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Scalia G, Porzio M, Costanzo R, Giurato E, Gibilisco F, Iacopino DG, Maugeri R, Nicoletti GF, Umana GE, Alessandrello R. Large Skull Metastasis in Follicular Thyroid Carcinoma: A Comprehensive Case Presentation and Systematic Review. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38621710 DOI: 10.1055/s-0044-1785650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Skull metastases from follicular thyroid carcinoma (FTC) are infrequent but clinically significant, often presenting with localized pain, neurologic deficits, and cranial nerve dysfunction. Early detection and accurate diagnosis pose challenges due to their asymptomatic nature in some cases. METHODS A systematic literature review, conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identified and analyzed 15 relevant studies focusing on large skull metastases in FTC. Data extraction and synthesis included clinical presentation, diagnostic methods, treatment strategies, and patient outcomes. RESULTS The systematic review encompassed 20 patients with secondary skull metastases from FTC, offering insights into the clinical diversity of this rare condition. Clinical presentations varied, with localized pain (70% of cases) and headaches being predominant symptoms. Imaging techniques, including computed tomography (CT) and magnetic resonance imaging (MRI), played a pivotal role in diagnosis. Surgical resection was considered in select cases, achieving complete or near-complete tumor removal in 30 to 50% of patients. Radiotherapy, including external beam radiation therapy (EBRT) and stereotactic radiosurgery (SRS), provided local control and symptom relief in 70 to 80% of cases. Systemic therapies, such as tyrosine kinase inhibitors (TKIs), showed promise in disease stabilization or regression (45% of patients). Prognosis remained poor, with a median overall survival of 6 to 12 months, reflecting an advanced and aggressive disease state. CONCLUSION Managing secondary skull metastases from FTC requires a comprehensive approach, including surgical intervention, radiotherapy, and potential systemic therapies. The rarity of these metastases underscores the need for further research to establish standardized treatment guidelines, explore molecular profiling, and investigate immunotherapy and combination therapies, offering hope for improved outcomes in this challenging clinical scenario.
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Affiliation(s)
- Gianluca Scalia
- Department of Head and Neck Surgery, Neurosurgery Unit, Garibaldi Hospital, Catania, Italy
| | - Massimiliano Porzio
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Roberta Costanzo
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Eliana Giurato
- Anatomic Pathology Unit, Garibaldi Hospital, Catania, Italy
| | | | | | - Rosario Maugeri
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | | | | | - Raffaele Alessandrello
- Department of Head and Neck Surgery, Neurosurgery Unit, Garibaldi Hospital, Catania, Italy
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Liu M, Dong A, Zuo C, Zhu Y, Fu X. Isolated Skull Metastasis With Unusual Spiculated Periosteal Reaction From Rectal Cancer Resembling Osteosarcoma on FDG PET/CT. Clin Nucl Med 2023; 48:1006-1008. [PMID: 37793159 DOI: 10.1097/rlu.0000000000004859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
ABSTRACT We describe FDG PET/CT findings in a case of isolated skull metastasis with spiculated periosteal reaction from rectal mucinous adenocarcinoma 8 years after proctectomy. The skull metastasis showed heterogeneous FDG uptake and multiple short spicules of bone producing the sunburst appearance resembling primary osteosarcoma or Ewing sarcoma. Familiarity with this atypical imaging appearance of the bone metastasis from rectal cancer may be helpful for the diagnosis and differential diagnosis.
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Affiliation(s)
- Mingyuan Liu
- From the Department of Neurology, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | | | | | - Yan Zhu
- Pathology, The First Affiliated Hospital of Naval Medical University
| | - Xiaoling Fu
- Department of Medical Oncology, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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3
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Gao L, Chen P, Yang L, Li Y, Han F, Liu H, Zhang J. Imaging Features of Primary Intraosseous Meningiomas. J Comput Assist Tomogr 2023; 47:934-939. [PMID: 37948369 DOI: 10.1097/rct.0000000000001492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe the imaging features of primary intraosseous meningiomas (PIMs) to aid an accurate diagnosis. METHODS Clinical materials and radiological data for 9 patients with pathologically confirmed PIMs were reviewed comprehensively. RESULTS Most lesions involved inner and outer plates of the calvaria and all were relatively well circumscribed. Upon computed tomography, portions of the solid neoplasm were hyperattenuated or isoattenuated. Hyperostosis was found in many lesions, but calcification was seen rarely. On magnetic resonance imaging, most neoplasms were hypointense on T1-weighted images, hyperintense on T2-weighted images, and heterogeneous on fluid-attenuated inversion recovery images. In most cases, the soft tissue of neoplasms showed hyperintense on diffusion-weighted imaging and hypointense on apparent diffusion coefficient. All lesions were obviously enhanced after gadolinium administration. Each patient accepted surgical treatment and recurrence was not observed during follow-up. CONCLUSIONS Primary intraosseous meningiomas are very rare tumors that occur usually in later life. They are well-defined and tend to involve the inner and outer plates of the calvaria, with a classic appearance of hyperostosis on computed tomography. Primary intraosseous meningiomas display hypointense on T1-weighted images, hyperintense on T2-weighted images, and hyperattenuated or isoattenuated on computed tomography. Hyperintense on diffusion-weighted imaging, hypointense on apparent diffusion coefficient can also be found. Obvious enhancement supplied additional information for an accurate diagnosis. A neoplasm with these features should raise the suspicion of a PIM.
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Affiliation(s)
- Lu Gao
- From the Departments of Diagnostic Radiology
| | - Peiyao Chen
- From the Departments of Diagnostic Radiology
| | - Lin Yang
- Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - Yang Li
- From the Departments of Diagnostic Radiology
| | - Fang Han
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai
| | - Heng Liu
- Department of Radiology, The Center for Medical Imaging of Guizhou Province, Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China
| | - Jiawen Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai
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4
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Oh J, Choi E, Aggarwal R. Metastatic Lung Adenocarcinoma: A Case of Unusual Presentation With a Skull Mass. Cureus 2023; 15:e42399. [PMID: 37621819 PMCID: PMC10446785 DOI: 10.7759/cureus.42399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
This case report describes an uncommon presentation of lung adenocarcinoma, which appeared as a skull mass. While not the first reported case in medical literature, it is still a rare occurrence for lung adenocarcinoma to present in this manner. This report focuses on the clinical presentation and treatment of an elderly male patient who had a progressively enlarging and painful skull mass. The initial imaging revealed an about 5 cm soft tissue mass at the dorsal midline of the parietal-occipital bone. Subsequent imaging identified a lung mass, and a biopsy of the skull bone confirmed that the mass was metastatic adenocarcinoma originating from the lung. For treatment, the patient underwent occipital partial resection of the mass, followed by wire mesh cranioplasty. Chemotherapy and external beam radiotherapy were administered to alleviate symptoms and control the spread of cancer. Lung carcinoma with distant metastasis is generally associated with a poorer prognosis. However, some supporting data suggest that early detection and aggressive management play crucial roles in preventing further metastasis and improving the patient's quality of life and overall survival rate. Skull bone metastasis from lung cancer is indeed a rare phenomenon, and cases like these contribute valuable knowledge to the field. By reporting such cases, healthcare professionals can gain a better understanding of the clinical manifestations, diagnostic challenges, and appropriate management strategies for these uncommon occurrences. This case report underscores the significance of maintaining a high index of suspicion and utilizing a multimodality approach to diagnose rare instances of calvarial metastasis.
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Affiliation(s)
- Jaha Oh
- Department of Internal Medicine, New York City (NYC) Health + Hospitals/Lincoln, Bronx, USA
| | - Eunhee Choi
- Department of Internal Medicine, New York City (NYC) Health + Hospitals/Lincoln, Bronx, USA
| | - Richa Aggarwal
- Department of Internal Medicine, New York City (NYC) Health + Hospitals/Lincoln, Bronx, USA
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5
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Iritani Y, Kato H, Kaneko Y, Shibata H, Iinuma R, Ogawa T, Suzui N, Miyazaki T, Matsuo M. Two cases of flow void sign of temporal bone metastasis from follicular thyroid carcinoma. Neuroradiol J 2023; 36:361-365. [PMID: 36384335 PMCID: PMC10268090 DOI: 10.1177/19714009221140488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
This report describes CT and MRI findings of temporal bone metastasis from follicular thyroid carcinoma in two cases. Both of these had large, osteolytic, hypervascular masses of the temporal bone, accompanied by internal scattered bone fragments and extraosseous mass formation on unenhanced and contrast-enhanced CT images. In the first case, several dilated and tortuous vessels within the markedly hypervascular mass were observed on the arterial phase of dynamic contrast-enhanced CT images. Compared with the signal intensity of the cerebellum, temporal bone masses showed slightly hypo- to slightly hyperintense on T1-weighted images and slightly hypo- to moderately hyperintense on T2-weighted images. Both cases had flow voids in abnormally dilated vessels within the mass on T1- and T2-weighted images. Thyroid follicular carcinoma rarely metastasizes the temporal bone and presents with an osteolytic hypervascular mass with flow void sign.
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Affiliation(s)
| | - Hiroki Kato
- Department of Radiology, Gifu University, Gifu, Japan
| | - Yo Kaneko
- Department of Radiology, Gifu University, Gifu, Japan
| | | | - Ryota Iinuma
- Department of Otolaryngology, Gifu University, Gifu, Japan
| | - Takenori Ogawa
- Department of Otolaryngology, Gifu University, Gifu, Japan
| | - Natsuko Suzui
- Department of Pathology, Gifu University Hospital, Gifu, Japan
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Wogram E, Schlunk F, Shah MJ, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : A 51-year-old Patient Presenting with Epistaxis and Occasional Headaches 16 Years after Diagnosis of a Grade 1 Chondrosarcoma of the Left Petrous Apex. Clin Neuroradiol 2023; 33:569-575. [PMID: 37171609 DOI: 10.1007/s00062-023-01294-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Affiliation(s)
- E Wogram
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - F Schlunk
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - M J Shah
- Department of Neurosurgery, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany.
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7
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Martins Gama J, Caetano Oliveira R, Teixeira P, Silva F, Abrantes C, Figueiredo P, Simões S, Rebelo O, Cipriano MA. An Immunohistochemical Study of Breast Cancer Brain Metastases: The Role of CD44 and AKT in the Prognosis. Appl Immunohistochem Mol Morphol 2023; 31:318-323. [PMID: 37093706 DOI: 10.1097/pai.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/02/2023] [Indexed: 04/25/2023]
Abstract
Breast cancer is a major health burden, and up to one-third of patients with breast cancer develop brain metastases, which are linked to a very poor prognosis. Few biomarkers are available to predict the prognosis of patients with metastases. Assessment by immunohistochemistry may be used as a tool to predict the behavior of these tumors. A retrospective transversal study including 114 patients (diagnosed between 2000 and 2016) with breast cancer brain metastases was carried out using archival biological material from 114 patients with breast cancer brain metastases. Expression of CD44, HER2, ER, PR, CA9, PDL-1, CD133, ALDH1, PTEN, AKT, PI3K, and AR markers was assessed by immunohistochemistry. The overexpression of CD44 and AKT was associated with worse overall survival ( P =0.047 and P =0,034, respectively), on univariate analysis, in the cohort of parenchymal and bone metastases; the impact of AKT expression was also evident in the parenchymal cohort on uni ( P =0.021) and multivariate analysis ( P =0.027). The remaining markers did not exhibit a statistical correlation. Immunohistochemistry markers such as CD44 and AKT may have a prognostic impact on survival in patients with breast cancer brain metastases. The conjugation with other markers may help with the stratification of patients and therapy.
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Affiliation(s)
| | - Rui Caetano Oliveira
- Department of Pathology
- Clinical Academic Center of Coimbra (CACC)
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment Genetics and Oncobiology (CIMAGO), Institute of Byophysics, Faculty of Medicine, University of Coimbra
| | | | | | - Carlos Abrantes
- Department of Pathology, Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra, Portugal
| | - Paulo Figueiredo
- Department of Pathology, Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra, Portugal
| | - Sandra Simões
- Neuropathology Laboratory, Department of Neurology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário Coimbra
| | - Olinda Rebelo
- Neuropathology Laboratory, Department of Neurology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário Coimbra
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8
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Zhao M, Wen F, Chen G, Xu Y. Computed tomography-guided 125 I radioactive-seed implantation therapy for skull metastasis from hepatocellular carcinoma. Asian J Surg 2023; 46:1031-1032. [PMID: 35961907 DOI: 10.1016/j.asjsur.2022.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Mengpeng Zhao
- Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, 661 Huanghe Second Road, Binzhou, Shandong Province, 256603, PR China
| | - Feifei Wen
- Department of Pathology, Binzhou Medical University Hospital, 661 Huanghe Second Road, Binzhou, Shandong Province, 256603, PR China
| | - Gang Chen
- Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, 661 Huanghe Second Road, Binzhou, Shandong Province, 256603, PR China
| | - Yingjiang Xu
- Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, 661 Huanghe Second Road, Binzhou, Shandong Province, 256603, PR China.
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9
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Xiong T, Jiang M, Ye X, Zhu G, Cao F, Cui Y, Yang M, Niu Y. Skull metastasis is a poor prognostic factor for prostate cancer patients with bone metastasis: a retrospective study based on a Chinese population. BMC Urol 2023; 23:13. [PMID: 36721133 PMCID: PMC9887768 DOI: 10.1186/s12894-023-01179-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/25/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Skull is a relatively rare metastasis site for prostate cancer (PCa). There is no evidence regarding the prognostic indication of skull metastasis (SM) in PCa patients. In this study, we analyzed the prognostic value of SM for metastatic PCa patients receiving androgen deprivation therapy (ADT). METHODS 107 consecutive patients were included from September 2008 to August 2021. All patients were administered with standard ADT. Abiraterone plus glucocorticoid and/or docetaxel chemotherapy were given after failure to castration-resistant prostate cancer. Clinical parameters and follow-up prognostic data were retrospectively analyzed. The association of clinical and pathological parameters with SM were analyzed. The progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier analysis and Cox regression analyses. RESULTS Patients with SM (n = 26) had significantly higher biopsy Gleason scores, higher clinical T stage, higher prostate-specific antigen level at diagnosis, and were more likely to have high-burden metastasis and lymph node metastasis, compared with those without SM (n = 81). They also showed significantly lower level of hemoglobin, albumin and serum calcium, along with higher level of alkaline phosphatase. SM was significantly associated with shorter medium PFS (9.4 vs. 18.3 months, p < 0.001) and OS (22.2 vs. 58.2 months, p < 0.001). Cox analysis demonstrated that SM was an independent risk factor for shorter PFS (hazard ratio 2.327 [1.429-3.789], p = 0.001) and shorter OS (hazard ratio 2.810 [1.615-4.899], p < 0.001). CONCLUSION In this study, we found that SM was significantly correlated with more aggressive disease and indicated poor prognosis in PCa patients with bone metastasis. Our study may provide useful reference for the risk stratification of PCa patients.
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Affiliation(s)
- Tianyu Xiong
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mingxin Jiang
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyiyuan Road, Haidian District, Beijing, China
| | - Xiaobo Ye
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guangyi Zhu
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyiyuan Road, Haidian District, Beijing, China
| | - Fang Cao
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yun Cui
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Minfu Yang
- grid.24696.3f0000 0004 0369 153XDepartment of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yinong Niu
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyiyuan Road, Haidian District, Beijing, China
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10
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Byun J, Kim JH. Revisiting the Role of Surgical Resection for Brain Metastasis. Brain Tumor Res Treat 2023; 11:1-7. [PMID: 36762802 PMCID: PMC9911712 DOI: 10.14791/btrt.2022.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Brain metastasis (BM) is the most common type of brain tumor in adults. The contemporary management of BM remains challenging. Advancements in systemic cancer treatment have increased the survival of patients with cancer. Although the treatment of BM is still complicated, advances in radiotherapy, including stereotactic radiosurgery and chemotherapy, have improved treatment outcomes. Surgical resection is the traditional treatment for BM and its role in the surgical resection of BM has been well established. However, refinement of the surgical resection technique and strategy for BM is needed. Herein, we discuss the evolving role of surgery in patients with BM and the future of BM treatment.
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Affiliation(s)
- Joonho Byun
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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11
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Gersey ZC, Zenonos GA, Gardner PA. Malignant Brain and Spinal Tumors Originating from Bone or Cartilage. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:477-506. [PMID: 37452950 DOI: 10.1007/978-3-031-23705-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Malignant bone tumors affecting the brain and spine are a rare and exceedingly difficult-to-treat group of diseases. Most commonly consisting of chordoma and chondrosarcoma, these tumors also include giant-cell tumors and osteosarcomas. This chapter will cover the background, epidemiology, genetics, molecular biology, histopathology, radiographic features, clinical manifestations, therapeutic approaches, and clinical management of each entity.
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Affiliation(s)
- Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul A Gardner
- UPMC Center for Cranial Base Surgery, 200 Lothrop Street, PUH B-400, Pittsburgh, PA, 15213, USA.
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12
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Arora V, Sidhu BS, Singh K. Comparison of computed tomography and magnetic resonance imaging in evaluation of skull lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00745-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Computed tomography (CT) and magnetic resonance imaging (MRI) have been incorporated into the basic imaging tools for evaluation of skull lesions. Despite the known advantages and disadvantages of CT and MRI in various aspects of evaluating skull lesions, it is not always feasible to perform both CT and MRI in evaluation of the same patient. The purpose of this study is to compare CT and MRI in evaluation of various skull lesions and to determine which imaging modality out of the two is more appropriate in evaluation of skull lesions and their characterization.
Results
There was no statistically significant difference between CT and MRI for detection of number of lesions, distribution of lesions, margins of the lesions, nature of the lesions, zone of transition, cortical breach, intralesional calcification, intralesional hemorrhage, associated soft tissue, and invasion into brain parenchyma (p value > 0.05 in all these parameters). Dural involvement was picked up better on MRI as compared to CT (p value 0.031). Another advantage of MRI over CT was better characterization of lesions by diffusion weighted imaging.
Conclusion
CT and MRI are equally efficient in providing adequate diagnostic information in various skull lesions and each of them can be used independent of the other to characterize and diagnose the lesions of skull. The slight advantage of MRI over CT is detection of dural involvement.
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13
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Singh A, Bhat N, Salivendra D, Pillai R. Recurrent Facial Paralysis-an Unusual Initial Presentation of Temporal Bone Metastasis in Case of Advanced Prostate Malignancy. Indian J Otolaryngol Head Neck Surg 2022; 74:3718-3720. [PMID: 36742710 PMCID: PMC9895329 DOI: 10.1007/s12070-021-02504-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/02/2021] [Indexed: 02/07/2023] Open
Abstract
Metastasis into temporal bone is uncommon. Involvement of facial nerve is rarer. We report an unusual case of metastatic prostatic carcinoma presenting initially as facial nerve palsy in an 82 year old male. Diagnostic pitfalls have been discussed. Radiological evaluation followed by biopsy was diagnostic.
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Affiliation(s)
- Ankita Singh
- Post Graduate Medical Officer in ENT, ENT Department, BARC Hospital, Mumbai, India
| | - Nalini Bhat
- ENT Department, BARC Hospital, Mumbai, India
| | | | - Raji Pillai
- Pathology Department, BARC Hospital, Mumbai, India
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14
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Sakai M, Kashiwagi N, Nakanishi K, Maeda N, Nakaya Y, Tanaka J, Watanabe S, Hongyo H, Tanaka Y, Yamada S, Kawata A, Toda S, Takano K, Arita H, Tomiyama N. Nonbrain metastases seen on magnetic resonance imaging during metastatic brain tumor screening. Jpn J Radiol 2022; 41:367-381. [PMID: 36374473 PMCID: PMC10066091 DOI: 10.1007/s11604-022-01362-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
AbstractAlthough metastases found during head magnetic resonance imaging (MRI) are not limited to metastatic brain tumors, the MRI is a very common method for “brain metastasis screening,” a modality that is being increasingly performed. In this review, we describe MRI findings of nonbrain metastases and discuss ways to avoid missing these lesions. Metastatic cranial bone tumors are among the most common nonbrain metastatic lesions found on head MRI, followed by leptomeningeal carcinomatosis. The other less-frequent metastatic lesions include those in the ventricle/choroid plexus, the pituitary gland and stalk, and the pineal gland. Metastases in the head and neck area, as well as cranial and intracranial lesions, should be carefully evaluated. Furthermore, direct geographical invasion, perineural spread, and double cancers should also be considered. While it is important to recognize these metastatic lesions on MRI, because they may necessitate a change in treatment strategy that could lead to an improvement in prognosis due to early introduction of therapy, nonbrain lesions should also be given greater attention, given the increasing survival of patients with cancer and advances in MRI technology, such as contrast-enhanced-3D T1-weighted imaging.
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Affiliation(s)
- Mio Sakai
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan.
| | - Nobuo Kashiwagi
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Katsuyuki Nakanishi
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Noboru Maeda
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Yasuhiro Nakaya
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Junichiro Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Shinichiro Watanabe
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Hidenari Hongyo
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Yu Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Sawaka Yamada
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Atsushi Kawata
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Sou Toda
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Koji Takano
- Department of Neurosurgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Hideyuki Arita
- Department of Neurosurgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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15
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Kurokawa R, Kurokawa M, Holmes A, Baba A, Bapuraj J, Capizzano A, Kim J, Srinivasan A, Moritani T. Skull metastases and osseous venous malformations: The role of diffusion-weighted and dynamic contrast-enhanced MRI. J Neuroimaging 2022; 32:1170-1176. [PMID: 35922879 DOI: 10.1111/jon.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Skull metastasis (SM) is a common secondary malignancy. We evaluated the diagnostic performance of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (MRI) in differentiating SM from osseous venous malformations and SM of various origins. METHODS This study included 31 patients with SM (median age, 64 years; range, 41-87 years; 29 women; 24 and 7 patients with breast and non-small cell lung cancer, respectively) and 16 with osseous venous malformations (median age, 68 years; range, 20-81 years; 10 women) who underwent both DWI and dynamic contrast-enhanced MRI between January 2015 and October 2021. Normalized mean apparent diffusion coefficients (ADCs) and dynamic contrast-enhanced MRI parameters were compared between SM and osseous venous malformations, and between breast cancer and non-small cell lung cancer. Multivariate stepwise logistic regression analyses were performed to identify statistically significant parameters. RESULTS Plasma volume and time-to-maximum enhancement were the most statistically significant parameters for differentiating SM from osseous venous malformations, with an area under the receiver operating characteristic curve of 0.962. The normalized mean ADC and peak enhancement values were the most statistically significant parameters for differentiating breast cancer from non-small cell lung cancer, with an area under the curve of 0.924. CONCLUSIONS Our results highlight the efficacious diagnostic performance of DWI and dynamic contrast-enhanced MRI in distinguishing SM from osseous venous malformations and differentiating SM of various origins.
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Affiliation(s)
- Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam Holmes
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jayapalli Bapuraj
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aristides Capizzano
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - John Kim
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Toshio Moritani
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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16
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Gupta S, Sharma G, Sajeevan S, Raut SN, Ahuja R, Joseph D, Gupta A, Gupta M. Varied Clinical Presentation and Management of Calvarial Metastases. Asian J Neurosurg 2022; 17:631-634. [PMID: 36570766 PMCID: PMC9771635 DOI: 10.1055/s-0042-1757626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Calvarium and skull base can be affected by a variety of benign, tumor-like, and malignant processes. Skull metastases (SMs) may be located in any layer of the skull and may be incidental or present with neurological symptoms during the diagnostic workup. In the present study, we discuss the occurrence of SMs from various index malignancies and their myriad clinical presentation. This data-based study includes patients of bone metastases between June 2018 and July 2020. Patients with skull bone metastases were recognized, and location of primary site, their clinical presentation, and management strategy were noted. Ten patients with skull bone metastases were identified during this period. Four patients had skull base location with clinical manifestation as syndromes. Six patients had primary from breast cancer, three from Ewing's sarcoma, and one from lung cancer. Management varied according to the primary site and symptoms of each patient. SM, though not rare, is often diagnosed incidentally but presents diagnostic and management challenges in the patient with cancer.
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Affiliation(s)
- Sweety Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,Address for correspondence Sweety Gupta, MD, FRCP Department of Radiation Oncology, All India Institute of Medical SciencesRishikesh, 6th Level, Medical College Block, Rishikesh, Uttarakhand, 249203India
| | - Gaurav Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sanjay Sajeevan
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sagar N. Raut
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rachit Ahuja
- Department of Radiation Oncology, Dr. Yashwant Singh Parmar Government Medical College, Nahan, Himachal Pradesh, India
| | - Deepa Joseph
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amit Gupta
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manoj Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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17
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Inada T, Nakakuki T, Nakajima N, Miyake H, Shibuya S, Sakamoto T, Ishikawa M. Skull metastases from extramammary Paget’s disease emerging 8 years after initial treatment with no local progression: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE22280. [PMID: 36164671 PMCID: PMC9514261 DOI: 10.3171/case22280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
The foci of distant metastasis from extramammary Paget’s disease (EMPD) are the lung, liver, truncal bones, vertebrae, and brain. However, skull metastases have not been reported.
OBSERVATIONS
The authors treated a patient with calvarial and skull base metastases from EMPD who had undergone wide local resection of EMPD 8 years before, and they report his clinical course.
LESSONS
Because EMPD with distant metastasis is fatal, it should be recognized that EMPD can metastasize to the skull even when it seemed to be in remission for several years.
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Affiliation(s)
| | | | | | | | | | | | - Makiko Ishikawa
- Dermatology, Kyoto Katsura Hospital, Kyoto City, Kyoto, Japan
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18
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Ota Y, Liao E, Capizzano AA, Baba A, Kurokawa R, Kurokawa M, Srinivasan A. Differentiation of Skull Base Chondrosarcomas, Chordomas, and Metastases: Utility of DWI and Dynamic Contrast-Enhanced Perfusion MR Imaging. AJNR Am J Neuroradiol 2022; 43:1325-1332. [PMID: 35953276 PMCID: PMC9451640 DOI: 10.3174/ajnr.a7607] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Differentiation of skull base tumors, including chondrosarcomas, chordomas, and metastases, on conventional imaging remains a challenge. We aimed to test the utility of DWI and dynamic contrast-enhanced MR imaging for skull base tumors. MATERIALS AND METHODS Fifty-nine patients with chondrosarcomas, chordomas, or metastases between January 2015 and October 2021 were included in this retrospective study. Pretreatment normalized mean ADC and dynamic contrast-enhanced MR imaging parameters were calculated. The Kruskal-Wallis H test for all tumor types and the Mann-Whitney U test for each pair of tumors were used. RESULTS Fifteen chondrosarcomas (9 men; median age, 62 years), 14 chordomas (6 men; median age, 47 years), and 30 metastases (11 men; median age, 61 years) were included in this study. Fractional plasma volume helped distinguish all 3 tumor types (P = .003, <.001, and <.001, respectively), whereas the normalized mean ADC was useful in distinguishing chondrosarcomas from chordomas and metastases (P < .001 and P < .001, respectively); fractional volume of extracellular space, in distinguishing chondrosarcomas from metastases (P = .02); and forward volume transfer constant, in distinguishing metastases from chondrosarcomas/chondroma (P = .002 and .002, respectively) using the Kruskal-Wallis H test. The diagnostic performances of fractional plasma volume for each pair of tumors showed areas under curve of 0.86-0.99 (95% CI, 0.70-1.0); the forward volume transfer constant differentiated metastases from chondrosarcomas/chordomas with areas under curve of 0.82 and 0.82 (95% CI, 0.67-0.98), respectively; and the normalized mean ADC distinguished chondrosarcomas from chordomas/metastases with areas under curve of 0.96 and 0.95 (95% CI, 0.88-1.0), respectively. CONCLUSIONS DWI and dynamic contrast-enhanced MR imaging sequences can be beneficial for differentiating the 3 common skull base tumors.
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Affiliation(s)
- Y Ota
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - E Liao
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A A Capizzano
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A Baba
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (A.B.), Jikei University School of Medicine Ringgold standard institution, Tokyo, Japan
| | - R Kurokawa
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (R.K.), The University of Tokyo Hospital, Tokyo, Japan
| | - M Kurokawa
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (M.K.), Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Ringgold standard institution, Bunkyo-ku, Japan
| | - A Srinivasan
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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19
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Pesce A, Armocida D, Fiorentino F, Ciarlo S, La Pira B, Salvati M, Frati A, Pompucci A, Palmieri M. Full-Thickness Craniodural Metastasis with Leptomeningeal Infiltration of Salivary Origin: A Radiological Lesson and a Technical Remark. Tomography 2022; 8:2164-2170. [PMID: 36136877 PMCID: PMC9498924 DOI: 10.3390/tomography8050181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022] Open
Abstract
Calvarial metastases are a relatively rare entity, with an overall incidence of 3-4%. Among these cases, metastases arising from salivary gland cancers are even rarer; in fact, large studies regarding salivary gland tumors showed that brain metastases are observed in 0.8% of the cases. Generally, bone metastases have been described in proximity to primary tumors, while bloodstream-disseminated lesions are often located inside the brain parenchyma. During every surgical step, traction on lower-lying infiltrated tissues must be avoided in order to successfully remove the lesion. This case report presents the first ever case of a 67-year-old woman affected by submandibular gland undifferentiated adenocarcinoma metastasis with a full-thickness involvement of the calvarium, pachy- and leptomeninges.
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Affiliation(s)
- Alessandro Pesce
- Neurosurgery Division, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Daniele Armocida
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
| | | | - Silvia Ciarlo
- Neurosurgery Department, A.O.U. ‘Mater Domini’, Università degli Studi ‘Magna Greacia’ di Catanzaro, 88100 Catanzaro, Italy
| | - Biagia La Pira
- Neurosurgery Department, Azienda Ospedaliera Fabrizio Spaziani, 03100 Frosinone, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico “Tor Vergata”, University of Rome ‘‘Tor Vergata”, 00133 Rome, Italy
| | - Alessandro Frati
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
- IRCCS—“Neuromed”, Via Atinense 18, 86077 Pozzilli, Italy
| | - Angelo Pompucci
- Neurosurgery Division, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Mauro Palmieri
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
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20
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Agarwal A, Kanekar S. Headache Attributed to Disorder of the Cranium and Base of the Skull. Neurol Clin 2022; 40:563-589. [PMID: 35871785 DOI: 10.1016/j.ncl.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The article describes the approach to imaging that clinicians should adopt in cases of headaches suspected to be secondary to cranial vault or skull-base disorder. As a rule, computed tomography (CT) is superior to MRI for most of the osseous lesions, and lesions of the middle and external ear. MRI provides a complimentary role to CT and is the modality of choice in a few conditions such as extraosseous neoplasms of the skull base.
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Affiliation(s)
- Amit Agarwal
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA.
| | - Sangam Kanekar
- Radiology Research, Division of Neuroradiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA
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21
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Cochinski R, Agarwal M, Albuquerque J, A de Almeida C, Stricker RP, F Uberti M, K Casqueiro AP, S Mendonça G, do Nascimento GRS, Miraldi F, Decnop M. Anatomy and Diseases of the Greater Wings of the Sphenoid Bone. Radiographics 2022; 42:1177-1195. [PMID: 35657765 DOI: 10.1148/rg.210094] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The greater wings of the sphenoid bone (GWS) comprise the components of the sphenoid bone that make up most of the posterior orbital wall and form the anterior and medial parts of the floor of the middle cranial fossa. Many important skull base foramina, which transmit vital neurovascular structures, are present in these paired wings on either side of the central body of the sphenoid bone. A wide variety of diseases can affect the GWS, ranging from benign osseus lesions to malignant primary and secondary bone abnormalities. The complex three-dimensional curved (winged) shape of the GWS and the wide array of pathologic entities that affect this bone can make it challenging for the radiologist to report the imaging findings accurately, especially in relation to the important skull base foramina. The authors describe a systematic approach to understanding the three-dimensional anatomy of the GWS and review important diseases, with the aid of imaging examples. Useful imaging "pearls" that can help in making specific diagnoses are provided throughout the article. ©RSNA, 2022.
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Affiliation(s)
- Renata Cochinski
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Mohit Agarwal
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Jessica Albuquerque
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Carolina A de Almeida
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Rafaela P Stricker
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Marcela F Uberti
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Ana Paula K Casqueiro
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Gabriel S Mendonça
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Galba R S do Nascimento
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Fernanda Miraldi
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
| | - Marcos Decnop
- From the Department of Radiology, Instituto Nacional de Câncer (INCA), Praça Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil 20230-130 (R.C., J.A., C.A.d.A., R.P.S., M.F.U., A.P.K.C., G.S.M., G.R.S.d.N., F.M., M.D.); and Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.)
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22
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Abstract
Though metastasis and malignant infiltration of the peripheral nervous system is relatively rare, physicians should have a familiarity with their presentations to allow for prompt diagnosis and initiation of treatment. This article will review the clinical presentations, diagnostic evaluation, and treatment of neoplastic involvement of the cranial nerves, nerve roots, peripheral nerves, and muscle. Due to the proximity of the neural structure traversing the skull base, metastasis to this region results in distinctive syndromes, most often associated with breast, lung, and prostate cancer. Metastatic involvement of the nerve roots is uncommon, apart from leptomeningeal carcinomatosis and bony metastasis with resultant nerve root damage, and is characterized by significant pain, weakness, and numbness of an extremity. Neoplasms may metastasize or infiltrate the brachial and lumbosacral plexuses resulting in progressive and painful sensory and motor deficits. Differentiating neoplastic involvement from radiation-induced injury is of paramount importance as it dictates treatment and prognosis. Neurolymphomatosis, due to malignant lymphocytic infiltration of the cranial nerves, nerve roots, plexuses, and peripheral nerves, deserves special attention given its myriad presentations, often mimicking acquired demyelinating neuropathies.
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23
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An ancient cranium from Dmanisi: Evidence for interpersonal violence, disease, and possible predation by carnivores on Early Pleistocene Homo. J Hum Evol 2022; 166:103180. [DOI: 10.1016/j.jhevol.2022.103180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/11/2022]
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24
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Staged surgical treatment for a giant hypervascular extra-intracranial metastasis of thyroid cancer using preoperative embolization and total microsurgical removal. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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25
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García Carretero R, Ordonez-Garcia M, Hernandez-Puche S, Arias-Baldo P. Paucisymptomatic clinical presentation of an advanced malignant lung disease: solitary skull metastasis as the initial exploratory sign. BMJ Case Rep 2022; 15:e248659. [PMID: 35228251 PMCID: PMC8886390 DOI: 10.1136/bcr-2021-248659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/04/2022] Open
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26
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Hoppe J, Kalckreuth T, Metelmann M, Rumpf JJ, Klagges S, Dietzsch S, Scherlach C, Kuhnt T, Kortmann RD, Seidel C. [Skull base metastases with cranial nerve deficits : Clinical profile of a severe disease]. DER NERVENARZT 2022; 93:812-818. [PMID: 35024880 PMCID: PMC9363291 DOI: 10.1007/s00115-021-01229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund und Ziele Schädelbasismetastasen sind eine seltene Manifestation onkologischer Erkrankungen. Wenn Hirnnerven beteiligt sind, können schon kleine Läsionen erhebliche funktionelle Beeinträchtigungen hervorrufen. Spezifische klinische Charakteristika wie neurologische Symptome, assoziierte Primärtumoren, Prognose und optimale Therapie der Erkrankung sind schlecht definiert und sollen in dieser Arbeit systematisch dargestellt werden. Methoden Mit einem monozentrischen retrospektiven Ansatz wurden Schädelbasismetastasen bei Patienten, die im Zeitraum von 2006 bis 2018 behandelt wurden, detailliert hinsichtlich klinischer Charakteristika, der durchgeführten Therapie und des weiteren Erkrankungsverlaufs analysiert. Ergebnisse Insgesamt 45 Patienten mit Schädelbasismetastasen und Hirnnervenausfällen wurden erfasst. Die häufigsten Primärtumoren waren Prostatakarzinom (27 %), Mammakarzinom (22 %) und multiples Myelom (16 %). Die am häufigsten betroffenen Hirnnerven waren Nervus trigeminus (42 %), Nervus oculomotorius (33 %) und Nervus facialis (27 %). 84 % aller Patienten wiesen außerhalb der Schädelbasis liegende weitere Knochenmetastasen auf. Eine durale Infiltration oder eine Meningeosis neoplastica lagen bei je 13 % der Patienten vor. Nach Bestrahlung waren 61 % der Patienten hinsichtlich der auf die Schädelbasismetastase zurückzuführenden Symptome klinisch stabil, bei 22 % hatten sich die Symptome gebessert. Das mediane Gesamtüberleben betrug 8 Monate (Spanne: 0,4–51 Monate). Bei Patienten, die mit einer dosiseskalierten Bestrahlung behandelt wurden, bestand eine längere Überlebenszeit (16,4 Monate vs. 4,7 Monate). Dieser Effekt persistierte auch in der multivariaten Analyse unter Berücksichtigung der Faktoren Karnofsky-Index, Metastasenanzahl, Primärtumor und Bestrahlungsdosis (HR 0,37, p = 0,02). Diskussion Schädelbasismetastasen mit Hirnnervenausfällen haben ein vielgestaltiges Bild und oft eine schlechte Prognose. Um potenziell eine Überlebenszeitverbesserung zu erreichen, sind präzise Diagnostik und Therapie Voraussetzung. Prospektive kontrollierte Untersuchungen sind notwendig.
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Affiliation(s)
- J Hoppe
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - T Kalckreuth
- Department of Radiation-Oncology, University Hospital Freiburg, Freiburg, Deutschland
| | - M Metelmann
- Department of Neurology, University Hospital Leipzig, Leipzig, Deutschland
| | - J J Rumpf
- Department of Neurology, University Hospital Leipzig, Leipzig, Deutschland
| | - S Klagges
- Sächsisches Krebsregister Leipzig, Leipzig, Deutschland
| | - S Dietzsch
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - C Scherlach
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Deutschland
| | - T Kuhnt
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - R D Kortmann
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - C Seidel
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland. .,, Stephanstr. 9a, 04103, Leipzig, Deutschland.
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Incidental finding of metastatic prostatic adenocarcinoma of frontotemporal bone presenting as subdual hematoma: A case report and review of literature. Ann Med Surg (Lond) 2022; 73:103142. [PMID: 34950476 PMCID: PMC8671100 DOI: 10.1016/j.amsu.2021.103142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and important: Prostatic cancer is often prone to metastasis and bone invasion. Skull metastasis in prostate cancer is uncommon, accounting for less than 2% of all metastases. However, frontotemporal bone metastasis without dural or brain metastasis is rare. Case presentation Herein, we report the case of a 91-year-old male patient who presented with a sudden-onset dizziness, a fall to the ground, and gradual loss of consciousness. Computed tomography (CT) of the brain revealed an aggressive bony lesion secondary to locally advanced metastatic malignancy and subdural hematoma. Subsequently, he underwent decompressive craniectomy. Histopathological and immunohistochemical (IHC) examinations demonstrated metastatic prostatic adenocarcinoma (PCa). Although after treatment by a multidisciplinary team, unfortunately, the patient expired two months after the surgery and could no longer be traced. Clinical discussion In the majority of reported cases, CT scans of the brain are often mistaken for subdural hematoma or meningioma. The present case suggests is a preliminary incidental case of a single frontotemporal bony lesion. This is the first case described in the literature of incidental finding of metastatic PCa presenting with asymptomatic characteristics. Conclusion Awareness of the possibility of metastatic PCa involving the skull bones, as well as histopathological and IHC examinations, are important to arrive at a correct initial diagnosis. Prostatic cancer (PCa) metastasis to frontotemporal bone is extremely rare. PCa metastasis to the frontotemporal bone had atypical clinical manifestations. Awareness of the possibility of skull metastasis of PCa is important for diagnosis.
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28
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[A Case of Ascending Colon Cancer with Skull Metastasis]. J UOEH 2021; 43:433-443. [PMID: 34897173 DOI: 10.7888/juoeh.43.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 55-year-old woman became aware of a tumor on the left side of the head in July, 2020 and was referred to our hospital in September because of its rapid growth. A head CT showed a neoplastic lesion of the skull. A CT from the neck to the pelvis revealed an ascending colon tumor and multiple lesions in the liver, which was suspected as metastasis. A colonoscopy also showed a type 2 like lesion in the ascending colon, and a biopsy showed adenocarcinoma. A pedunculated polyp had been pointed out in the ascending colon at another hospital four years previously, and the pathological result was an adenoma, but endoscopic mucosal resection was not performed. It is considered that the adenoma became advanced colon cancer with metastasis through the mechanism of multistage carcinogenesis. Metastatic lesions of the ascending colon cancer was suspected with regard to the skull lesion. In addition to the rapid growth, surgical removal was desirable from the viewpoint of cosmetology, and surgery was performed in November. The postoperative pathological diagnosis was a metastatic skull tumor derived from ascending colon cancer. The diagnosis was Stage IVb according to the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma (9th Edition). Although chemotherapy was started after surgery, the metastatic liver cancer increased rapidly and the patient passed away in April, 2021.
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Radeczky P, Moldvay J, Fillinger J, Szeitz B, Ferencz B, Boettiger K, Rezeli M, Bogos K, Renyi-Vamos F, Hoetzenecker K, Hegedus B, Megyesfalvi Z, Dome B. Bone-Specific Metastasis Pattern of Advanced-Stage Lung Adenocarcinoma According to the Localization of the Primary Tumor. Pathol Oncol Res 2021; 27:1609926. [PMID: 34629961 PMCID: PMC8496061 DOI: 10.3389/pore.2021.1609926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/26/2021] [Indexed: 01/17/2023]
Abstract
Background: Patients with advanced-stage lung adenocarcinoma (LADC) often develop distant metastases in the skeletal system. Yet, the bone-specific metastasis pattern is still controversial. We, therefore, aimed to examine how the primary tumor location affects bone specificity and survival in LADC patients diagnosed with skeletal metastases. Methods: In total, 209 bone-metastatic Caucasian LADC patients from two thoracic centers were included in this study. Focusing on the specific location of primary tumors and bone metastatic sites, clinicopathological variables were included in a common database and analyzed retrospectively. Skeletal metastases were diagnosed according to the contemporary diagnostic guidelines and confirmed by bone scintigraphy. Besides region- and side-specific localization, primary tumors were also classified as central or peripheral tumors based on their bronchoscopic visibility. Results: The most common sites for metastasis were the spine (n = 103) and the ribs (n = 60), followed by the pelvis (n = 36) and the femur (n = 22). Importantly, femoral (p = 0.022) and rib (p = 0.012) metastases were more frequently associated with peripheral tumors, whereas centrally located LADCs were associated with humeral metastases (p = 0.018). Moreover, we deduced that left-sided tumors give rise to skull metastases more often than right-sided primary tumors (p = 0.018). Of note, however, the localization of the primary tumor did not significantly influence the type of affected bones. Multivariate Cox regression analysis adjusted for clinical parameters demonstrated that central localization of the primary tumor was an independent negative prognostic factor for overall survival (OS). Additionally, as expected, both chemotherapy and bisphosphonate therapy conferred a significant benefit for OS. Conclusion: The present study demonstrates unique bone-specific metastasis patterns concerning primary tumor location. Peripherally located LADCs are associated with rib and femoral metastases and improved survival outcomes. Our findings might contribute to the development of individualized follow-up strategies in bone-metastatic LADC patients and warrant further clinical investigations on a larger sample size.
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Affiliation(s)
- Peter Radeczky
- Department of Thoracic Surgery, National Institute of Oncology, Semmelweis University, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Judit Moldvay
- MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Budapest, Hungary.,Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Janos Fillinger
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Beata Szeitz
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Bence Ferencz
- Department of Thoracic Surgery, National Institute of Oncology, Semmelweis University, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Kristiina Boettiger
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Melinda Rezeli
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Krisztina Bogos
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Ferenc Renyi-Vamos
- Department of Thoracic Surgery, National Institute of Oncology, Semmelweis University, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Balazs Hegedus
- Department of Thoracic Surgery, Ruhrlandklinik, University Clinic Essen, Essen, Germany.,2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Zsolt Megyesfalvi
- Department of Thoracic Surgery, National Institute of Oncology, Semmelweis University, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Balazs Dome
- Department of Thoracic Surgery, National Institute of Oncology, Semmelweis University, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria
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Bistazzoni S, Bonetto S, Domenico Bellocchi S. Solitary Calvarial Metastasis As the First Presentation of Urothelial Bladder Cancer. Cureus 2021; 13:e17257. [PMID: 34422506 PMCID: PMC8370711 DOI: 10.7759/cureus.17257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/05/2022] Open
Abstract
The most common sites of metastasis from urothelial carcinoma of the bladder include the lymph nodes, bones, lungs, liver, and peritoneum. Bladder carcinoma metastases of the head are uncommon. In the English literature, only a few cases of bladder carcinoma metastasis to the skull base have been reported, and no cases of metastasis to the calvaria have been reported previously. We present the first case of calvarial metastasis from bladder carcinoma that preceded the diagnosis of the primary tumor. Bladder calvarial metastasis as the first evidence of a primary tumor is a rare event and a sign of an advanced stage of the disease. Therefore, adequate staging is essential to ensure appropriate treatment. Surgical treatment of calvarial injuries is usually secure.
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31
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Chang YS, Moonis G, Juliano AF. Posterior Skull Base Anatomy and Pathology. Semin Ultrasound CT MR 2021; 42:295-306. [PMID: 34147164 DOI: 10.1053/j.sult.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A posterior skull base lesion is an uncommon radiological finding that may be noted incidentally or during targeted imaging of patients with clinical symptoms attributable to the lesion. It may be inflammatory or neoplastic in etiology, or may simply be an anatomic variant or a "don't-touch" lesion that should not be misinterpreted as something more ominous. A systematic approach to the evaluation of the posterior skull base is therefore required in order to differentiate lesions requiring immediate attention from those requiring a less urgent course of action or none at all. This review will focus on the imaging features of pathologic conditions that are more commonly encountered in posterior skull base CT and MR examinations.
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Affiliation(s)
- Yuh-Shin Chang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gul Moonis
- Columbia University Irving Medical Center, New York, New York
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
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32
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Peters N, Zemeer MZZ, Waters C, Bambury R. Dural spread from metastatic prostate cancer. BMJ Case Rep 2021; 14:14/4/e239726. [PMID: 33906871 PMCID: PMC8088242 DOI: 10.1136/bcr-2020-239726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
A 59-year-old man with a known breast cancer type 1 gene mutation and a 2-year history of metastatic prostate cancer to bone and lymph nodes presented with a sudden onset of thunderclap headache, photophobia and a left sided facial droop. He was being treated at the time with the poly ADP ribose polymerase inhibitor Rucaparib. Of note, 6 weeks prior to this presentation, he had been diagnosed with malignant spinal cord compression at T3-T6, he underwent an emergency decompressive laminectomy and had received palliative postoperative radiotherapy. An urgent CT brain revealed dural metastases from his prostate cancer, with extensive oedema and midline shift. He underwent palliative whole brain radiotherapy but died 2 weeks later.
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Affiliation(s)
- Niamh Peters
- Medical Oncology, Cork University Hospital, Cork, Ireland
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33
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Yip JWL, Hilliar L, Le K, Loh H, Mansberg R. 68Ga-Prostate-Specific Membrane Antigen Solitary Base of Skull Prostate Adenocarcinoma Metastasis. Clin Nucl Med 2021; 46:63-65. [PMID: 33181755 DOI: 10.1097/rlu.0000000000003390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 74-year-old man with prostate adenocarcinoma (Gleason 7) was referred for Ga-prostate-specific membrane antigen (PSMA-HBED-CC) PET/CT scan for staging. Findings confirmed the prostate malignancy and demonstrated a solitary metastasis in the left skull base, with no evidence of regional or distant metastasis elsewhere. Solitary base of the skull metastasis may be subtle and easily overlooked, highlighting the need for thorough evaluation of the region.
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Affiliation(s)
| | | | - Ken Le
- From the Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood, NSW, Australia
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34
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Fujii D, Shimoda H, Uehara N, Fujita T, Teshima M, Shinomiya H, Kakigi A, Terakawa T, Fujisawa M, Nibu KI. Facial nerve palsy as the presenting feature of metastatic prostatic cancer in the temporal bone. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2020. [DOI: 10.1080/23772484.2020.1865165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Daichi Fujii
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Otolaryngology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Hikari Shimoda
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Natsumi Uehara
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Fujita
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akinobu Kakigi
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoaki Terakawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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35
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Adachi K, Maeda Y, Hayama M, Kitaguchi Y, Nojima S, Nitta K, Obata S, Nakatani A, Tsuda T, Takeda K, Morii E, Inohara H. Skull Base Metastasis of Breast Cancer With Oculomotor and Trochlear Nerve Palsy. EAR, NOSE & THROAT JOURNAL 2020; 101:NP270-NP272. [PMID: 33035131 DOI: 10.1177/0145561320963676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Skull base metastatic tumors are rare. Breast cancer in particular can cause bone metastases after a long period of time. A 70-year-old woman presented with multiple cranial nerve palsy. Magnetic resonance imaging revealed a lesion that extended from the orbit to the base of the skull, and the patient was referred to our department. Ophthalmological evaluation showed left visual acuity impairment, left oculomotor nerve palsy, and left trochlear nerve palsy. Endoscopic biopsy performed 5 years after the completion of breast cancer treatment revealed skull base metastases. In unilateral multiple cranial nerve palsy, the possibility of skull base metastases should be considered.
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Affiliation(s)
- Kana Adachi
- Department of Otorhinolaryngology-Head and Neck Surgery, 13013Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yohei Maeda
- Department of Otorhinolaryngology-Head and Neck Surgery, 13013Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Hayama
- Department of Otorhinolaryngology-Head and Neck Surgery, 13013Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiyuki Kitaguchi
- Department of Ophthalmology, 13013Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Nojima
- Department of Pathology, 13013Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kanae Nitta
- Department of Surgery, Otemae Hospital, Osaka, Japan
| | - Sho Obata
- Department of Otorhinolaryngology-Head and Neck Surgery, 13013Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ayaka Nakatani
- Department of Otorhinolaryngology-Head and Neck Surgery, 13013Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Tsuda
- Department of Otorhinolaryngology-Head and Neck Surgery, 13013Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Takeda
- Department of Otorhinolaryngology-Head and Neck Surgery, 13013Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, 13013Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, 13013Osaka University Graduate School of Medicine, Osaka, Japan
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Othman IA, Zahedi FD, Husain S. Base of Skull Metastatic Adenocarcinoma from the Breast 23 Years after the Primary Diagnosis. Case Rep Med 2020; 2020:2610597. [PMID: 32802078 PMCID: PMC7414367 DOI: 10.1155/2020/2610597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022] Open
Abstract
Breast cancer metastases to the base of the skull with concomitant infiltration into the paranasal sinuses and nasopharynx are exceptionally rare with only small numbers of reported literatures. Greenberg et al. in 1981 described five clinical syndromes with regards to the base of skull metastases and the clinical presentation of each syndrome related to its anatomical location. Often, metastases to the base of the skull remain asymptomatic until the lesion has increased to a considerable size causing bony destruction and impingement to the surrounding structures. When involving the paranasal sinuses or nasopharynx, the most common presenting symptoms mimic those of rhinosinusitis and, hence, may delay the accurate diagnosis. We are reporting a case of base of skull metastasis from breast carcinoma, 23 years after the primary diagnosis. To the best of our knowledge, our case is the first case to report latent metastasis of more than 20 years.
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Affiliation(s)
- Iylia Ajmal Othman
- Department of Otorhinolaryngology Head and Neck Surgery, Kulliyyah of Medicine, IUniversity Malaysia, Kuantan, Pahang, Malaysia
| | - Farah Dayana Zahedi
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Salina Husain
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Cholangiocarcinoma Metastasis to the Spine and Cranium. Ochsner J 2020; 20:197-203. [PMID: 32612476 PMCID: PMC7310165 DOI: 10.31486/toj.18.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Cholangiocarcinoma (CCC), a rare tumor arising from the viscera, has a poor prognosis. Although CCC is prone to metastasis, spread to the cranium and spine is exceedingly rare. Treatment for metastatic disease is palliative, with total resection of the primary lesion the only cure. We describe a case of metastatic CCC to the spine and cranium treated with surgical resection. Case Report: A 61-year-old male with a history of hepatitis C with liver transplant and incidental discovery of CCC presented with gradually increasing back pain. Physical examination revealed a palpable nontender mass in the parieto-occipital area. Computed tomography survey of the spine and head revealed mixed sclerotic and lytic lesions of the T9, T11, L2, and L5 vertebral bodies, a lytic lesion on the T6 vertebral body, and a 1.4-cm lesion in the right occipital calvarium. The patient underwent right occipital craniotomy for excisional biopsy of the calvarial mass with gross total resection and immunohistochemical confirmation of CCC. The patient was started on gemcitabine chemotherapy and radiation therapy for spinal metastases. Three months later, the patient died from metastatic disease complications. Conclusion: To our knowledge, only 6 cases of cranial CCC have been reported, and only 2 reported mixed cranial/spinal involvement. We report a rare case of CCC metastasis to the spine and cranium that was treated with surgery, chemotherapy, and radiotherapy. CCC should be considered an exceedingly rare etiology with treatment options aimed solely at palliation. This case supplements the existing literature to inform medical and surgical decision-making.
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Custom-Made Porous Hydroxyapatite Cranioplasty in Patients with Tumor Versus Traumatic Brain Injury: A Single-Center Case Series. World Neurosurg 2020; 138:e922-e929. [PMID: 32272268 DOI: 10.1016/j.wneu.2020.03.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cranioplasty is a common neurosurgical procedure with the goal of restoring skull integrity. Custom-made porous hydroxyapatite prostheses have long been used for cranial reconstruction in patients with traumatic brain injury. We present a large consecutive series of 2 groups of patients undergoing cranioplasty with hydroxyapatite custom bone and compare the adverse events (AEs) between the 2 groups. METHODS We examined a series of consecutive patients who underwent cranioplasty using custom-made porous hydroxyapatite implants following tumor resection and traumatic brain injury at a single center between March 2003 and May 2018. The implants were designed and produced according to the surgeon's specifications and based on the patient's computed tomography scan data obtained through a standardized protocol. AEs were recorded. RESULTS Information on 38 patients with tumor and 39 patients with traumatic brain injury was collected and analyzed. A significant difference in the timing of surgery was found between the 2 groups; single-stage surgery was performed in 84% of patients in the tumor versus 8% of those in the traumatic brain injury group (P < 0.0001). The rate of AEs was not significantly different between the 2 groups (P = 0.4309) and was not related to the timing of surgery. CONCLUSIONS Custom-made hydroxyapatite cranioplasty is a solution for cranial reconstruction in patients with cranial tumors. The low incidence of AEs in a consecutive series of patients with either trauma or tumors demonstrates that these prostheses represent a safe solution independent of the characteristics of cases.
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Patel R, Mehta A, Suri K, Bocian H, Hu J. Phyllodes tumor with metastases to the skull managed with local excision: A case report. Rare Tumors 2019; 11:2036361319890710. [PMID: 31807262 PMCID: PMC6880032 DOI: 10.1177/2036361319890710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The behavior of phyllodes tumors is unpredictable and can behave as benign fibroadenomas or malignant neoplasms mimicking the course of aggressive sarcomas, characterized by distant metastases and a high short-term mortality. The malignant forms are treated with surgery and adjuvant chemotherapy, but often with poor outcomes. We examine the first reported case of an aggressive osteosarcoma subtype of phyllodes tumor that recurred in the skull after total mastectomy and adjuvant chemotherapy. The skull lesion was treated with excision, and the patient currently remains disease-free.
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Affiliation(s)
- Ronak Patel
- Internal Medicine, University of Southern California, Los Angeles, CA, USA
| | - Arjun Mehta
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - Kabir Suri
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Hillel Bocian
- Internal Medicine, University of Southern California, Los Angeles, CA, USA
| | - James Hu
- Medical Oncology, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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Pechenkina K, Fan W, Luo X. What's that big thing on your head? Diagnosis of a large frontoparietal lesion on an Eastern Zhou skull from Henan, China. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 26:84-92. [PMID: 31349131 DOI: 10.1016/j.ijpp.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 06/18/2019] [Accepted: 06/23/2019] [Indexed: 06/10/2023]
Abstract
We carried out a differential diagnosis of a large frontoparietal lesion on a human skull from a Late Bronze Age archaeological site located on the Central Plain of China, dating to between 771 and 476 BC. The head of this individual was covered in cinnabar, a mercury-based pigment that later was used for medicinal purposes in China. The lesion was well-circumscribed and involved the outer and inner tables of the skull, slight diploë thickening, and coarsening of bone trabeculae with expansion of intertrabecular spaces. We show that the observed changes are most consistent with cavernous hemangioma of the skull, a benign vascular malformation that preferentially affects older adults. Hemangiomas are often neglected in the paleopathological literature because of their benign nature - they tend to be asymptomatic and do not affect quality of life to a significant degree. Nevertheless, they produce characteristic lesions that can be confused with several other conditions with unrelated etiologies, including congenital hemoglabinopathies, traumas, malignant or benign neoplasms, and Paget's disease. We outline the diagnostic criteria that distinguish cavernous hemangioma from other conditions affecting the skull.
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Affiliation(s)
| | - Wenquan Fan
- Henan Provincial Institute of Cultural Relics and Archaeology, China
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41
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Bandoh N, Ichikawa H, Asahi A, Kono M, Harabuchi S, Sato R, Uemura A, Goto T, Yamaguchi T, Kato Y, Furukawa H, Takei H, Harabuchi Y. Lung Adenocarcinoma with Cheek Dysesthesia as an Initial Symptom: A Case Report and Literature Review. Case Rep Oncol 2019; 12:650-656. [PMID: 31572154 PMCID: PMC6751463 DOI: 10.1159/000502053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/18/2022] Open
Abstract
Metastasis from lung carcinoma to the sphenoid bone is rare. Patients with symptoms related to sphenoid bone metastasis as the initial presentation of carcinoma are thus also rare. Herein, we report the case of a patient presenting with only cheek dysesthesia as the first sign of lung adenocarcinoma. The 74-year-old woman presented with a 2-month history of left cheek dysesthesia. CT showed a tumor around 2.5 cm in diameter with heterogeneous enhancement of the central focus at the left foramen rotundum in the sphenoid bone. We endoscopically biopsied the tumor through the left sphenoid sinus. Results of histologic examination were consistent with lung adenocarcinoma. FDG-PET/CT analysis demonstrated lung carcinoma that had already metastasized to mediastinal lymph nodes and multiple bones, such as the ribs and lumbar vertebras, in addition to the sphenoid bone. As EGFR gene mutation (p.L858R) was identified, the patient was treated with oral gefinitib. This treatment proved quite effective, and the patient remains alive without tumor growth as of 18 months.
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Affiliation(s)
- Nobuyuki Bandoh
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Japan
| | - Haruyuki Ichikawa
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Japan.,Department of Surgical Pathology, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Atsuyoshi Asahi
- Department of General Medicine, Hokuto Hospital, Obihiro, Japan
| | - Michihisa Kono
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Japan.,Department of Surgical Pathology, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Shohei Harabuchi
- Department of Surgical Pathology, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Ryosuke Sato
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Japan
| | - Akihiro Uemura
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Japan
| | - Takashi Goto
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Japan
| | - Tomomi Yamaguchi
- Department of Biology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Obihiro, Japan
| | - Yasutaka Kato
- Department of Biology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Obihiro, Japan
| | - Hironori Furukawa
- Department of Biology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Obihiro, Japan
| | - Hidehiro Takei
- Department of Surgical Pathology, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Japan
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42
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Tao Y, Yagi K, Nishimura H, Hara K, Matsubara S, Uno M. Orbitotemporal Bone Cyst of Metastatic Breast Cancer: Case Report and Literature Review. World Neurosurg 2019; 130:267-270. [PMID: 31319189 DOI: 10.1016/j.wneu.2019.07.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Metastatic breast cancer in the bone rarely has a cystic appearance, and while it is common in the orbit, its metastasis to the orbitotemporal skull is rare. Consequently, it is difficult to diagnose it. We report and discuss a rare case of metastatic breast cancer with simple cyst appearance in the orbitotemporal region of the skull. CASE DESCRIPTION A 63-year-old woman presented with mild double vision only on left gaze that lasted for 2 months. Ten and a half years ago, the patient underwent surgery for tumor resection of a stage 3 breast adenocarcinoma, followed by radiotherapy and administration of anticancer therapy. Thereafter, she continued hormonal therapy with antiestrogen drugs, which was discontinued a half year ago because there was no recurrence during treatment. On admission, magnetic resonance imaging (MRI) showed a single and simple cystic lesion in the orbitotemporal region of the skull. The cyst was filled with fluid of different intensity, indicative of a hemorrhagic component. Additional gadolinium-contrasted MRI showed no enhancing effects in the lesion. The cyst was totally removed by surgery, and the histologic examination confirmed the diagnosis of breast adenocarcinoma. Intensity-modulated radiotherapy was then administered, and the patient started follow-up hormonal therapy with antiestrogen agents. No recurrence in the orbitotemporal region of the skull occurred during 6 months after the surgery. CONCLUSIONS Metastatic breast cancer should be considered in the differential diagnosis even if it appears as a simple cyst in the orbitotemporal bone after long-term remission.
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Affiliation(s)
- Yoshifumi Tao
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
| | - Hirotake Nishimura
- Department of Pathology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Keijirou Hara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Shunji Matsubara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Benevento I, DE Felice F, Bulzonetti N, Caiazzo R, Cassese R, Musio D, Tombolini V. Successful Treatment of Anal Canal Cancer Metastasis to the Cranial Bones: A Case Report and Literature Review. In Vivo 2019; 33:1347-1353. [PMID: 31280229 DOI: 10.21873/invivo.11610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/10/2022]
Abstract
Single metastasis to the cranial bone represents a very uncommon occurrence that can arise from an anal canal cancer. No cases of cranial bone metastasis from anal canal carcinoma are available in the literature. Herein, we present a case of a unique metastatic lesion to the right parietal bone that occurred after curative chemoradiotherapy of primary squamous cell anal canal carcinoma. The patient received radiotherapy and systemic platinum-based chemotherapy, with optimal local control, high compliance and a well tolerable level of toxicity.
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Affiliation(s)
- Ilaria Benevento
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Francesca DE Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Nadia Bulzonetti
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Rossella Caiazzo
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Raffaele Cassese
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Daniela Musio
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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Gomez CK, Schiffman SR, Bhatt AA. Radiological review of skull lesions. Insights Imaging 2018; 9:857-882. [PMID: 30232767 PMCID: PMC6206383 DOI: 10.1007/s13244-018-0643-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/17/2018] [Accepted: 06/28/2018] [Indexed: 11/29/2022] Open
Abstract
Abstract Calvarial lesions are often asymptomatic and are usually discovered incidentally during computed tomography or magnetic resonance imaging of the brain. Calvarial lesions can be benign or malignant. Although the majority of skull lesions are benign, it is important to be familiar with their imaging characteristics and to recognise those with malignant features where more aggressive management is needed. Clinical information such as the age of the patient, as well as the patient’s history is fundamental in making the correct diagnosis. In this article, we will review the imaging features of both common and uncommon calvarial lesions, as well as mimics of these lesions found in clinical practice. Teaching Points • Skull lesions are usually discovered incidentally; they can be benign or malignant. • Metastases are the most frequent cause of skull lesions. • Metastatic lesions are most commonly due to breast cancer in adults and neuroblastoma in children. • Multiple myeloma presents as the classic “punched out” lytic lesions on radiographs. • Eosinophilic granuloma is an osteolytic lesion with bevelled edges.
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Affiliation(s)
- Carrie K Gomez
- Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14602, USA.
| | - Scott R Schiffman
- Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14602, USA
| | - Alok A Bhatt
- Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14602, USA
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Ugga L, Cuocolo R, Cocozza S, Ponsiglione A, Stanzione A, Chianca V, D'Amico A, Brunetti A, Imbriaco M. Spectrum of lytic lesions of the skull: a pictorial essay. Insights Imaging 2018; 9:845-856. [PMID: 30232766 PMCID: PMC6206388 DOI: 10.1007/s13244-018-0653-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/18/2018] [Accepted: 08/07/2018] [Indexed: 12/17/2022] Open
Abstract
Abstract Lytic lesions of the skull include a wide range of diseases, ranging from benign conditions such as arachnoid granulations or vascular lacunae, to aggressive malignant lesions such as lymphomas or metastases. An early and correct characterisation of the nature of the lesion is, therefore, crucial, in order to achieve a fast and appropriate treatment option. In this review, we present the radiological appearance of the most frequent lytic lesions of the skull, describing findings from different imaging modalities (plain X-rays, CT and MRI), with particular attention to diagnostic clues and differential diagnoses. Teaching Points • Osteolytic skull lesions may be challenging to diagnose. • Association of different imaging techniques may aid image interpretation. • Clinical information and extensive knowledge of possible differential diagnoses is essential. • Some osteolytic tumours, although benign, may present as locally aggressive lesions. • Malignant lesions require accurate staging, followed by variable treatment approaches.
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Affiliation(s)
- Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Vito Chianca
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Alessandra D'Amico
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
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Cho S, Choi JY, Kim JY, Seo KW, Chang HK, Park YS, Kim BS. Solitary osteolytic skull metastasis as the only recurrence of advanced gastric cancer: a case report and literature review. Br J Neurosurg 2018; 36:111-114. [DOI: 10.1080/02688697.2018.1498968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Seongmin Cho
- Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Jae Young Choi
- Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Jong Yeol Kim
- Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Hee Kyung Chang
- Department of Pathology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Yong-Seok Park
- Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Byung Sup Kim
- Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
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47
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Seong GH, Lee J, Choi SW, Hong Y, Son MJ, Shim JW, Kim JY, Kang SY. An Isolated Skull Lesion in Syphilis. Headache 2018; 58:1122-1124. [PMID: 29781128 DOI: 10.1111/head.13319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Gi-Hun Seong
- Department of Neurology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi-Do, Republic of Korea
| | - Jeeun Lee
- Department of Neurology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi-Do, Republic of Korea
| | - Sang Won Choi
- Department of Neurology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi-Do, Republic of Korea
| | - Yooha Hong
- Department of Neurology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi-Do, Republic of Korea
| | - Myeong Jin Son
- Department of Neurology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi-Do, Republic of Korea
| | - Jung Won Shim
- Department of Pathology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi-Do, Republic of Korea
| | - Joo Yong Kim
- Department of Neurology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi-Do, Republic of Korea
| | - Suk Yun Kang
- Department of Neurology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Gyeonggi-Do, Republic of Korea
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48
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Freiburg Neuropathology Case Conference : A Painless Mass Lesion of the Parietal and Occipital Bones. Clin Neuroradiol 2018; 28:301-306. [PMID: 29696306 DOI: 10.1007/s00062-018-0691-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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49
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Messina M, Ricci F, Spina B, Boccardo F. Single Skull Metastasis 15 Years after Primary Treatment of Prostate Cancer and with Undetectable PSA Levels: A Case Report and Review of the Literature. TUMORI JOURNAL 2018; 99:e220-4. [DOI: 10.1177/030089161309900517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prostate cancer is the first cause of skull metastases in men, accounting for 12–18% of all cases. This condition is generally a late event in the course of the disease, involving patients with disseminated lesions. Quite rarely is skull involvement the first and single site of distant recurrence. We report the case of a patient who developed a single skull lesion 15 years after primary treatment of prostate cancer, in the presence of undetectable PSA levels. Pathological assessment performed after resection of the lesion revealed a metastasis from prostate carcinoma. Basing on this experience the appearance of craniofacial pain or a nerve deficit in patients with a history of prostate cancer should alert the clinician to exclude distant recurrence of disease, even in the presence of undetectable PSA levels and even if many years have elapsed since the treatment of the primary tumor. Knowledge of these manifestations will reduce any diagnostic delay and lead to the effective delivery of appropriate treatment.
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Affiliation(s)
- Marco Messina
- Department of Internal Medicine, School of Medicine, University of Genoa, Genoa
- Department of Medical Oncology, San Raffaele G Giglio Foundation Institute, Cefalù
| | - Francesco Ricci
- Department of Internal Medicine, School of Medicine, University of Genoa, Genoa
| | - Bruno Spina
- Department of Histopathology and Cytology, IRCCS San Martino University Hospital, IST National Cancer Research Institute, Genoa, Italy
| | - Francesco Boccardo
- Department of Internal Medicine, School of Medicine, University of Genoa, Genoa
- Academic Department of Medical Oncology, IRCCS San Martino University Hospital, IST National Cancer Research Institute, Genoa, Italy
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50
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Nolan C, Deangelis LM. Overview of metastatic disease of the central nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2018; 149:3-23. [PMID: 29307359 DOI: 10.1016/b978-0-12-811161-1.00001-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In 2016, the American Society of Clinical Oncology reported that 1.7 million Americans were diagnosed with cancer; this number will rise to 2.3 million in the United States and 22 million worldwide in 2030. This rising need is being met by an explosion of new cancer therapies, including: immune checkpoint inhibitors, T-cell therapies, tumor vaccines, antiangiogenic therapies, and various targeted therapies. This armamentarium of targeted therapies has led to better systemic control of disease and longer patient overall survival (OS). The incidence of metastatic disease to the central nervous system (CNS) is rising as patients are living longer with these more effective systemic therapies. Prolonged OS allows increased time to develop CNS metastases. The CNS is also a sanctuary for metastatic tumor cells that are protected from full exposure to therapeutic concentrations of most anticancer agents by the blood-brain barrier, the tumor microenvironment, and immune system. In addition, CNS metastases often develop late in the course of the disease, so patients are frequently heavily pretreated, resulting in drug resistance. Although genomic profiling has led to more effective therapies for systemic disease, the same therapy may not be effective in treating CNS disease, not only due to failure of blood-brain barrier penetration, but from discordance between the molecular profile in systemic and CNS tumor.
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Affiliation(s)
- Craig Nolan
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Lisa M Deangelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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