PMC9297453_01
(a and b) Axial cervical contrast-enhanced CT scan showing a left heterogeneous posterior cervical mass, with a massive destruction of the occipital bone without a periosteal reaction, associated to an endocranial extension repressing the left cerebellum without invading it. (c and d) Cervical MRI, axial and frontal T2-weighted images showing a hyper-intense irregular and heterogeneous mass centered on the occipital bone, surrounded by a hypo-intense halo with a loco-regional and endocranial extension repressing the left hemi cerebellum.
10.1177_2050313X221113940-fig1.jpg
PMC9297453_01_10.1177_2050313X221113940-fig1.jpg
fig1-2050313X221113940
CT scan revealed a posterior cervical mass measuring 63 mm x 75 mm x 50 mm reaching the superficial cervical fascia, the parotid gland and the sternocleidomastoid muscle with an endocranial extension and a destruction of the occipital bone and the retro-auricular temporal bone and with punctiform calcifications within the lesion (Figure 1). It showed a significant enhancement, predominantly on the peripheral parts (Figure 1).
(a) Perioperative image after the mass resection, showing the occipital bone lesion (black arrow). (b) Macroscopic view of the resected cervical mass, showing a hemorrhagic mass 8 cm x 6 cm x 3 cm.
10.1177_2050313X221113940-fig2.jpg
PMC9297453_01_10.1177_2050313X221113940-fig2.jpg
fig2-2050313X221113940
We noted the presence of an important lesion at the occipital bone reaching and repressing the left cerebellum, yet the dura mater was intact (Figure 2).
The lesion consists of multiple vessels of varying sizes and proportions, haphazardly arranged: dilated capillaries (black arrows) ((a): H&E 50x) and thick muscle walls veins (blue arrows) with regular endothelium ((b) H&E 200x). Vessels dissociate occipital bone ((c) H&E 100x) and extend to subcutaneous fat and skeletal muscle ((d) H&E 100x).
10.1177_2050313X221113940-fig3.jpg
PMC9297453_01_10.1177_2050313X221113940-fig3.jpg
fig3-2050313X221113940
We did not record the presence of arterial vessels with their various parietal tunics and elastic laminae (Figure 3).