MALT lymphoma (dura)

MALT lymphoma of the dura (also known as primary dural lymphoma), a subset of primary leptomeningeal lymphoma, is rare, accounting for a very small proportion of CNS lymphoma and and even smaller proportion of dural masses.

They are, unlike other CNS lymphomas, related to mucosa-associated lymphoid tissue (MALT), and as a result have an indolent course and far better prognosis. On imaging, they are difficult to diagnoses pre-operatively as primary dural lymphomas share many similarities with meningiomas which are vastly more frequent.

Primary dural lymphoma are most often encountered in middle aged individuals, more commonly in females. They account for < 1% of all CNS lymphoma 1

Presentation is usually indolent with symptoms related to mass effect, without features helpful in distinguishing them from meningiomas 1

Unlike other PCNSL lymphomas which are usually of non-Hodgkin B-cell lineage, primary dural lymphomas tend to arise from mucosa-associated lymphoid tissue (MALT), although how and why this is so remains unclear 1 (see MALT lymphoma for a general discussion).

Primary dural lymphoma shares imaging features with other small round blue cell tumours, and other dural masses. These tumours present as a extra-axial lobulated masses, that may be either solitary or multiple, and are difficult to distinguish from meningiomas. 

CT

Due to high cellularity, these tumours are typically hyperdense (as are other CNS lymphomas) 1. They generally enhance vividly. 

MRI
  • T1: isodense to grey matter
  • T1 C+
    • vivid enhancement (usually homogeneous)
    • brain tumour interface may be indistinct
  • T2
    • iso to hypodense to grey matter
    • oedema common in adjacent brain
  • DWI/ADC: restricted diffusion

Primary dural lymphomas are non-aggressive and patients have excellent outcomes regardless of treatment 1

The differential diagnosis is essentially that of other dural masses, including: 


Lymphoma
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Article Information

rID: 32688
Section: Pathology
Tags: refs, cases
Synonyms or Alternate Spellings:
  • Primary dural lymphomas
  • Primary dural lymphoma

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