large B cell lymphoma mimicking parafalcine meningioma

A 58-year-old immunocompetent woman presented with complaints of recent onset recurrent generalised tonic-clonic seizures and left hemiparesis. On MRI a dural-based heterogeneously enhancing mass was seen along the falx cerebri...

Primary diffuse large B-cell lymphoma of the dura with skull and scalp involvement: A case report and brief review of the literature.

Primary dural lymphoma (PDL) refers to a lymphoma with epidural or subdural involvement and is a rare subtype of primary central nervous system lymphoma. Diffuse large B-cell lymphoma (DLBCL) presenting as PDL is extremely rare. The present study reports a case of PDL with skull and scalp involvement in a 56-year-old man. Magnetic resonance imaging (MRI) revealed that the tumor was located under the right parietal inner plate and was attached to the dura mater. Following contrast-enhanced MRI, markedly enhanced tumor signals were observed, and mild homogeneous enhancement was observed in the diploë and soft tissues under the scalp, near the parietal bone. Under general anesthesia, the patient underwent craniotomy and tumor resection. The postoperative pathological diagnosis was DLBCL. Tumors were additionally identified inside the skull and subcutaneous tissues. The patient was administered chemotherapy postoperatively, and the prognosis subsequent to the 4-year follow-up was favorable. Primary malignant lymphoma should be considered in the differential diagnosis of scalp masses and meningeal lesions. Early diagnosis and individualized treatment is closely associated with a favorable outcome.

Primary dural lymphoblastic B-cell lymphoma: a rare subtype of aggressive dural lymphoma

Lymphomas arising in the dura mater represent a rare subset of primary central nervous system lymphoma (PCNSL). The majority of primary dural lymphoma (PDL) are low-grade marginal zone lymphomas (MZL) characterized by an indolent course and favorable long-term outcomes. Primary aggressive dural lymphomas are exceedingly rare with a paucity of cases reported in the literature. Herein, we describe a case of primary lymphoblastic dural lymphoma. To our knowledge, this is the second report of an isolated dural B-lymphoblastic lymphoma (B-LBL) in an immunocompetent patient.

Primary meningeal malt lymphoma mimicking lymphoplasmacytic meningioma: A case report

Primary meningeal lymphomas are rare. Here, we discuss a case of a 59 year old female who underwent an operation to remove a dural based frontal mass that was thought to be meningioma preoperatively. Histopathological assessment revealed the tumour to be a meningeal MALT lymphoma with amyloid deposition. Dural lymphomas may mimic meningiomas and subdural hematomas radiologically. Distinction of a primary meningeal MALT lymphoma from a lymphoplasmacytic meningioma may be difficult based solely on morphological grounds and ancillary tests are often necessary.

RARE-03PRIMARY DURAL LYMPHOMA: SINGLE INSTITUTION STUDY OF TREATMENT AND OUTCOME

BACKGROUND: Primary dural lymphoma (PDL) is a rare form of primary intracranial lymphoma. Clinical and radiographic presentation often suggest a meningioma. Pathology often shows a low grade B-cell marginal zone lymphoma (MZL). MZL is very radiosensitive to relatively low dose of RT. Previous series have reported a high risk for systemic recurrence. METHODS: A retrospective review of primary dural lymphoma treated at the University of Miami Heath System between 08/2004-10/2014. RESULTS: Eleven patients were identified. Six were women. Median age at diagnosis was 48 years (range: 30 to 68). The most frequent symptoms at presentation were seizure (40%), headache (40%) and cranial nerve palsies (37%). Brain-MRI showed a single extra-axial enhancing lesion in 9 patients and multiple in two. Work-up was negative for systemic and leptomeningeal disease in all patients. Two patients had a history of HIV at diagnosis. All patients underwent resection/biopsy with an initial diagnosis of meningioma. Pathology showed marginal zone B-cell lymphoma (MZL) in all patients. One patient refused RT and was treated with rituximab. Ten patients were treated with focal RT. One of these patients refused to continue RT after been treated with 16 Gy. All others received between 30.6 to 36 Gy. Nine patients achieved complete response (CR) and two were lost to follow-up. Median follow-up was 3.3 years (range, 0.7 to 10 years). No patient developed a systemic relapse. Two patients developed CNS recurrences. One of these patients had progression of disease after being treated with 16 Gy and had a second course of RT (36 Gy), achieving CR. Another patient was treated with bendamustine/rituximab at progression and achieved CR. All patients are alive. CONCLUSIONS: Patients with PDL have a good prognosis. CR can be achieved with relatively low dose focal RT. No systemic relapses were observed in our series.

EPID-29DURAL PRIMARY MARGINAL ZONE LYMPHOMA WITH LARGE B-CELLS PRESENT: A CASE REPORT AND REVIEW OF THE LITERATURE

A 64-year-old female presented with personality changes, acalculia, falls, headache and nausea. CT and MR imaging of the head revealed a homogeneously contrast-enhancing 7 cm x 4.4 cm x 4.4 cm right frontal dural-based mass, concerning for a meningioma. She underwent a right frontal craniotomy with complete resection. Post-operative pathology demonstrated sheets of lymphocytes and plasma cells with small numbers of germinal cells present. The infiltrate was limited to the dura and leptomeninges. Immunophenotype as demonstrated by immunohistochemistry and flow cytometry was diagnostic of an extranodal marginal zone lymphoma with extensive plasmacytic differentiation. Given the normal bone marrow biopsy and absence of disease on CT chest, abdomen, and pelvis, she was diagnosed with an extranodal primary dural-based marginal zone B-cell lymphoma (MZL) with plasmacytic differentiation. Primary dural lymphomas are a well-described subset of primary central nervous system (CNS) lymphomas that most commonly present as low grade lymphomas. MZLs generally carry a much better prognosis than typical diffuse large B-cell lymphomas. This case illustrates that hematopoietic malignancies should be considered in the differential diagnosis of dural based masses in addition to meningiomas or less common dural metastases, solitary fibrous tumors, leiomyosarcomas, and hemangiopericytomas. Typically dural based lymphomas have increased vasogenic edema compared to meningiomas. Unlike other extranodal MZLs, dural based MZLs have no strong association with chronic inflammatory conditions, infections, or immunosuppression. The literature supports that MLZs are very radiosensitive; with excision and low dose-localized radiation therapy, patients may remain disease free locally. However, systemic recurrence may occur, possibly because the dura is outside the blood brain barrier. Appropriate diagnosis is important as it has both prognostic and treatment implications.

Primary Diffuse Large B-cell Lymphoma of Dura and Cranial Vault

Primary central nervous system lymphoma (PCNSL) is an extranodal non-Hodgkin lymphoma that is deep seated and despite effective treatment regimens the prognosis is poor with a 5-year survival of 10%. Primary dural lymphoma a rare form of PCNSL, is usually a low-grade B-cell lymphoma of the mucosa-associated lymphoid tissue type or marginal zone B-cell lymphomas. Primary dural diffuse large B-cell lymphoma, as an aggressive form, is extremely rare with only 13 cases reported in literature. We present a short series of 3 cases of this rare variety of primary dural lymphomas along with the review of literature. They mimic meningiomas and involve the cranial vault, with scalp swelling being the most common presentation. They are staged as Ann-Arbor stage IE primary high-grade large B-cell lymphoma of the dura and, at present, owing to rarity of the disease, are treated as PCNSLs. Whether the high-grade dural lymphomas behave like aggressive PCNSLs and exact management in view of the fact that they appear to be outside blood-brain barrier will require the review of larger series and case reports.

Case Report: Primary dural based diffuse large B-Cell lymphoma in a 14 year-old boy.

Primary dural lymphoma is a subentity of primary leptomeningeal lymphoma which represents 0.1% of all non-Hodgkin's lymphomas. Only five cases have been reported so far. We report a very rare case of primary dural-based lymphoma in a 14 year-old boy presenting with mass effect. The patient was managed with excision of the lesion and removal of the involved bone. Post-operatively, the patient showed good recovery. He was then referred to the oncology unit for further chemo- and radiation therapy. A high index of suspicion should therefore be kept in order to diagnose the condition in a timely fashion and then plan for appropriate management since diffuse large cell lymphoma has a relatively benign clinical prognosis.

Primary dural MALT lymphoma mimicking a meningioma: A case report

Background: Primary dural lymphoma is a rare subtype of primary central nervous system lymphoma. Mucosa-associated lymphoid tissue (MALT) lymphomas are the most common subtype of non-Hodgkin's lymphomas primarily involving the dura. They usually appear as single or multiple extra axial lesions with homogeneous contrast-enhancement mimicking a meningioma.