Intracranial primary dural diffuse large B-cell lymphoma successfully treated with chemotherapy

Diffuse large B-cell lymphoma (DLBCL) presented as a primary dural lesion is an extremely rare entity, which may be misdiagnosed as meningioma. Patients with symptomatic meningioma are usually treated with tumor resection. The five previously described cases of intracranial dural DLBCL were treated with surgery followed by chemotherapy and/or radiotherapy, with a favorable outcome, but with potential sequels. We reported the first case of DLBCL, presented as a primary dural lesion, successfully treated with chemotherapy only in a 52-year-old woman presented in October 2011 with rapidly progressive headaches, nausea and vomiting. Magnetic resonance imaging of the brain and head computed tomography showed a lesion en plaque in the right parieto-occipital region, tracking the dura matter, and osteolytic lesions. The patient underwent an open tumor biopsy, and the diagnosis of DLBCL was established. The patient received dexamethasone, cisplatin and cytarabine (DHAP) followed by methotrexate plus cytarabine, and obtained a durable complete response. Thus, intracranial dural DLBCL must be considered in differential diagnosis of meningeal lesions, particularly when a rapid progression of symptoms and osteolytic lesions are present, because an early diagnosis and rapid initiation of treatment, even though with chemotherapy, is associated with favorable outcome.