PMC8597780_01
Schematic showing the location of the cranial mass in the patient's parieto-occipital region.
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Upon review of systems, the patient manifested having a cranial mass located in the parieto-occipital region for the past 13 years (Figure 1), which he believed had developed after head trauma he suffered in a motor vehicle accident.
A and B (coronal and sagittal views respectively) - Bone computed tomography (CT). Large midline permeative calvarial lesion with areas of thickening/erosion of the inner table and extensive periosteal reaction; C - Coronal post-gadolinium fat-saturated T1 sequence. Large intraosseous mass with demonstration of intracranial extension, invasion into the superior sagittal sinus, and regional dural thickening and enhancement.
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T1 sequence showed a large intraosseous mass with demonstration of intracranial extension, invasion into the superior sagittal sinus and regional dural thickening and enhancement (Figure 3). The favored pre-operative clinical diagnosis was osteosarcoma.
Gross examination of the resected bone. The image shows a fragment of calvarium measuring 22.5 cm in its longest axis, 7 cm in the coronal plane, and up to 1.5 cm in thickness. The bone is expanded by a mass.
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No areas of necrosis were grossly identified (Figure 4).
Photomicrographs of the tumor. A - Smear preparation showing cells with meningothelial differentiation forming whorls (H&E, 400x); B - predominantly intraosseous tumor with associated hyperostosis (H&E 200x); C - few scattered mitotic figures (red arrows) (H&E 400x); D - focally elevated Ki-67 proliferation rate (100x); and invasion into adipose tissue (arrow).
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