Primary Cranial Vault Lymphoma Misdiagnosed as Atypical Meningioma: A Case Report

Primary non-Hodgkin's lymphoma of the bone is an unusual presentation of Hodgkin's lymphoma, with primary cranial vault lymphoma (PCVL) being the rarest of bone lymphomas. We describe a case of an immunocompetent elderly patient with new onset gait imbalance and cognitive delays. Brain imaging showed a large extra-axial mass with osseous invasion. An initial misdiagnosis of meningioma led to delays in management. Further work up included a brain magnetic resonance image showing a large right transcalvarial parietal mass. The mass was surgically removed, and pathology revealed B-cell lymphoma with low-grade features thus establishing the diagnosis of PCVL. Management included subtotal resection of the tumor followed by adjuvant radiation therapy. The patient has achieved a durable response for over a year. Meningioma and PCVL have similar imaging and clinical presentations. This case report addresses differing features of the tumors and explores therapeutic options for management of PCVL.