PMC6159124_01
Clinical photograph of the patient at presentation, demonstrating the "lump" on the forehead.
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On examination, the lump (Figure 1) over the frontal region was hard, fixed and tender on palpation.
Axial CT slice (a) demonstrating the frontal bone metastasis involving both the outer and inner tables of the bone; three-dimensional reconstruction (b) of the lesion demonstrating the location within the frontal bone.
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CT scan demonstrated that the lesion involved both the outer and the inner tables of the frontal bone (Figure 2).
Haematoxylin and eosin histopathology revealing pleomorphic tumour cells having predominantly eosinophilic cytoplasm, prominent nucleoli and cells being arranged in both trabecular and solid patterns.
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Upon core needle biopsy, the lesion on haematoxylin and eosin staining (Figure 3) demonstrated pleomorphic tumour cells having predominantly eosinophilic cytoplasm, prominent nucleoli and cells arranged in both trabecular and solid patterns.
(a) Coronal positron emission tomography scan slice revealing highly avid lesion in the liver, thoracic vertebrae as well as less avid lesions in the lungs; (b) multiple lesions in the liver on CT scan; (c) post-vertebral fixation image revealing multiple cannonball metastases in both lungs.
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The lesions in the liver, lungs and dorsal vertebrae were also visualized on digital reconstruction of CT images (Figure 4). After fixation of vertebral metastasis (Figure 4c), his involved vertebrae were irradiated with a dose of 20 Gy in five fractions with 6-MV beam by a single direct field, calculated using the skin-source distance of 100 cm with a depth of 4 cm.