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Case Report

Primary diffuse large B‑cell non‑Hodgkin

lymphoma of the cranial vault

2
1
1
Shantanu Ghosh , Debabrata Das , Praveen Kumar , Rahul Varshney 1
1 Department of Neurosurgery, Calcutta National Medical College, Kolkata 700014, West Bengal, India.
2 Department of Ophthalmology, Midnapore Medical College, Midnapore 721101, West Bengal, India.
ABSTRA CT
Primary non‑Hodgkin lymphoma of the cranial vault with extra and intracranial extension in a nonimmunocompromised patient is
extremely uncommon. Until date, only limited number of such cases has been reported in the literature and none was the lesion
located as a diffuse swelling in the forehead. Imaging of the present case showed in a homogenous contrast enhancement mass
involving the scalp of bifrontal supraorbital compartment and intracranial extra axial extension through the frontal bone with extension
to the right orbit and right ethmoidal sinus. The intracranial mass was excised along with involved dura. Histopathology of the mass
showed diffuse large B‑cell non‑Hodgkin lymphoma.
Key words: B‑cell, cranial vault, non‑Hodgkin lymphoma

INTRODUCTION outpatient department with a history of a progressively
growing painless scalp swelling over the frontal region
Primary cerebral non-Hodgkin lymphoma (NHL) is for 2 years, headache for 1 year. He had progressive
a rare group of neoplasm and are mostly intraaxial loss of vision for 8 months and behavioral changes for
with frequent invasion of pachy and leptomeninges. the last 6 months. He had no past history of fever and
[1]
Primary malignant lymphoma arising from skull vault or head injury. He was normotensive and nondiabetic. The
scalp without involvement of the cerebral parenchyma clinical examination revealed a firm and well-defined
and systemic or skeletal manifestation is also rare. nontender immovable solitary subcutaneous swelling,
Only few cases have been reported in the literature. [2-4] measuring 10 cm × 8 cm without any bruit or
Involvement of bone is commonly seen with secondary pulsation in the frontal region [Figure 1]. He had no
NHL including that of the scalp. NHL originating lymphadenopathy or hepatosplenomegaly. Physical
[1]
primarily in the skeletal location is seen only up to 4% of examination of other systems was normal. On ocular
cases. Initial involvement of the skull is extremely rare examination, visual acuity in both eyes was of no
at presentation, and primary cranial vault lymphoma perception of light. Fundoscopy revealed bilateral
constitutes only 0.2% of lymphoma cases. However, atrophic papilledema. Hematological examination
[5]
primary NHL arising only in the cranial vault or scalp showed hemoglobin level of 11.0 g/dL, white blood
without involving the cerebral parenchyma or without cell count of 5,840/mm with a normal differential and
3
systemic involvement is extremely rare. Here, we are platelet count of 234,000/mm . Blood biochemistry
3
reporting this case because of its rare occurrence. was also normal. Antihuman immunodeficiency
virus antibody was negative. Magnetic resonance
CASE REPORT imaging (MRI) of the head showed a fairly large mass
with mixed signal intensity of the skull vault within
A 37-year-old male patient was admitted from our homogenous contrast enhancement involving the scalp
of bifrontal supraorbital compartment. The mass was
Access this article online extending into the right orbit and right ethmoidal sinus
Quick Response Code: through its anterosuperior part [Figure 2]. However
Website: muscle cone, eyeball and optic nerves were not
www.nnjournal.net
involved. Left orbit and left ethmoid was not involved.
DOI: The mass was located within diploe of the frontal bone
10.4103/2347-8659.139723 with intracranial extension through frontal bone with
extraaxial extension into bifrontal compartment. The

Corresponding Author: Dr. Shantanu Ghosh, Department of Neurosurgery, Calcutta National Medical College,
Kolkata 700014, West Bengal, India. E‑mail: shashwata_shantanu@yahoo.co.in

98 Neuroimmunol Neuroinflammation | Volume 1 | Issue 2 | September 2014