title: Mantle Cell Lymphoma with Central Nervous System Involvement Simulating Bilateral Subdural Hematomas.
abstract: We describe a 71-year-old-patient receiving antiplatelet therapy and being attended by emergency medical services for psychomotor retardation and gait disturbance. An emergency computed tomographic scan showed a bilateral subacute hematoma. The patient reported a fall 2 weeks earlier. We performed bilateral drills and saw a solid mass that was biopsied. The patient had a history of mantle cell lymphoma (MCL) in complete remission (results of bone marrow biopsy and whole-body positron emission tomography-computed tomography scans were normal 6 months earlier). We diagnosed an intracranial MCL by immunohistochemistry, flow cytometry, and fluorescence in situ hybridization. We performed magnetic resonance imaging. The results of a new bone marrow biopsy were positive for recurrence of MCL. MCL constitutes approximately 5%-6% of non-Hodgkin lymphoma. The incidence of central nervous system (CNS) involvement between MCLs is 4.1%. After a review of the literatures we found small series comprising 3-5 cases and a multicenter study with 57 cases. Until now, the median survival was 3.7 months. Ibrutinib, an oral Bruton tyrosine kinase inhibitor, has demonstrated efficacy and CNS penetration in relapsed or refractory MCL with rapid and complete response even after 1 year of follow-up. Our patient received ibrutinib and had a complete response at 3 months, which was maintained to the present (6 months). After a review of the literature, we found different pathologies that can mimic subdural hematomas. However, this is the first report of a lymphoma with CNS involvement mimicking bilateral subdural hematomas. This report contributes to the knowledge of lymphomas with CNS involvement. Its strange radiographic appearance and histologic type make it unique.
authors.affiliation: Department of Neurosurgery, Hospital General Universitario de Castellón, Castellón, Spain. Electronic address: luisgermangb@hotmail.com.
authors.forename: Luis Germán
authors.initials: LG
authors.lastname: González-Bonet
authors.affiliation: Department of Hematology, Hospital General Universitario de Castellón, Castellón, Spain.
authors.forename: Raimundo
authors.initials: R
authors.lastname: García-Boyero
authors.affiliation: Department of Pathology, Hospital General Universitario de Castellón, Castellón, Spain.
authors.forename: John
authors.initials: J
authors.lastname: Gaona-Morales
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D003937:Diagnosis, Differential; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging*; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D020522:Lymphoma, Mantle-Cell / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D008279:Magnetic Resonance Imaging; D010880:Piperidines; D011720:Pyrazoles / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D010880:Piperidines; D011720:Pyrazoles; D011743:Pyrimidines; C551803:ibrutinib; D000225:Adenine
keywords: Central nervous system; Mantle cell lymphoma; Subdural hematoma