Gotoh M, Tsuno K, Handa A, Nishiura T, Ishimitsu H, Nishida A
Department of Neurological Surgery, Iwakuni National Hospital, 2-5-1 Kuroiso-cho, Iwakuni 740-8510, Japan.
No Shinkei Geka. 2001 Mar;29(3):259-64.
The authors report the case of a 54-year-old male with extraaxial primary malignant lymphoma associated with calcified chronic subdural hematoma. He slowly developed progressive headache accompanied by a bulge in the left forehead. Skull radiogram showed a large biconvex calcification in the left frontoparietal region, with concave change in the overlying bone. Computed tomograms and magnetic resonance images revealed a left frontoparietal chronic subdural hematoma surrounded by a calcified rim, with marginal enhancement in the frontal portion extending upward to the subcutaneous tissue through the underlying bone. The lesion was suspected to be an infectious calcified hematoma. The patient underwent a craniotomy for the removal of the hematoma. It was observed that the tumor was located mainly in the epidural and subdural space. The extent of the tumor corresponded with the enhanced area of the lesion in the preoperative neuroimages. The histological diagnosis was malignant lymphoma of B cell origin. General examination, which included bone marrow study and Ga scintigraphy, failed to prove systemic lymphoma. Extraaxial primary malignant lymphoma is extremely rare, and this is the first report of a lymphoma associated with calcified chronic subdural hematoma. The authors review the literature and discuss the clinical features and the pathogenesis of the lesion.
作者报告了一例54岁男性患者,患有与钙化性慢性硬膜下血肿相关的轴外原发性恶性淋巴瘤。他逐渐出现进行性头痛,并伴有左前额隆起。颅骨X线片显示左额顶叶区域有一个大的双凸形钙化,其上覆骨质有凹陷改变。计算机断层扫描和磁共振成像显示左额顶叶慢性硬膜下血肿被钙化边缘包绕,额叶部分边缘强化,通过下方骨质向上延伸至皮下组织。该病变被怀疑为感染性钙化血肿。患者接受了开颅血肿清除术。术中观察到肿瘤主要位于硬膜外和硬膜下间隙。肿瘤范围与术前神经影像中病变的强化区域相符。组织学诊断为B细胞起源的恶性淋巴瘤。包括骨髓检查和镓闪烁扫描在内的全身检查未能证实存在系统性淋巴瘤。轴外原发性恶性淋巴瘤极为罕见,这是首例与钙化性慢性硬膜下血肿相关的淋巴瘤报告。作者回顾了文献并讨论了该病变的临床特征和发病机制。