ML-10 PRIMARY DIFFUSE LARGE B-CELL LYMPHOMA OF THE CRANIAL VAULT: A CASE REPORT

BACKGROUND: Tumors other than meningiomas, cavernous malformations and metastatic tumors rarely originate in the cranial vault. We report a case of primary diffuse large B-cell lymphoma of the cranial vault. CASE DESCRIPTION: A 58-year-old woman was referred to our hospital because of a right frontal subcutaneous mass that had rapidly increased in size. The patient had been well until approximately 2 months before this referral, when she had slight difficulty in opening the right eye. Thereafter she had headaches and a swelling of the forehead. She was seen in a neurosurgery clinic and referred to our hospital. She had no past history of serious illnesses, operations or hospitalizations. On examination, there was a fixed firm mass, 13 cm in size, in the right side of the forehead. The skin on the center of the mass was stretched and took on a reddish hue. Neurological examination was negative. Blood chemistry tests showed lactate dehydrogenase four times above normal and a slight increase in alkaline phosphatase, amylase and lipase. Beta-2-microglobulin was normal. Bone windows of computed tomography (CT) of the head showed hyperostosis and permeative lytic changes of the frontal bone. Postcontrast MRI showed a large enhanced subgaleal lesion extending through the bony calvarium with a large subdural component. Histological examination after a biopsy was characteristic for a diffuse large B-cell lymphoma. Postcontrast CT of the abdomen and FDG-PET showed metastatic lesions in the pancreas, kidneys and cervical lymph nodes. The patient has been treated by CHOP chemotherapy and has been well. CONCLUSIONS: We present a case of primary diffuse large B-cell lymphoma of the cranial vault. We recommend including this tumor variant in the differential diagnosis of rapid growing cranial vault tumors.