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A case of hodgkin's disease complicated by a meningioma presenting with punched out lesions on skull x ray

A case of hodgkin's disease complicated by a meningioma presenting with punched out lesions on skull x ray

Journal of Osaka Medical College 47(2): 51-56, 62

A 56-year-old man was diagnosed as having Hodgkin's disease (Stage III) in May, 1984, and was progressing favorably with COPP therapy. Subsequently he developed diplopia and frontal and posterior cervical pain. He was admitted to the Department of Neurosurgery of our hospital in January, 1985, for evaluation and treatment. Examination on admission revealed signs of cranial nerve involvement (VI, IX, X and XII), with restricted neck movements. Skull X-ray demonstrated multiple punched-out lesions, forward displacement of C1 and C2, and destruction of the clivus. Brain CT demonstrated areas of demineralization around the clivus and a tumor showing contrast enhancement in the same region. Initial steroid therapy failed to ameliorate the symptoms of cranial nerve involvement; COPP therapy was ineffective, and the patient died. At autopsy the lungs, liver, spleen and kidneys were found to be infiltrated with Hodgkin's cells, and there were pulmonary edema, right-sided adhesive pleuritis, fibrous pericarditis, a meningioma of the right side of the clivus, local thinning of the cranium, and Pneumocystitis carinii pneumonitis. The concurrence of a meningioma producing punched-out bone lesions in association with Hodgkin's disease, as in the present case, is a rarity that deserves particular mention.

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