Objective: Hematological malignancy presenting primarily with central nervous system (CNS) manifestations is rare and often portends a worse prognosis. The aim of this study is to report the spectrum of hematological malignancies presenting primarily with CNS symptoms. Materials and Methods: All histologically verified hematological malignancies involving CNS from January 2016 to December 2018 were included. The presence of lymphadenopathy, organomegaly, and bone marrow (BM) examination results was recorded to rule out a spread from systemic disease. The diagnosis was aided by special stains (reticulin) and immunohistochemistry (IHC) as appropriate. Antibodies used were CD20, CD3, CD10, Bcl 2, Bcl 6, MUM 1, CD138, CD68, MPO, PCK, and Ki67. The Hans algorithm was used to classify diffuse large B cell lymphoma (DLBCL) into germinal center B-cell (GCB) and non-GCB types. Results: During the study period, 18 DLBCLs, 4 plasmacytomas, and 3 myeloid sarcomas (MSs) were diagnosed. DLBCLs included 16 primary central nervous system lymphomas (PCNSLs) and 2 systemic lymphomas with evidence of lymphadenopathy. PCNSLs had male predominance and a mean of 46 (14–67) years. Frontal lobe was the most common location. Seven (70%) PCNSLs were non-GCB type and 3 (30%) were GCB type. One was a primary spinal T cell/histiocyte-rich large B cell lymphoma (a variant of DLBCL). Two were diagnosed as corticoid-mitigated lymphoma. One of the three MS cases had acute myeloid leukemia on BM examination and the rest two were isolated spinal masses with normal BM study. There were four spinal plasmacytomas, presenting with cord compression. Conclusion: Primary CNS presentation of hematological malignancies requires a high index of suspicion clinically and radiologically, and diagnosis requires IHC for proper classification.

Patients with brain metastasis survival has been improved due to better diagnostic and treatment approaches. Quality of life is a major concern for these subset of patients. Seahorse of brain “Hippocampus” is the structure which plays a major role in cognitive functions which can be further alter the quality of life of these patients. Hippocampus sparing whole brain external beam radiotherapy in brain secondaries with simultaneously respecting the doses to the target volumes can be considered a novel approach for acceptable quality of life in these patients.

Context: Distant metastasis is a rare, primary manifestation of follicular carcinoma of the thyroid. Case Report: We report a case of a 72-year-old woman presenting with a solid mass located in the left parieto-occipital region. The 3D computed tomography (CT) showed a large solid mass supplied by branches of the external carotid artery. After magnetic resonance imaging, a probable diagnosis of meningioma was made. The patient underwent surgery where a soft mass invading the superior sagittal sinus was encountered and resected. Histological examination revealed a thyroid follicular neoplasm with positive staining for thyroglobulin and thyroid transcription factor I on immunohistochemical analysis. Postoperatively, levels of thyroid hormones were normal. Subsequent ultrasonogram revealed a nodule in the thyroid gland, which on fine needle aspiration cytology was diagnosed as a follicular neoplasm. Treatment was planned for the thyroid gland, the patient receiving chemotherapy including sorafenib. Conclusions: The present case emphasizes that although they are uncommon, dural metastasis can be mistaken for meningiomas. Confirmation of diagnosis as meningioma should be established only after the histopathological analysis. Thyroid follicular carcinoma should be included in the differential diagnosis in cases of extrinsic tumoral lesions.

Inflammatory pseudotumors (IPs) encompass a wide spectrum of pathological entities of varying nomenclatures such as plasma cell granuloma, xanthomatous pseudotumor, and hypertrophic pachymeningitis. Majority of them are of uncertain etiology. Such tumor-mimicking lesions have been described in the lungs, liver, peritoneum, and retroperitoneal spaces. Primary convexity meningeal occurrence without intracerebral extension or extracranial presence is uncommon. We present one such rare case of a 50-year-old woman having a convexity primary meningeal IP with a 4-year follow-up post-excision.Radiology of IP may be nonspecific and pathological diagnosis is necessary in most cases to rule out meningeal neoplasms or infections, autoimmune/vasculitic, and other unusual mimics. Although surgical excision is warranted, complete resection may not be necessary if the frozen report is diagnostic. The differential diagnosis and treatment options are discussed further and a flowchart is provided depicting the meningeal tumor mimics.

Giant cell tumors arising from the skull base are rare. We present a case of a giant cell tumor arising from clivus, which was managed by surgery, radiotherapy, and denosumab therapy.

Primary CNS lymphoma (PCNSL) is a rare variant of extranodal non-Hodgkin’s lymphoma and accounts for 3%–5% of all primary brain tumors. Their intraventricular location is extremely rare with only a few cases on record so far. All the reported cases showed bilateral ventricular involvement. We report the first case of unilateral lateral ventricle PCNL in a 22-year-old female who presented with intractable vomiting and headaches. Computed tomography (CT) followed by magnetic resonance imaging (MRI) revealed lobulated altered signal intensity lesion in the left temporal horn of lateral ventricle with surrounding peritumoral edema causing midline shift. With these imaging features, the diagnosis of intraventricular meningioma was suggested. Microscopic examination of the excised mass revealed round-to-ovoid tumor cells with scant eosinophilic cytoplasm with large and hyperchromatic nuclei, prominent nucleoli, irregular nuclear membrane, and frequent mitotic figures. The tumor cells are positive for leukocyte common antigen, CD20, CD10, CD43; and were negative for CD3, synaptophysin, chromagranin, pan-cytokeratin (pan-CK), Epstein-Barr virus (EBV), and glial fibrillary acidic protein. The Ki-67 was very high (80%). With these histopathological and immunohistochemistry (IHC) findings, diagnosis of NHL of diffuse large B cell type was rendered.