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| LETTER TO EDITOR |
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| Year : 2013 | Volume
: 61
| Issue : 3 | Page : 334-336 |
A case of primary skull lymphoma: Review of literature
Sudhansu Sekhar Mishra1, Satya Bhusan Senapati1, Manmath Kumar Dhir1, Srikanta Das1, Subrat Burma2
1 Department of Neurosurgery, Shriram Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India
2 Department of Pathology, Shriram Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India
| Date of Submission | 11-Nov-2012 |
| Date of Decision | 13-Nov-2012 |
| Date of Acceptance | 30-May-2013 |
| Date of Web Publication | 16-Jul-2013 |
Correspondence Address:
Satya Bhusan Senapati
Department of Neurosurgery, Shriram Chandra Bhanja Medical College and Hospital, Cuttack, Odisha
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.115101
How to cite this article:
Mishra SS, Senapati SB, Dhir MK, Das S, Burma S. A case of primary skull lymphoma: Review of literature. Neurol India 2013;61:334-6 |
Sir,
Extranodal lymphoma can be either primary or secondary and can involve any organ. Bone involvement is commonly secondary and non-Hodgkin lymphoma (NHL) type. Primary NHL of the skull is extremely rare. This report presents a case of primary NHL of the skull in a non-immunocompromised individual and reviews the literature. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22]
A 34-year-old male presented with painless progressive swelling over left frontal area for over 1-year duration. Local examination, X-ray skull, plain and contrast cranial computed tomography (CT) scan were inconclusive [Figure 1]a-c. Skiagram of chest, ultrasound abdomen, and bone marrow biopsy revealed no abnormality. Left frontal circumferential craniectomy surrounding the lesion, with 1 cm healthy skull margin was done. Extracranial portion was removed along with involved bone, epidural component curetted out and dura cauterized. Histological and immunopathologic examination confirmed the diagnosis of diffuse large B-cell lymphoma [Figure 2]a-c. Post-operatively patient was treated with chemotherapy (CHOP regimen, containing cyclophosphamide, adriamycin, vincristine and prednisolone ), followed by local radiation therapy. After 6 months of surgery, patient is doing well, without signs of systemic dissemination.
Review of English literature revealed 24 such cases [Table 1]. | Table 1: Comprehensive review of published 24 reports in different journal, along with present case is given in tabular form blow
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Clinical presentations can be as a solitary or diffuse skull lesion with or without focal deficits. Hyperdense contrast enhancing mass was the CT finding in all the 20 patients who had CT scan. Hyperintense with contrast enhancement in T1-weighted was the magnetic resonance imaging finding in three cases and isointense in other three patients. Of the 23 patients, skull bone erosion (BE) was found in 14 patients, hyperostiosis in three patients and soft tissue component without skull BE in three patients. The optimum treatment includes surgery plus systemic chemotherapy and local radiotherapy. In patients with immunocompromized state, diffuse lesions and patients who do not tolerate systemic chemotherapy; biopsy followed by involved field radiation therapy is a reasonable alternate option.
We conclude that primary skull lymphoma is very rare and the possibility must be kept in mind in the differential diagnosis of primary skull lesions, irrespective of the immune status.
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[Figure 1], [Figure 2]
[Table 1]
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