PMC4014821_01
Plain X-rays showing large lenticular shaped expansion of a calvarial lesion in AP view, with irregular margins expanding the bone from in front of the coronal suture anteriorly, adjacent to the petrous base inferiorly, behind the lambdoid suture posteriorly and juxta to the sagittal suture in the midline
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F1
Plain X-ray showed a wide lucent trabeculated area expanding the bone [Figure 1].
Horizontal nonenhanced sections, a multicompartmental, trabeculated mass expanding the calvarial bone in all directions is visible. The density of the lesion in the hypodense regions varied between -50 and -100. These hypodensities were separated by osseous and calcified septations and foci
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F2
There was no significant enhancement after contrast material injection [Figure 2].
Horizontal, coronal and sagittal angio-enhancing, standard, and 3D sections showing mild vascularity of the lesion and its interface with the dura mater
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F3
Three dimensional CT and CT angiographic reconstruction of the cranium elucidated the geographical pattern of the lesion in relation with the whole skull and the remarkable vascular markings all around the lesion [Figure 3].
Axial T1W and T2W MR images showing hyperintense trabeculated lesion expanding the calvarial bone both intra- and extra-cranially. The tumoral tissue extended within the diploe of the adjacent frontal, temporal, occipital bones, and toward the midline suture
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F4
T2W images, the lesion was nonhomogeneously hypeintense and trabeculated with no perilesional edema [Figure 4]. There was no remarkable enhancement after contrast material injection.
FLAIR sequence of MR images in coronal view showing mixed hypo- and hyper-intensities compatible with mixed lipoid and hemosiderin/clot filled compartments in the vicinity of the tumor
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F5
In the FLAIR-images, the lesion was trabeculated and nonhomogeneously hypointense [Figure 5].
a and b, demonstrating the lesional flap involving the thickened bone measuring 20 x 13 x 6 cm regarding the greatest diameter of the lesion. Both the outer and inner cortical surfaces were irregular, and the overlying periosteum was discolored. The vascular markings of the inner surface of the bone were remarkable. The cut surface of the lesion was shiny-yellow with fat bobbles. 6c, showing the specimen after formalin fixation and before decalcification containing yellow-brown lesion with varying consistencies
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F6
It was a yellowish lipomatous bone with cancellous and vascular components [Figure 6]. The Sudan black stain was positive for neutral lipid cells in the tissue [Figure 6].