PMC5223761_01
Imaging findings of skull metastasis and hepatic metastasis in a patient with malignant gastrointestinal stromal tumor. A: Post-contrast brain CT image reveals a 7.7 cm sized, well-defined mass (arrows) centered on the diploic space of the calvaria. B: Abdomen CT image reveals a hypodense single metastasis (arrow) in left medial segment of the liver. C and D: Axial T1- (C) and T2-weighted (D) MR images show heterogeneous signal intensity of the skull metastasis. The dura (arrows) is intact and the underlying cortex appears compressed. Note the multiple signal voids on T2-weighted image. E: After gadolinium enhancement, the mass demonstrates heterogeneous enhancement.
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The mass continued to grow, and CT scan of brain and abdomen which were taken three months later showed a large mass located in the parietal cranial vault suppressing adjacent brain and a small single liver metastasis (Fig. 1). Subsequent MRI revealed a heterogeneously enhancing mass of approximately 7.7 cm ex tent involving the right parietal bone, parietal scalp, and parietal convexity with a heterogeneous signal intensity on a T1/T2 weighted image, multiple signal void on a T2 weighted image, and fatty marrow signal loss with enhancement (Fig. 1).
Pathology of a resected skull tumor. A: Metastatic gastrointestinal stromal tumor in the skull. The tumor consists of atypical spindle cells with high cellularity and infiltrative growth pattern with destruction of normal bone tissue (H&E, x100). B: High power view of the tumor. Mitotic figures (arrows) are frequently noted (H&E, x400). C: Tumor cells are positive for c-kit (c-kit immunostain, x400).
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Diagnosis of metastatic GIST was confirmed by pathologic examination (Fig. 2).