PMC4534606_01
MRI scan of the head, 7/9/2014. (a) Axial T1 image shows a large posterior skull base mass. Note the normal bright fatty marrow (short green arrow) compared to darker signal from the mass (long green arrow). (b) Axial T1 image shows the mass (red oval) involving both the jugular foramen and the hypoglossal canal. Note the normal position of the contralateral jugular foramen (short red arrow) and the hypoglossal canal (long red arrow) for reference. (c) Axial T2 image shows involvement of the petrous temporal bone (blue oval) extending into the posterior inferior mastoid air cells, with bright reactive mastoid fluid (blue arrow).
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The MRI revealed an extensive tumor involving the skull base, including the clivus and petrous temporal bone with extension into the posterior-inferior mastoid air cells (Figure 1).
CT scan of the head without contrast, axial images, 8/11/2014, showing a destructive lesion centered within the left occipital bone with extension into the inferior mastoid temporal bone (a) and occipital condyle (b).
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This confirmed presence of an infiltrative bony lesion involving the skull base (Figure 2).
Left petrous bone biopsy, immunohistochemistry staining positive for pan keratin.
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Biopsy confirmed metastatic prostate carcinoma:the tissues staining for pan keratin (Figure 3) and PSA (Figure 4).
Left petrous bone biopsy, immunohistochemistry staining positive for PSA.
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Biopsy confirmed metastatic prostate carcinoma:the tissues staining for pan keratin (Figure 3) and PSA (Figure 4).
Nuclear medicine bone scan, using technetium 99m-MDP, posterior view; it shows intense radiotracer uptake in the left temporal bone and focal radiotracer localization in the upper thoracic spine.
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To complete a metastatic workup, a technetium 99m scintigraphy was performed, which demonstrated intense radiotracer uptake in the left temporal bone consistent with biopsy-proven metastatic prostate carcinoma (Figure 5).