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Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Neurol Neurosurg Psychiatry. 2007 July; 78(7): 769.
PMCID: PMC2117709

Massive transcalvarial lymphoma

A 76‐year‐old woman presented with a 2 week history of left‐sided hemiparesis thought to be caused by a stroke, and a progressively enlarging lump on the back of her head which was thought to be a haematoma. Subsequent scans showed the lesion to extend intracranially (fig 11),), with involvement of the intervening bone (fig 22).

figure jn110239.f1
Figure 1 Enhanced axial CT scan showing the tumour on both sides of the calvarium.
figure jn110239.f2
Figure 2 Bone window axial CT showing the extent of the bone erosion.

Her hemiparesis improved with steroids but her mobility did not. MRI showed the extent of intracranial invasion ((figsfigs 3–5). Biopsy of the extracranial portion revealed a soft yellow tumour of moderate vascularity, and histology showed it to be a diffuse large B cell lymphoma Further investigation revealed no evidence of disease in the rest of the body: bone marrow trephine was unremarkable and she was HIV negative.

figure jn110239.f3
Figure 3 Axial T2 weighted MRI showing the intracranial and extracranial extent of the tumour.
figure jn110239.f4
Figure 4 Enhanced coronal T1 weighted MRI.
figure jn110239.f5
Figure 5 Sagittal T1 weighted MRI.


Although transcalvarial lymphoma is a recognised phenomenon,1,2,3,4,5 this case is unique because of the size of the lesion. It is impossible to determine whether the lymphoma arose from the brain or from the calvarial bone—all previous reports describe primary bone disease spreading into the brain.

Primary cerebral lymphoma accounts for 1% of intracranial neoplasms and the incidence has increased in recent decades as a result of immunosuppression caused by AIDS and following organ transplantation. The vast majority of tumours are monoclonal B cell non‐Hodgkin's lymphomas with an exceptionally small proportion of true T cell lymphomas; primary Hodgkin's lymphoma of the central nervous system is almost never seen.

She received radiotherapy but there was no response. Unfortunately, she developed a severe chest infection and died 2 weeks after starting radiotherapy. A post mortem was not performed.


Competing interests: None.


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3. Parekh H, Sharma R, Keogh A. et al Primary malignant non‐Hodgkin's lymphoma of cranial vault: a case report. Surg Neurol 1993. 39286–289.289 [PubMed]
4. Kantarci M, Erdem T, Alper F. et al Imaging characteristics of diffuse primary cutaneous B‐cell lymphoma of the cranial vault with orbital and brain invasion. AJNR Am J Neuroradiol 2003. 241324–1326.1326 [PubMed]
5. Bhatia S, Smally A, Dekker P. Primary non‐Hodgkin's lymphoma of the cranial vault. Clin Oncol (R Coll Radiol) 1997. 9195–196.196 [PubMed]

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