Tumoral Mimics of Subdural Hematomas: Case Report and Review of Diagnostic and Management Strategies in Primary B-Cell Lymphoma of the Subdural Space

Om J. Neeley, Khaled Mohammad Al-Hreish, Salah G. Aoun, Tarek Y. El Ahmadieh, Aaron Plitt, Awais Z. Vance, Jesse Manuel Jaso, Kimmo J. Hatanpaa, Jonathan A. White

Research output: Contribution to journalReview article

Abstract

Background: Subdural lymphomas are a rare subtype of primary central nervous system lymphomas that can radiographically mimic epidural blood and pose a diagnostic challenge. They can complicate treatment if not preemptively identified. Methods: We present a case report of a subdural lymphoma that mimicked a compressive subdural hematoma, and we review the PubMed database for similar cases. Results: A 77-year-old woman presented with a transient left facial droop and what appeared to be a subdural hematoma on computed tomography scan. The patient underwent surgery, during which grossly abnormal solid epicortical adherent tissue was noted instead of the expected appearance of a subdural hematoma. An intraoperative biopsy was suggestive of lymphoma, and the surgery was converted to a craniectomy. Pathology confirmed the diagnosis of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. The patient underwent radiotherapy with no complications or recurrence. Magnetic resonance imaging demonstrated complete resolution of the mass at 3 months after treatment, at which time the patient underwent a synthetic cranioplasty. Seven case reports of primary dural lymphomas mimicking subdural blood were found, with variable pathologic subclassifications. Conclusions: Although rare, a primary dural lymphoma can be mistaken for a subdural hematoma on computed tomography scan. The most common subtype is low-grade extranodal marginal zone lymphomas. It is important to keep these diseases in the differential diagnosis, especially when there is incongruence between imaging and the clinical picture, as earlier detection correlates to a stronger therapeutic response.

Original languageEnglish (US)
Pages (from-to)49-54
Number of pages6
JournalWorld Neurosurgery
Volume133
DOIs
StatePublished - Jan 2020

Fingerprint

Subdural Space
Subdural Hematoma
B-Cell Lymphoma
Lymphoma
Tomography
Marginal Zone B-Cell Lymphoma
PubMed
Differential Diagnosis
Radiotherapy
Therapeutics
Central Nervous System
Magnetic Resonance Imaging
Databases
Pathology
Biopsy
Recurrence

Keywords

  • B-cell lymphoma
  • CNS lymphoma
  • Lymphoma
  • Marginal zone
  • Subdural hematoma mimic
  • Subdural space

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Tumoral Mimics of Subdural Hematomas : Case Report and Review of Diagnostic and Management Strategies in Primary B-Cell Lymphoma of the Subdural Space. / Neeley, Om J.; Al-Hreish, Khaled Mohammad; Aoun, Salah G.; El Ahmadieh, Tarek Y.; Plitt, Aaron; Vance, Awais Z.; Jaso, Jesse Manuel; Hatanpaa, Kimmo J.; White, Jonathan A.

In: World Neurosurgery, Vol. 133, 01.2020, p. 49-54.

Research output: Contribution to journalReview article

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abstract = "Background: Subdural lymphomas are a rare subtype of primary central nervous system lymphomas that can radiographically mimic epidural blood and pose a diagnostic challenge. They can complicate treatment if not preemptively identified. Methods: We present a case report of a subdural lymphoma that mimicked a compressive subdural hematoma, and we review the PubMed database for similar cases. Results: A 77-year-old woman presented with a transient left facial droop and what appeared to be a subdural hematoma on computed tomography scan. The patient underwent surgery, during which grossly abnormal solid epicortical adherent tissue was noted instead of the expected appearance of a subdural hematoma. An intraoperative biopsy was suggestive of lymphoma, and the surgery was converted to a craniectomy. Pathology confirmed the diagnosis of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. The patient underwent radiotherapy with no complications or recurrence. Magnetic resonance imaging demonstrated complete resolution of the mass at 3 months after treatment, at which time the patient underwent a synthetic cranioplasty. Seven case reports of primary dural lymphomas mimicking subdural blood were found, with variable pathologic subclassifications. Conclusions: Although rare, a primary dural lymphoma can be mistaken for a subdural hematoma on computed tomography scan. The most common subtype is low-grade extranodal marginal zone lymphomas. It is important to keep these diseases in the differential diagnosis, especially when there is incongruence between imaging and the clinical picture, as earlier detection correlates to a stronger therapeutic response.",
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T1 - Tumoral Mimics of Subdural Hematomas

T2 - Case Report and Review of Diagnostic and Management Strategies in Primary B-Cell Lymphoma of the Subdural Space

AU - Neeley, Om J.

AU - Al-Hreish, Khaled Mohammad

AU - Aoun, Salah G.

AU - El Ahmadieh, Tarek Y.

AU - Plitt, Aaron

AU - Vance, Awais Z.

AU - Jaso, Jesse Manuel

AU - Hatanpaa, Kimmo J.

AU - White, Jonathan A.

PY - 2020/1

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N2 - Background: Subdural lymphomas are a rare subtype of primary central nervous system lymphomas that can radiographically mimic epidural blood and pose a diagnostic challenge. They can complicate treatment if not preemptively identified. Methods: We present a case report of a subdural lymphoma that mimicked a compressive subdural hematoma, and we review the PubMed database for similar cases. Results: A 77-year-old woman presented with a transient left facial droop and what appeared to be a subdural hematoma on computed tomography scan. The patient underwent surgery, during which grossly abnormal solid epicortical adherent tissue was noted instead of the expected appearance of a subdural hematoma. An intraoperative biopsy was suggestive of lymphoma, and the surgery was converted to a craniectomy. Pathology confirmed the diagnosis of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. The patient underwent radiotherapy with no complications or recurrence. Magnetic resonance imaging demonstrated complete resolution of the mass at 3 months after treatment, at which time the patient underwent a synthetic cranioplasty. Seven case reports of primary dural lymphomas mimicking subdural blood were found, with variable pathologic subclassifications. Conclusions: Although rare, a primary dural lymphoma can be mistaken for a subdural hematoma on computed tomography scan. The most common subtype is low-grade extranodal marginal zone lymphomas. It is important to keep these diseases in the differential diagnosis, especially when there is incongruence between imaging and the clinical picture, as earlier detection correlates to a stronger therapeutic response.

AB - Background: Subdural lymphomas are a rare subtype of primary central nervous system lymphomas that can radiographically mimic epidural blood and pose a diagnostic challenge. They can complicate treatment if not preemptively identified. Methods: We present a case report of a subdural lymphoma that mimicked a compressive subdural hematoma, and we review the PubMed database for similar cases. Results: A 77-year-old woman presented with a transient left facial droop and what appeared to be a subdural hematoma on computed tomography scan. The patient underwent surgery, during which grossly abnormal solid epicortical adherent tissue was noted instead of the expected appearance of a subdural hematoma. An intraoperative biopsy was suggestive of lymphoma, and the surgery was converted to a craniectomy. Pathology confirmed the diagnosis of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. The patient underwent radiotherapy with no complications or recurrence. Magnetic resonance imaging demonstrated complete resolution of the mass at 3 months after treatment, at which time the patient underwent a synthetic cranioplasty. Seven case reports of primary dural lymphomas mimicking subdural blood were found, with variable pathologic subclassifications. Conclusions: Although rare, a primary dural lymphoma can be mistaken for a subdural hematoma on computed tomography scan. The most common subtype is low-grade extranodal marginal zone lymphomas. It is important to keep these diseases in the differential diagnosis, especially when there is incongruence between imaging and the clinical picture, as earlier detection correlates to a stronger therapeutic response.

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KW - CNS lymphoma

KW - Lymphoma

KW - Marginal zone

KW - Subdural hematoma mimic

KW - Subdural space

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