Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 3533  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  » Next article
  » Previous article 
  » Table of Contents
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
  »  Article in PDF (69 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  


  In this Article
 »  References

 Article Access Statistics
    Viewed6649    
    Printed100    
    Emailed6    
    PDF Downloaded118    
    Comments [Add]    
    Cited by others 6    

Recommend this journal

   
LETTER TO EDITOR
Year : 2003  |  Volume : 51  |  Issue : 2  |  Page : 293-294

Primary cranial vault non-Hodgkin’s lymphoma


Department of Neurosurgery National Institute of Mental Health and Neuro Sciences Bangalore-560029

Correspondence Address:
Department of Neurosurgery National Institute of Mental Health and Neuro Sciences Bangalore-560029
bindira@nimhans.kar.nic.in



How to cite this article:
Mongia S, Shukla D, Indira Devi B, Reddy T V. Primary cranial vault non-Hodgkin’s lymphoma . Neurol India 2003;51:293-4


How to cite this URL:
Mongia S, Shukla D, Indira Devi B, Reddy T V. Primary cranial vault non-Hodgkin’s lymphoma . Neurol India [serial online] 2003 [cited 2019 Aug 23];51:293-4. Available from: http://www.neurologyindia.com/text.asp?2003/51/2/293/1127


Sir,
Primary cerebral non-Hodgkin's lymphomas are a rare group of neoplasms. They are mostly intraaxial. Invasion of pachy and leptomeninges is frequent,[1] however, primary malignant lymphoma arising within the skull vault or scalp without involvement of the cerebral parenchyma, systemic or skeletal manifestation, is rare. Sporadic cases have been reported in the literature.[2],[3],[4]
A 25-year-old man presented with a history of progressively increasing scalp swelling and local pain over the past 6 months. On examination, a 10 x 15 cm large scalp swelling was present in the right fronto-temporo parietal region. The scalp swelling was non-compressible and of variable consistency.
X-ray examination showed no bony erosion. CT scan showed scalp swelling. There was no intracranial abnormality. A near total excision of the right fronto-temporo parietal swelling was performed. Histology revealed non-Hodgkin's lymphoma. Ultrasonography of the abdomen, peripheral smear and bone marrow examination were negative for lymphoma. Postoperatively, he received radiotherapy along with adjuvant chemotherapy.
Bony involvement is commonly seen with secondary non-Hodgkin's lymphoma including that of the scalp[1]. However, non-Hodgkin's lymphoma originating primarily in the bones is seen in only about 3-4% of patients. The most common bone involvement is seen in the femur or pelvis (50%), humerus (20%) with the remaining 30% occurring in the spine, ribs, mandible and scapula.[2],[3]
Primary lymphoma of the skull vault is extremely rare.[1] A true primary malignant lymphoma of the bone is defined as “a solitary mass lesion with no evidence of disease at other sites and no systemic dissemination within 6 months of the detection of tumor”.[5] Our patient did not show any evidence of disease at other sites, there was no systemic dissemination even after 2-and-a-half years following the detection of the tumor at the vault / scalp.
In some cases plain X-ray of the skull may not show the destruction of the bone, as malignant lymphoma often has a permeative growth pattern with a soft tissue compartment and very little cortical destruction.[2] This finding was seen in our case. Pathologically, the spread of the disease to the meninges suggests that the lymphoma cells grow through the diploic spaces along the emissary veins and nerves that pass through the dura to the leptomeninges.[2] Our patient did not have any intracranial spread.
Lymphomas of the cranial vault usually involve the pericranium, underlying meninges and subcutaneous tissues. These lesions are effectively treatable by surgery and radiotherapy with a good outcome in most cases.[2],[3] A high index of clinical suspicion, awareness of the characteristic CT features and aggressive therapy are therefore required. Although this condition is rare, the diagnosis must be considered in the differential diagnosis, in any patient with a scalp mass extending through the skull. The prognosis of a lymphoma appearing in the skull vault is uncertain, but any involvement of the cerebral structures by direct invasion or by leptomeningeal seeding should indicate a less favorable prognosis.
 

  »   References Top

1.Braunstein EM, White SJ. Non-Hodgkin's lymphoma of bone. Radiology 1980;135:59-63.  Back to cited text no. 1  [PUBMED]  
2.Holtas S, Monajati A, Utz R. Computed tomography of malignant lymphoma involving the skull. J Comp Assist Tomog 1985;9:725-7.  Back to cited text no. 2  [PUBMED]  
3.Maiuri F, Conero G, Giamundo A. Primary lymphoma of the cranial vault. J Neurosurg Sci 1987;31:183-6.  Back to cited text no. 3    
4.Agbi CB, Bannister CM, Turnbull IW. Primary cranial vault lymphoma mimicking a meningioma. Neurochirurgica (Stuttg) 1983;26:130-2.  Back to cited text no. 4  [PUBMED]  
5.Shoji H, Miller TR. Primary reticulum cell sarcoma of bone: Significance of clinical features upon the prognosis. Cancer 1971;28:1234-44.  Back to cited text no. 5  [PUBMED]  

 

Top
Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow