80 year-old man, history withheld

Images

Doctor's Information

Name : Mishka
Family :Ghofrani
Affiliation : -----
Academic Degree: Radiologist
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.

Case Section

Head & Neck Imaging

Patient's Information

Gender : Male
Age : 80

Clinical Summary

80 year-old man, history withheld

Imaging Findings

The patient was an 80 year old male with a history of surgically treated SCC of the scalp presenting with a growing mass and pain at the site of the previous lesion. Skull x-rays show a large midline lytic lesion involving both of the parietal bones associated with a substantial soft tissue mass. On MRI, there is a subcutaneous soft tissue mass of heterogeneous signal intensity, low in T1WI and high on T2 WIs, which has invaded the outer and inner tables and the diploic space and involves the underlying meninges. There is also a marked vasogenic edema extending to the deep white matter in right hemisphere. The high signal within the superior sagittal sinus suggests its involvement which is confirmed on MR venography. Also note the skin flap transferred from the patient's the glutteal region. Pathologically the brain itself was spared.

Differential Diagnosis

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Final Diagnosis

Recurrent SCC

Discussion (Related Text)

Erosion of the skull from extracranial tumors is rare but is occasionally seen. Thus an extracranial dermoid cyst can produce erosion of the underlying bone, but most cases are associated with more malignant tumors. Rodent ulcers and epitheliomas can invade and erode underlying bone in face or scalp.

References

Sutton D: Textbook of radiology and imaging, 7th ed. London: Churchill livingstone, 2003.