Dural MALT lymphoma with disseminated disease

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Kelly S. Matmati
Nabil Matmati
Yusuf A. Hannun
Zoran Rumboldt
Sunil Patel
John Lazarchick
Robert Stuart
Pierre Giglio *
(*) Corresponding Author:
Pierre Giglio | giglio@musc.edu

Abstract

Central nervous system (CNS) lymphoma involving the dura mater is very rare and histologically is usually a subtype of non-Hodgkin’s lymphoma (NHL) termed mucosa-associated lymphoid tissue (MALT) lymphoma. We present a case of a 46-year old woman with dural MALT lymphoma that was found to also involve a lacrimal gland, inguinal lymph nodes, and bone marrow. Magnetic resonance imaging of the brain showed an extra-axial enhancing mass approximately 6 cm in maximum diameter along the right frontotemporal convexity. Histopathology of the resected dural mass showed MALT lymphoma expressing CD20, CD52, CD19, and CD38. Molecular studies of the B-cell receptor heavy chain demonstrated monoclonality at the involved sites. The patient was treated with four cycles of fludarabine, mitoxantrone, and rituximab with complete remission. She had recurrence in the subcutaneous tissue of the back at 12 months but has remained free of intracranial disease for 31 months. A review of the literature reveals 57 cases of dural MALT lymphoma. Only 4 had extra-CNS involvement at presentation, and only 3 had local recurrence of the dural tumor. Because of the indolent behavior of this tumor, the intracranial portion can be treated conservatively after resection with or without chemotherapy. Deferral of brain radiation can be considered with close clinical and neuroimaging follow up.

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Author Biographies

Kelly S. Matmati, MUSC

Department of Neurosciences, Medical University of South Carolina, Charleston, SC.  Resident Physician

Nabil Matmati, MUSC

Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC.  Postdoctoral fellow.

Yusuf A. Hannun, MUSC

Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC.  Professor

Zoran Rumboldt, MUSC

Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.  Professor

Sunil Patel, MUSC

Department of Neurosciences, Medical University of South Carolina, Charleston, SC.  Professor.

John Lazarchick, MUSC

Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC.  Professor.

Robert Stuart, MUSC

Department of Medicine (Hematology/Oncology Division), Medical University of South Carolina, Charleston, SC.  Professor.

Pierre Giglio, MUSC

Department of Neurosciences, Medical University of South Carolina, Charleston, SC.  Associate Professor