Presentation
Progressively growing scalp tumor for more than 5 years. HIV positive but not on treatment.
Patient Data
Large lobulated soft tissue mass most likely arising from the scalp, demonstrates homogenous diffusion restriction and heterogenous enhancement, infiltrating the parietal bone with a large intracranial extension and mass effect, engulfing and narrowing a long segment of the superior sagittal sinus with resultant signs of intracranial hypertension.
The imaging differential considerations were extra-nodal lymphoma, soft tissue sarcoma, and squamous cell carcinoma of the scalp.
Case Discussion
Extranodal lymphomas are rare and scalp lymphomas are extremely rare. This was histopathology proven diffuse large B-cell non Hodgkin lymphoma (germinal center phenotype). Further work up with CT chest abdomen and pelvis for metastasis or possible primary nodal disease, found no other nodal or solid organ disease. Diffuse large B-cell lymphoma are associated with immunodeficiency, as in this case.
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