Dural-Based Follicular Lymphoma Mimicking Meningioma With Favorable Response To Chemotherapy

A 51-year-old female with history of stage IV Follicular Lymphoma (FL) initially placed on surveillance imaging for two years, started developing progressively worsening left-sided headache, jaw pain, and ear fullness. Physical examination revealed no focal neurological deficits. Magnetic Resonance Imaging (MRI) of the brain with gadolinium showed the presence of homogenously enhancing dural-based lesions arising from the bilateral medial aspect of the middle cranial fossae, left greater than right with mass effect over the left inferomedial aspect of the temporal lobe (Figure 1 A, B). These dura-based lesions were concerning for either meningioma versus possible lymphomatous involvement with intracranial extension of her FL. Neither cerebrospinal fluid analysis nor dural biopsy were obtained at that time. Nevertheless, given the concern for progression of her FL, she received six cycles of bendamustine and rituximab with almost complete resolution of her headaches following the first cycle of treatment. The patient was then placed on maintenance rituximab monotherapy for an additional 18 months and had an updated systemic imaging along with MRI of the brain with gadolinium following the completion of her treatment revealing no evidence of lymphadenopathy and complete resolution of her dural-based lesions, respectively (Figure 1 C, D), suggesting that these dural lesions were most likely related to lymphomatous infiltration from her FL with overall favorable response to chemotherapy.