Four Lessons in Transcranial Lesions

Abstract

Background Lesions involving the skull are rare and often discovered incidentally by imaging studies. Skull lesions are most commonly benign but may also be malignant. Typically, lesions of the skull are evaluated by computed tomography and/or magnetic resonance imaging. Imaging features can also suggest whether an identified lesion is benign or malignant. Definitive diagnosis of transcranial lesions ultimately requires biopsy and surgical resection. Cases Atypical meningioma: A 57-year-old woman with a history of hypertension and arthritis presented with a left frontal scalp mass. Imaging revealed a large left frontal transcranial heterogeneous mass with intracranial and extracranial extension. Malignant ossifying fibromyxoid tumor: A 26-year-old woman with history of hypothyroidism, polycystic ovarian syndrome, and sciatica presented with a left parietal scalp mass. Imaging demonstrated a large left homogenous parietal transcranial mass with intracranial and extracranial extension. Breast carcinoma metastasis: A 64-year-old woman with history of ER/PR/Her2-neu–negative, high-grade invasive ductal carcinoma status post mastectomy, lymph node dissection, and chemotherapy with early termination due to adverse effects presented with a left parietal scalp mass. Imaging demonstrated a large left parietal transcranial mass. Glioblastoma: A 52-year-old man with a history of glioblastoma status post resection x2, chemoradiation, and craniectomy, who was found to have a second recurrence. Imaging demonstrated tumor surrounding the resection cavity in the left parietal/temporal region with extension through the craniotomy defect into the scalp soft tissue.