PMC10070291_01
Preoperative X-ray and digital subtraction angiography. (a and b) Skull X-ray. Note mixture of permeative deossification and sclerosis with preserved outline of the skull (black arrowheads) underlying the subcutaneous tumor (white arrowheads). (c and d) Lateral digital subtraction angiography of the right external carotid artery (c) and right internal carotid artery (d). The angiograph shows poor vascularization of the extracranial and intracranial compartments of the tumor from both the external and internal carotid artery circulations. Line of circles: the outer table of the skull; line of squares: the contour of the skin.
SNI-14-107-g001.jpg
PMC10070291_01_SNI-14-107-g001.jpg
F1
Skull X-rays showed slight permeative deossification of the outer table and diploic space, sclerosis of the inner table, and preserved outline of the skull underlying the subcutaneous tumor [Figures 1a and b]. Digital subtraction angiography (DSA) showed a partial tumor stain from the bilateral middle meningeal arteries, left superficial temporal artery, and bilateral supraorbital arteries, with a large avascular area [Figures 1c and d].
Preoperative computed tomography (CT) and magnetic resonance imaging. (a and b) Axial CT of the brain parenchyma window (a) and the bone window (b). The large extracranial component and relatively small intracranial component (arrowheads on [a]) sandwiched the cranial vault with permeative deossification (arrowheads on [b]) and periosteal reaction (arrows on [b]). (c-f) T1-weighted imaging (c), T2-weighted imaging (d), and post contrast T1-weighted imaging in the axial plane (e) and sagittal plane (f). The dura mater is raised from the cranial vault (arrowheads on [d]), and subdural extension (arrows on [e] and [f]) and brain invasion (arrowheads on [e] and [f]) are observed. Note that the cranial vault contour is preserved despite the large mass size in (b).
SNI-14-107-g002.jpg
PMC10070291_01_SNI-14-107-g002.jpg
F2
Computed tomography (CT) of the head showed a hyperdense subcutaneous mass and mixed mildly hyper and hypodense subdural mass [Figure 2a]. CT showed mild periosteal reaction, permeative lytic changes of the outer and inner tables, smudgy interfaces between the diploe and the outer and inner tables, and preserved original skull contour despite the large tumor sandwiching the cranial vault [Figure 2b]. Contrast-enhanced (CE) CT of the head showed a diffuse and heterogeneously enhanced mass sandwiching the cranial vault, with hypodense edema in the right frontal lobe. On magnetic resonance imaging (MRI), the mass lesion was isointense on T1- and T2-weighted imaging (T1WI and T2WI, respectively) and heterogeneously enhanced with subarachnoid extension on CE-T1WI [Figures 2c-f].
Histopathological features of the tumor and metastatic lesions. (a) Hematoxylin and eosin staining of the tumor at x400 magnification, (b) post contrast axial computed tomography of the abdomen, and (c-e) fluorodeoxyglucose F 18 positron emission tomography (FDG-PET) of the head (c), neck (d), and abdomen (e). The cranial vault lymphoma shows a stronger signal on FDG-PET than does the brain (c). Note metastatic lesions in the lymph nodes of the neck (d) and in the pancreas (arrow on [b] and strong signal in [e]) and kidneys (arrowheads on [b] and strong signal in [e]).
SNI-14-107-g003.jpg
PMC10070291_01_SNI-14-107-g003.jpg
F3
Histological findings were characteristic of a diffuse large B-cell lymphoma [Figure 3a]. CE-CT of the abdomen, chest, and pelvis, as well as fluorodeoxyglucose F 18 positron emission tomography (FDG-PET), showed metastatic lesions in the lymph nodes of the head and neck, in the pancreas, and in the kidneys [Figures 3b-e]. FDG-PET also showed a stronger signal in the cranial vault lymphoma than in the brain parenchyma [Figure 3c].