Role of Ultrasound in a Rare Case of Primary Lymphoma of the Cranial Vault
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IMAGING
Role of Ultrasound in a Rare Case of Primary Lymphoma of the Cranial Vault Renato Farina 1
&
Francesco Aldo Iannace 1 & Andrea Conti 1 & Pietro Valerio Foti 1 & Corrado Inì 1 & Antonio Basile 1
Accepted: 7 October 2020 # Springer Nature Switzerland AG 2020
Abstract The primary lymphoma of the skull is very rare. We describe a case of a 48-year-old woman with a palpable, soft, painless swelling of the soft tissues of the right frontal region, in absence of neurological symptoms. The ultrasonography showed the presence of solid, very vascularized, subcutaneous, and intra-thecal tissue and bone erosion of the internal and external cranial theca. A CT scan of the skull, thorax, and abdomen was performed to exclude further manifestations of the disease and an MRI examination of the brain to exclude involvement of the intracranial structures. CT and MRI confirmed the presence of the intrathecal and extra-thecal mass that infiltrated the external and internal cranial theca, the scalp, and the epidural region without infiltration of the cerebral cortex. The patient underwent mass removal surgery and histological analysis, which allowed the diagnosis of non-Hodgkin B cell lymphoma. Keywords Ultrasound . Color Doppler . Cranial vault . Primary bone lymphoma
Introduction Non-Hodgkin lymphomas of the skull are infrequent and generally secondary. A primary bone localization is rare [1, 2], especially in the skull [3]; only 37 cases have been reported in the literature [4, 5]. The word primary refers to a lymphoma which has not spread from other locations; it must not be detectable in the bone marrow biopsy; in the end, it must not be found elsewhere in the body within 6 months from the time of initial diagnosis [6].
Clinical Symptoms Generally, the onset is asymptomatic, and the patient only shows the appearance of a soft and painless swelling of the scalp. The This article is part of the Topical Collection on Imaging Electronic supplementary material The online version of this article (https://doi.org/10.1007/s42399-020-00577-6) contains supplementary material, which is available to authorized users. * Renato Farina [email protected]
symptomatology is linked to the intracranial extension of the mass which can infiltrate the epidural and subdural region and rarely the cerebral cortex, causing neurological symptoms.
Methods of Imaging Examination Ultrasonography is the first imaging examination to be performed. It allows to assess the subcutaneous soft tissues and to detect bony erosions. CT allows us to study the tumor mass, focusing the bone erosion, and can also exclude the spreading of the disease. MRI is performed to study the neoplastic mass and its relationship with intracranial structures. The integration between the aforementioned methods guarantees a complete diagnostic framework of the disease.
Differential Diagnosis The differential diagnosis includes other skull tumors such as metastatic carcinoma [7], osteomyelitis [8], granuloma [9], plasmacytoma [10], meningioma [11], anaplastic meningioma [12
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