Dural-based large B-cell lymphoma masquerading as a tentorial meningioma

Abstract

A 53-year-old woman presented with a 2-week history of headache and vertigo. Computed tomography revealed a hyperdense tumor, measuring 30 × 31 × 36 mm in diameter, in the anteromedial parts of the cerebellar hemispheres. Cerebral magnetic resonance imaging 10 days later revealed an apparent extra-axial tumor with broad attachment to the medial tentorium cerebelli and rapid growth to a diameter of 40 × 41 × 46 mm. Cerebral angiography revealed no obvious feeding vessels or tumor stains. The patient underwent biopsy through the left occipital transtentorial route. The histological appearance was consistent with diffuse large B-cell lymphoma. Intracranial lymphoma may present as a dural tumor that mimics a meningioma. Rapid tumor growth incongruous with benign meningiomas should be assumed to be possible lymphoma, and prompt biopsy should be performed.

Keywords: Dural-based; Lymphoma; Mimic meningioma; Occipital transtentorial approach.

Fig. 1

Noncontrast axial computed tomography (CT) scan showing a hyperdense tumor (T) in the anteromedial parts of the cerebellar hemispheres and mild ventriculomegaly (A). Post-contrast coronal (B) and sagittal (C) CT scans showing that the tumor, measuring 30 × 31 × 36 mm, is located in the posterior fossa, adjacent to the lower surface of medial tentorium cerebelli (TCe) and between the vein of the cerebellomesencephalic fissure (*) and declival vein (**), and compresses the dorsal brainstem, resulting in stenosis of the aqueduct.

Fig. 2

Axial T1- (A), T2- (B), and diffusion-weighted (C) magnetic resonance imaging show the tumor appearing as hypointensity on T1- and mixed intensity on T2- and diffusion-weighted sequences, respectively, accompanied by an extensive perilesional brain edema (B). On contrast examination, the tumor is well-demarcated, measuring 40 × 41 × 46 mm, and intensely enhanced (D–F).

Fig. 3

Lateral views of the right (A) and left internal (B), right (C) and left vertebral (D), and left external carotid arteriography (E) detecting no obvious feeding vessels from the internal carotid, vertebrobasilar, or external carotid system.

Fig. 4

Photomicrographs of resected specimens showing sheet-like proliferation of anaplastic cells with a high nuclear-cytoplasmic ratio and pleomorphism (A, hematoxylin, and eosin stain). These cells are positively stained for CD20 (B). Original magnification of A and B, × 400.

Fig. 5

Noncontrast axial (A) and sagittal (B) computed tomography scans performed 10 days after the beginning of chemotherapy showed a marked regression of the tumor (T) and cerebral ventricles with patent aqueduct.