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Bulky centroblastic non‐Hodgkin's lymphoma of the cranium vault mimicking brain involvement managed with chemotherapy. A case report
Author(s) -
Landys Karl E.,
Berg Gertrud E. B.,
Torgerson Jarl SSon,
Klingenstierna Hans A. G.,
Ridell Börje S.,
Johansson Bengt R.
Publication year - 1995
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19951001)76:7<1261::aid-cncr2820760725>3.0.co;2-h
Subject(s) - medicine , vincristine , chemotherapy , cranial vault , lymphoma , surgery , prednisone , cyclophosphamide , scalp , methotrexate , radiology , pathology , skull
Background . Patients with central nervous system (CNS) involvement by high grade non‐Hodgkin's lymphoma (NHL) have a poor prognosis. The roles of computed tomography, radiotherapy, and intrathecal and systemic chemotherapy still need to be defined. Methods . A patient with bulky cranial lymphoma mimicking brain involvement is reported. A 62‐year‐old man was admitted with a huge scalp lump, headache, fatigue, and focal and generalized neurologic symptoms. Computed tomography showed an abnormal mass in the frontoparietal region involving the subcutaneous scalp, osteolytic destruction of the cranial vault, and a bulky mass that was interpreted to be intracranial. A systemic survey also revealed bulky retroperitoneal involvement and focal involvement of the spleen. Biopsy revealed a B‐cell NHL of centroblastic type according to the Kiel classification. Results . The patient was treated with a modified combination of cyclophosphamide plus mitoxantrone plus vincristine plus prednisone (CNOP) and intrathecal methotrexate. The patient responded with complete remission, including partial bone restoration of the cranium. At the time of this writing, his relapse free survival lasted 5 years. Conclusions . The initial interpretation of this case indicated that systemic chemotherapy with modified CNOP plus intrathecal methotrexate would be useful in the management of NHL with CNS involvement. The clinical outcome with rapid neurologic repair and also bone restoration of the cranial vault within 5 years suggests that the lymphoma probably never penetrated the dura and a successful treatment was achieved with combination chemotherapy only.