PMC5981183_01
Clinical picture of the patient that had a large swelling on his scalp covering his right eye lid. (a) Front side and (b) right side
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F1
Upon palpation the lesion was firm but without any tenderness [Figure 1].
(a) CT scan imaging showing infiltrating mass at the frontal region. (b) CT scan reveal bone discontinuity due to bony destruction
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F2
Computed tomography (CT) scan of the head revealed a calvarial soft tissue mass predominantly located in right frontoparietal with infiltrating mass on the frontal region and associated right frontal bone defect [Figure 2a and b].
The MRI scan showing (a) lobulated mass at frontal region which (b) enhanced homogenously after contrast administration. (c) The mass extends to the frontal base viewed by coronal plane and (d) shows various intensity on T2 imaging
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F3
T1 showing lobulated mass at frontal region [Figure 3a], which enhanced homogenously after contrast administration [Figure 3b]. T2 imaging [Figure 3d]. The tumor showed extension from extracranial compartment through the bony defect into the right frontal lobe and frontal base. The decision was made to pursue resection.
(a) Recurrence of mass on the previous surgery site with marked enhancement on T1 imaging. (b) Contralateral cavernous sinus showing new mass that was not seen on previous images
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F4
The images show local recurrence on right frontal lobe; interestingly, a new lesion was prominent on contralateral cavernous sinus [Figure 4].
PMC5981183_02
Clinical picture of the patient with two large lumps on his head. (a) Front side and (b) left side. (c) Head CT scan reveal bone discontinuity due to bony destruction
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F5
On physical examination, we encountered two firm, noncompressible, nontender, nonpulsatile masses that measured approximately 6 x 5 cm and 8 x 8 cm in the frontal region with head CT scan reveal bone discontinuity due to bony destruction [Figure 5].
Intraoperative findings. (a) A cranioplasty measuring 4 x 4 cm was performed with a large scalp defect. (b) Postoperative image after 6 months. (c) High-cellular density of spindle-shaped tumor cells with frequent mitotic figures (high power fields with hematoxylin and eosin stain). (d) S-100 immuno-histochemistry, IHC. (e) Ki-67 IHC
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F6
After excising the mass, the scalp defect measured approximately 15 x 12 cm and the reconstruction was completed using a myocutaneous flap with a muscle cuff along with the vascular pedicle [Figure 6a and b]. Light microscopy revealed that the tumor cells were monomorphic spindle-shaped cells with frequent mitotic figures [Figure 6c]. Immunohistochemistry revealed positive immunoreactivity with S-100 and ki-67 protein [Figure 6d and e].