Bing-Neel syndrome mimicking a meningioma.

A 42-year-old woman presented with progressively worsening right occipital headaches, increased with Valsalva. Brain MRI revealed an enhancing right tentorial leaflet extra-axial mass with adjacent vasogenic edema, which was presumed to be a meningioma (figure). A subtotal resection of the mass was performed and demonstrated pathologic features compatible with lymphoplasmacytic lymphoma (Bing-Neel syndrome), subsequently treated with ibrutinib. Bing-Neel syndrome is a very rare complication of Waldenstrom macroglobulinemia that is characterized by CNS involvement by malignant lymphoplasmacytic cells.1,2 The most common imaging features are leptomeningeal or dural infiltration or localized tumoral form with parenchymal involvement.1,2