STAGE IE NON-HODGKINS-LYMPHOMA INVOLVING THE DURA - A CLINICOPATHOLOGICAL STUDY OF 5 CASES

Objective and Design.-Non-Hodgkin's lymphomas rarely present as a loca lized mass involving the dura. In this report we describe the clinical , histologic, and immunohistochemical features of five cases of stage IF non-Hodgkin's lymphoma involving the dura. Patients.-Four women and one man, 36 to 67 years of age (median, 50.6 years). Results.-Myelogr aphy and magnetic resonance imaging scans revealed discrete expansile masses involving the dura of the cervical, thoracic, and lumbar region s of the spinal cord and the frontal lobe of the brain. Histologically , the tumors were classified in the Working Formulation as small lymph ocytic (2), diffuse large cell (2), and large cell immunoblastic (1) ( anaplastic large cell lymphoma). Four tumors were of B-cell lineage an d the anaplastic large-cell lymphoma was of T-cell lineage. The two sm all lymphocytic neoplasms had immunoglobulin heavy-chain gene rearrang ements as shown by either Southern blot hybridization or the polymeras e chain reaction. Four patients underwent decompression laminectomy; t hree received spinal radiation; two received chemotherapy (one intrath ecal, one systemic) for lymphocytosis of the cerebrospinal fluid. The dural mass overlying the frontal lobe was excised and focally irradiat ed. Clinical follow-up was available for all patients. Four patients w ere alive 12 to 40 months after diagnosis and showed no evidence of re current or disseminated disease. The patient with anaplastic large-cel l lymphoma died 10 days after laminectomy, secondary to pulmonary thro mboemboli. Conclusions.-We conclude that non-Hodgkin's lymphomas of va ried histologic types and of either B- or T-cell lineage may rarely pr esent as a stage IF dural mass. These lesions appear to have a good in itial response to treatment; however, longer clinical follow-up is nec essary to assess the incidence of relapse and final outcome.