title: [A Case of Primary Dural Lymphoma of Jugular Tubercle Mimicking Lower Clival Meningioma].
abstract: Primary dural lymphoma (PDL) is a rare type of primary central nervous system lymphoma (PCNSL); however, its clinical etiology and appearance on magnetic resonance images (MRI) are similar to those of meningioma. We report a case of PDL mimicking a meningioma in the jugular tubercle, with hemiparesis and double vision, and review the published PDL case reports. A 41-year-old woman experienced numbness on her right side, and reported right hemiparesis and double vision 2 days thereafter. Her cranial computed tomography (CT) scan showed a mass lesion in the posterior fossa, and contrasted MRI revealed homogenous tumor with a dural tail sign in the left jugular tubercle. The patient was diagnosed as having jugular tubercle meningioma. However, her symptoms disappeared promptly with the injection of dexamethasone, and follow-up MRI showed that the tumor had diminished. After 9 months, her double vision recurred and MRI results indicated tumor regrowth. She underwent sub-total resection of the tumor via the left trans-condylar fossa approach. A histological diagnosis was PDL. She was treated with 3 courses of high-dose methotrexate, and subsequent MRI results showed a partial reduction of the residual tumor. PDL is histologically associated with marginal zone lymphoma (MZL), and is sensitive to radiation and chemotherapy. This patient responded well to high-dose methotrexate alone. PDL is one of the important differential diagnoses of meningioma.
authors.affiliation: Department of Neurosurgery, Chiba Central Medical Center.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
authors.forename: Motoki
authors.initials: M
authors.lastname: Sato
authors.forename: Ken
authors.initials: K
authors.lastname: Kado
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Fukuda
authors.forename: Takao
authors.initials: T
authors.lastname: Nakamura
authors.forename: Iwao
authors.initials: I
authors.lastname: Yamakami
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Iwadate
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000175:diagnosis*; D008579:Meningioma / Q000175:diagnosis*; D064847:Multimodal Imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome