Primary Hematolymphoid Lesions of the Meninges: A Clinicopathologic Study of 9 Cases Presenting as Mimics of Meningioma.
Charles B Hutchinson, Imran Siddiqi, Patrick Buckley, Anne Buckley, Endi Wang. Duke University Medical Center, Durham, NC
Background: Primary hematolymphoid lesions of the meninges are rare and only a few cases have been reported in the English literature. We report our experience with primary meningeal hematolymphoid neoplasms and review their clinicopathologic spectrum.
Design: 9 primary meningeal hematolymphoid lesions were identified in our database from 2000-2010. The histopathologic features were reviewed along with clinical, laboratory and imaging data. Primary meningeal lesions were defined as those with meningeal association by imaging or histology and no prior diagnosis of lymphoma or leukemia.
Results: Of 9 cases reviewed, the patient ages ranged from 30 to 59 years old (mean 40 years) and males predominated [5:4]. All cases except one were non-Hodgkin lymphoma (NHL). Subtypes of NHL included 4 cases of diffuse large B-cell lymphoma (DLBL), 3 cases of marginal zone lymphoma (MALT) and 1 case of Burkitt-like lymphoma. The remaining case was Castleman's disease, plasma cell variant, which arose in the setting of panhypopituitarism. 8 cases presented with imaging studies mimicking meningioma, while one case (DLBL) presented with imaging which resembled discitis. None of cases were associated with prior or subsequent central nervous system (CNS) neoplasms. One case (MALT) had prior chemotherapy and radiation for glassy cell carcinoma of the uterine cervix. One case (Burkitt-like lymphoma) had a prior CNS abnormality (Chiari malformation).
Conclusions: The most common diagnoses were DLBL and MALT lymphoma. 1 case was associated with prior chemotherapy and radiation suggesting a therapy-related pathogenesis. In 8 cases, pre-operative imaging was consistent with meningioma and the remaining case had imaging consistent with discitis. Follow up is available for 3 patients. 2 cases with DLBL are alive at 1.75 and 2 years with no recurrence. 1 case of MALT, which was status post renal transplant, is alive at 1 year with no recurrence. These data highlight that hematolymphoid lesions may arise primary to the meninges and often mimic meningioma by clinical and imaging studies.
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 242, Tuesday Afternoon