Elsevier

Surgical Neurology

Volume 58, Issues 3–4, September–October 2002, Pages 246-250
Surgical Neurology

Primary B-cell lymphoma of the clivus: Case report

https://doi.org/10.1016/S0090-3019(02)00845-5Get rights and content

Abstract

BACKGROUND

Lymphomas usually present in extranodal sites late in the course of the disease. Moreover, it is uncommon for a primary non-Hodgkin’s lymphoma to present with cranial nerve palsies; reports in the literature are rare.

CASE DESCRIPTION

We report the case of a 60-year-old woman with complaints of headache and double vision. MRI revealed an expansive clival lesion without pituitary invasion. An endoscopic transsphenoidal procedure was performed for diagnosis and partial resection of the mass.

CONCLUSION

Primary diffuse large B-cell lymphoma of the clivus is rare. An endoscopic transsphenoidal approach to the skull base is described, along with characteristic clinical, radiologic, and pathologic findings of the lesions.

Section snippets

Case report

A 60-year-old woman with persistent headaches for 2 months presented to the Emergency Department complaining of sudden onset of double vision while driving. The visual defect initially occurred only on left lateral gaze, but rapidly progressed to a constant state. Covering one eye relieved the patient’s visual symptoms. The headaches had been treated with antibiotics because a computed tomography (CT) scan showed possible sphenoid sinusitis. Medical history included a functional endoscopic

Discussion

Diffuse large B-cell lymphoma may occur at any age, but the peak incidence is in the 60s. Patients often present with a rapidly enlarging symptomatic mass at a single node or at an extranodal site. Common sites in the head and neck include Waldeyers ring, salivary glands, nasal cavity, paranasal sinuses, thyroid gland, and orbit [14]. Involvement of the bone marrow is usually late in the course of the disease.

If left untreated, diffuse B-cell lymphomas are rapidly fatal because of their

Conclusion

Diffuse large B-cell lymphoma of the clivus is an uncommon condition, and the primary clival location of the lymphoma without any other nodal site is also rare. An endoscopic transsphenoidal approach to the skull base is described along with characteristic clinical, radiologic, and pathologic findings of the lesions. When patients present with persistent headaches and diplopia, space-occupying lesions of the sella should be considered.

References (14)

  • P.U. Freda et al.

    Advances in pituitary tumor therapydifferential diagnosis of sellar masses

    Endocrinol Metab Clin

    (1999)
  • C.A. Allan et al.

    Pituitary chondrosarcomaan unusual case of a sellar mass presenting as pituitary adenoma

    J Clin Endocrinol Metab

    (2001)
  • M. Breidert et al.

    Diabetes insipidus in a patient with a highly malignant b-cell lymphoma and stomatitis

    Exp Clin Endocrinol Diabetes

    (2000)
  • J.P. Crapanzano et al.

    Chordomaa cytologic study with histologic and radiologic correlation

    Cancer

    (2001)
  • R.B. Erlich et al.

    Primary lymphoma of the skull presenting as multiple cranial nerve palsies

    Leuk Lymphoma

    (1996)
  • P.U. Freda et al.

    Extensive personal experienceunusual causes of sellar/parasellar masses in a large transsphenoidal surgical series

    J Clin Endocrinol Metab

    (1996)
  • J.P. Greer et al.

    Non-Hodgkin lymphomas

There are more references available in the full text version of this article.

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