[Osteoblastic skull metastasis of lung cancer]

A case of osteoblastic skull metastasis of lung cancer is reported. A 56-year-old female patient was admitted to our hospital with complaints of headache and tumor of the right parietal bone. A plain skull X-ray showed hyperostotic feature of the right parietal bone. CT scan displayed that right parietal bone became thick and osteoblastic. Soft tissue was shown in the hyperostotic bone under MRI. An external carotid angiogram showed that the skull tumor was fed by the middle meningeal artery. The skull tumor and 2 solid intracerebral tumors were extirpated. Histological examination revealed adenocarcinoma in the skull and intracerebral lesions. The present case indicates that osteoblastic stimulating factor may be secreted by lung cancer.

[Primary malignant lymphoma of the right parietal bone in childhood--a case report]

Primary malignant lymphoma of the bone is quite rare in childhood. Its incidence was reported to be less than 1% in Japanese patients. A 14 year-old boy admitted to Mie University Hospital because of tumor of the skull in August 1988 is reported. Biopsy of the tumor revealed non-Hodgkin's lymphoma (diffuse large cell type). Bone marrow aspiration on admission showed infiltration of lymphoma cells. Surface marker analysis of lymphoma cells in bone marrow was performed by a panel of monoclonal antibodies. The surface phenotype of lymphoma cells conformed with that of non-T, non-B lymphoid cells. The patient was treated by high-risk lymphoma protocol formulated in the Department of Pediatrics, Mie University and achieved complete remission.

Clinical indicators of intracranial lesion on computed tomographic scan in children with parietal skull fracture

We conducted a review of 98 cases of pediatric traumatic parietal skull fracture in which computed tomographic (CT) scans of the head were obtained during a seven-year period. There were 69 instances of an associated intracranial lesion identified in 47 children, including parenchymal injury (23), epidural hematoma (17), subdural hematoma (11), cerebral edema (ten), and subarachnoid hemorrhage (eight). Compared with 51 other children with parietal skull fracture and normal CT scans, the clinical characteristics significantly associated with the presence of an intracranial lesion were symptoms of neurologic dysfunction (loss or altered level of consciousness and/or seizure activity), neurologic compromise on examination (altered level of consciousness and/or focal deficit), or complicated skull fracture (bilateral, diastatic, and/or depressed). Of the 47 children with an intracranial lesion on CT scan, 44 had at least one of these significant clinical characteristics (sensitivity, 93%; specificity, 50%; positive-predictive value, 62%; and negative-predictive value, 96%). Children who sustain traumatic parietal skull fracture commonly experience associated intracranial injury. Those with evidence of neurologic deficit or complicated skull fracture are at particularly high risk, and should receive cranial CT scan evaluation.

Scaphocephaly associated with other abnormalities: report of case

The clinical and radiological findings of a case of scaphocephaly have been presented and related to the patient's history. The main findings were: A small cranial index. Developmental abnormalities of the hands detected both clinically and radiographically. History of congenital deformities of the feet. Aplasia of three premolars. History of pain in the occipital region at earlier age.

Desmoplastic fibroma of parietal bone simulating eosinophilic granuloma. Case report

Desmoplastic fibroma is a distinctive and rare neoplasm of bone. Only one previous example has been reported in the calvaria. The diagnostic and surgical aspects of a case of desmoplastic fibroma of the skull that radiographically simulated eosinophilic granuloma are reported.

Severe perifolliculitis capitis with osteomyelitis

This report describes a severe case of perifolliculitis capitis with the rare complication of skull osteomyelitis, a combination not previously reported. The patient demonstrated the typical features of perifolliculitis capitis, namely, rubbery, hard, elevated nodules involving almost the entire scalp with multiple deep-seated abscesses. Bone was exposed in two areas and the diagnosis of skull osteomyelitis was confirmed by skull x-ray films and bone biopsy specimens, which grew Staphylococcus aureus. The patient was treated with enteral hyperalimentation, intravenous antibiotics, and multiple debridements of the scalp, including the involved periosteum and outer cortex of the exposed bone, followed by reconstruction with split-thickness skin grafts. A complete eradication of the disease with closure of all open wounds and clearance of osteomyelitis of the skull was achieved.

Intraosseous lipoma of the skull: a report of two cases

Case histories of a 12-year-old boy and a 20-year-old woman with hyperostosis of the frontoparietal bones are presented. Microscopical examination of the lesions showed intraosseous lipoma with hyperostosis of diploë. In both cases, only the prominent part of the tumor was removed for cosmetic reasons. The results were satisfactory, and there was no evidence of recurrence over a period of six years.

Infantile myofibromatosis. Report of two cases

Two cases of infantile myofibromatosis were presented. Case 1 was a 6-month-old girl with multiple nodular lesions in the left parietal bone, dermis of abdominal wall, chest wall, right upper arm, and bilateral femur. Case 2 was a 12-month-old girl with solitary nodular lesions in the left parietal bone having a tendency to enlarge. Histologically, these tumorous lesions consisted of broad bundles of well oriented spindle-shaped cells superficially resembling smooth muscle tissue. In electron microscopy, the constituent cells combined ultrastructural characteristics of both fibroblasts and smooth muscle cells., Immunoperoxidase method showed that anti-smooth muscle antibodies binded to the cytoplasm of the bundle forming cells. From these results, it may be concluded that the lesion consisted of pure proliferation of myofibroblasts, and its peculiar growth behavior was discussed, though the histogenesis still remains obscure.

[A case of multiple myeloma showing intracranial hypertension due to large cranial mass lesions]

It is well known that the case of multiple myeloma shows punched-out lesions of the cranium without intracranial hypertension. In this paper a case of multiple myeloma is reported showing intracranial hypertension due to a large tumor that developed in the left parietal bone. There are only 13 case reports about cranial mass lesion of multiple myeloma since 1928. A 52 year-old female was admitted to Iwate Prefectural Isawa Hospital suffering from headache, nausea and vomiting. She had been already diagnosed as multiple myeloma and treated with chemotherapy using Cyclophosphamide, Melphalan and Prednisolone for 2 years. On admission, a large subcutaneous mass was presented on the left parietal region. Craniogram revealed large osteolytic lesion of the left parietal bone and 3 punched-out lesions of the frontal bone. CT scan revealed a large mass lesion in the left epidural space, diploe and subcutaneous space. Angiography showed avascular area. Brain scintigram showed diffuse hot area. Other skeletal bones showed no abnormality. Laboratory examination revealed high concentration of gamma-globulin and high erythrocyte sedimentation rate. Electrophoresis showed high value of immunoglobulin G; immunoglobulin assay was as follows: IgG-6000 mg/dl, IgA-150 mg/dl, IgM-410 mg/dl, IgE-0 mg/dl. Serum electrolytes were within normal limits. Urine didn't include Bence-Jones protein. The patient was diagnosed as multiple myeloma suffering from intracranial hypertension caused by large tumor which developed in the left parietal bone. On the operation, large tumor was existed in the epidural and subcutaneous space invading into the diploe but without infiltration into the dura mater or cerebral cortex.(ABSTRACT TRUNCATED AT 250 WORDS)

Communication between epidural hematoma and cephalhematoma in a neonate

A case of neonatal epidural hematoma caused by falling at a premature delivery is presented. It accompanied a cephalhematoma communicating to the epidural hematoma through a fracture of the skull. The mechanism of this peculiar form of neonatal epidural hematoma is discussed.

Parietal osteomyelitis and epidural abscess: a delayed complication of fetal monitoring

Infected cephalohematomas are extremely rare. In this report an infant of 14 weeks developed an infected cephalohematoma, osteomyelitis of the parietal bone and an epidural abscess after fetal monitoring with scalp electrodes. Streptococcus pneumoniae was isolated from the purulent aspirate.

Experience with the temporoparietal fascial free flap

The temporoparietal fascia is an ideal tissue source for free transfer to distant sites where ultrathin coverage is either desirable or mandatory. The fascia's dependable vascular anatomy facilitates the technical aspects of microvascular transfer by means of its large vessels, ample pedicle, and ability to be grafted on either side. Furthermore, this highly vascular tissue is available in surprisingly large quantities, and its donor scar is hidden in the hair. The authors have found this flap useful (1) in covering exposed bone and tendon without adding unwanted bulk, (2) in providing thin flap coverage or lining in major facial reconstruction, (3) in covering vital structures such as exposed nerves and vessels, (4) in providing neovascularity both as a recipient graft bed and for control of chronic infection, and (5) in reestablishing gliding-tendon mechanisms. The authors have successfully employed this free flap in 15 cases which involved deformities of the ankle, foot, Achilles tendon, forearm, hand, nose, and contralateral ear and scalp. Seven cases are utilized to illustrate the broad application of this unique and versatile free flap.

Computed tomography of a diploic epidermoid cyst of the skull

The computed tomographic (CT) and other roentgenological characteristics of a skull diploic epidermoid cyst in a 14-year-old boy with Ito syndrome, a neurocutaneous syndrome, are presented. When this boy was 3 years 10 months of age, a plain roentgenogram of the skull showed an area of decreased density in the left parietal bone. The area has grown for the subsequent 10 years plus and a characteristic sclerotic margin has become evident. CT examination showed a cystic lesion in the diploe, the outer third of high density and the inner third low density. CT allowed prediction of the operative and histological findings. It was useful not only for the diagnosis but also in the pathogenesis.