Primary Diffuse Large B-Cell Lymphoma (DLBCL) of the Cranial Vault with Epidural Lesion: A Case Report

Background Primary diffuse large B-cell lymphoma (DLBCL) of the cranial vault is an extremely rare extranodal lymphoma. Lesions may extend through the calvarium and attach to the dura without systemic dissemination, often mimicking meningioma or plasmacytoma on imaging. Because of this overlap, diagnosis before surgery may be challenging. Case Description We report a 69-year-old male patient presenting with two subcutaneous scalp lesions overlying the cranial vault. Imaging with CT and MRI scan revealed an infiltration of the underlying bone with an epidural lesion, which was surgically removed, due to its radiological resemblance to meningioma. We performed craniotomy and cranioplasty at the same time. Histopathological and immunohistochemical analysis confirmed a diagnosis of DLBCL-NOS. In the postsurgical period, the patient received chemotherapy. At the time of reporting, the patient is completing the fourth cycle of R-CHOP and remains clinically stable without systemic disease. Conclusion Primary cranial vault DLBCL with epidural lesion is a rare diagnostic challenge in neurosurgical practice. It can mimic benign or metastatic skull lesions on imaging. Surgical excision or biopsy is essential for definitive diagnosis, and once lymphoma is confirmed, prompt systemic chemotherapy is the treatment of choice.