Calvarial Metastasis Research Articles

The Surgical Management of Intracranial Metastasis Secondary to Follicular Cell-Derived Thyroid Carcinoma.

Intracranial metastases (ICM) from follicular cell-derived thyroid carcinoma (FCDTC) are rare and are associated with a poor prognosis. The objective of this study is to report our experience in the surgical management of patients with ICM secondary to FCDTC. Patients with FCDTC who underwent surgical resection of an ICM were identified at our institution from 1998 to 2018. Thirty-two patients were included in this study. Nineteen patients (59%) had involvement of the brain parenchyma only, 8 (25%) had a dural-based metastasis, 3 (9%) had a calvarial metastasis with dural extension, and 2 (6%) had a skull base metastasis with dural extension. In patients who had an R0-1 resection, the estimated lesional control at the site of resection was 91% at 3 years. However, overall ICM control was 37% at 3 years due to the progression of other ICM lesions. The 1-year disease-specific survival (DSS) was 87% and 5-year DSS was 37%. ICM management in FCDTC is based on the size, number, and location of metastatic lesions. Complete resection of ICM may provide lesional control at the site of resection, however, DSS is poor due to the presence of other ICMs and metastases at multiple distant sites.

Ischemic Stroke due to Intracerebral Steal from Calvarial Metastasis: a Case Report (P2-5.001)

<h3>Objective:</h3> NA <h3>Background:</h3> Malignancy is an important risk factor for ischemic stroke. Various mechanisms may explain the association between cancer and ischemic stroke, including hypercoagulation, accelerated atherosclerosis, and toxic effects of chemotherapy and radiation. Here, we report a rare case in which a patient with known occlusive radiation vasculopathy (ORV) presented with ischemic strokes caused by an “intracerebral steal” phenomenon from new metastatic calvarial lesions. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 64-year-old woman with remote history of left neck squamous cell carcinoma and prior left frontal stroke from left common carotid artery (CCA) occlusion secondary to ORV presented to the emergency department with acute-onset right hemiparesis. Brain magnetic resonance imaging revealed scattered infarcts in the convexity of the left hemisphere as well as adjacent calvarial destruction. On functional and structural MRI, the calvarial lesion demonstrated increased vascularity and diffusion restriction. CT angiography redemonstrated complete occlusion of the left CCA and strong right-to-left collateral circulation across the anterior communicating artery. The remainder of the stroke workup, including echocardiogram, laboratory analyses, venous dopplers, and carotid ultrasound was unrevealing. CT scans of the chest, abdomen and pelvis revealed only lytic lesions in the T11 vertebra, left ilium and right sacrum, and biopsy of the latter revealed adenocarcinoma. <h3>Conclusions:</h3> In this patient, neck radiation therapy had resulted in a chronic occlusion of the left CCA. Years later, a hypervascular skull metastasis drew from this limited blood supply, causing ischemic strokes in the parenchyma adjacent to the hypermetabolic calvarial metastasis. This case of an “intracerebral steal” phenomenon demonstrates how hypervascular extradural lesions may also lead to ischemia, particularly in cases of ipsilateral poor hemodynamic reserve. <b>Disclosure:</b> Miss Murthy has nothing to disclose. Dr. Kumar has nothing to disclose. Dr. Testai has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Swanson Martin &amp; Bell, LLP. Dr. Testai has received publishing royalties from a publication relating to health care. Edward Michals has stock in Off Color Brewing. Edward Michals has received personal compensation in the range of $100,000-$499,999 for serving as a Staff Physician with University of Illinois.

A rare case of maxillary osteoclastoma with pulmonary and calvarial metastasis

A rare case of maxillary osteoclastoma with pulmonary and calvarial metastasis

An atypical imaging characteristic of calvarial metastasis of neuroblastoma as multiple multi-loculated cystic masses with internal blood-fluid levels: a case report

As the third most common malignancy of childhood, Neuroblastoma has a great propensity to metastasize to multiple organs. The most common site of metastasis is the bone and bone marrow. Concerning the central nervous system, neuroblastoma usually involves the calvarium and the external dural surface. The skull metastases may show different appearances, including: multiple lytic bone lesions, bone thickening, hair-on-end periosteal reaction, irregular suture widening and/or plaque like epidural deposits. Here we present a case of metastatic neuroblastoma, appearing as multiple multi-loculated cystic epidural masses with internal blood-fluid levels as a rare imaging manifestation of calvarial metastasis. An 8-year-old boy with known history of autism, presented to the emergency department with a 3-month history of intermittent fever, malaise and myalgia and headache along with significant weight loss. Laboratory examination revealed elevated ESR and CRP and anemia. On Abdomino-Pelvic imaging a well-defined, 45*30*24mm, solid-cystic mass was observed, replacing the normal left adrenal gland. On brain MRI, multiple multi-loculated cystic, lentiform masses were observed on the external surface of cerebral hemispheric dura. Multiple fluid-fluid levels were noted in the locules in some of which the dependent fluid was hyperintense on T1w and FLAIR and hypointense on T2w sequences, compatible with blood, representing blood-fluid level. The wall and septa of the masses, enhanced after contrast administration. Associated abnormal marrow signal and aggressive type periosteal reactions were identified in the overlying bone. All of the lesions had increased uptake in MIBG scan. Bone marrow biopsy revealed small round cells, diagnostic for neuroblastoma. The patient underwent chemotherapy treatment. All calvarial/epidural metastatic lesions resolved after chemotherapy and residual adrenal tumor was resected. Cystic epidural lesions, especially when associated with adjacent abnormal bone marrow signal, or periosteal reaction and containing blood-fluid level should raise the suspicion of a calvarial metastasis.

A Rare Cause of Severe Hypoglycemia in Intracranial Hemangiopericytoma Associated With Non-Islet Cell Tumor Hypoglycemia

A 60-year-old man with a history of metastatic intracranial hemangiopericytoma and type 2 diabetes mellitus presented with acute episodes of confusion and dizziness. A magnetic resonance imaging scan of the brain showed progressing calvarial metastasis without intracranial abnormality. He was found to have severe persistent hypoglycemia. The initial hypoglycemia work-up revealed low serum insulin and C-peptide level and negative panel for oral hypoglycemic agents. Further laboratory testing revealed an elevated insulin-like growth factor II (IGF II):IGF-I ratio and low β-hydroxybutyrate, consistent with nonislet cell tumor hypoglycemia. The patient received prednisone and his hypoglycemia improved.

Calvarial Metastasis with Dural Sinus Invasion: A Case Report

Metastatic disease to the calvaria with invasive dural venous sinus extension presents unique diagnostic and management challenges in cancer patients. Treatment options are not standardized. We report a case of a 62-year-old female who presented with breast cancer calvarial metastasis and upper sagittal sinus extension, and in whom a complete resection of the lesion was performed. Surgery may be helpful in selected cancer patients for symptomatic relief as well as survival benefits.

P02.06.B Calvarial metastases: overview of the different entities and the pre-, intra- and postoperative course

Abstract Background Calvarial metastases are most often in cancer with systematic bony metastatic disease. Calvarial metastases occur via hematogenous spread, retrograde seeding through Batson’s venous plexus, or direct extension. A variety of different primary tumours can cause calvarial metastases. The lesions can be palpable on the skin, cause local swelling and, depending on the location, neurological deficits can also occur. The aim of this research is to present an overview of the different entities and the neurosurgical management. Material and Methods Retrospectively, all patients who underwent surgery on a calvarial metastasis in our department between 2004 and 2021 (n=22) were identified. Data on the morphological and histological findings as well as the pre-, intra- and postoperative course were gathered and analysed. Results Swelling (n=14), cosmetically disturbing (n=9), pain (n=6), neurological deficits (n=4), epilepsy (n=3) and B-symptoms (n=1) were the main complaints. 7 had no symptoms at the time of diagnosis. There was a side preference with most of the lesions occurring on the right (n=13), less on the left (n=5) or bilateral (n=4). Calvarial metastases are divided in primary lesions, originating in the bone and secondary lesions infiltrating the bone. The majority of lesions originated from the bone except two, which wer secondary infiltrating the bone. 20 were not limited to the bone, infiltrating adjacent tissue (skin 70%, dura 85%, brain 35%). 18 lesions were osteolytic except four, where no further description was provided. Intraoperatively, craniectomy or in case of biopsy a craniotomy was performed. 70% of cases required Dural plastic. Depending on history and location the operative approach was biopsy (n=1), extended (n=6), subtotal (n=1) or complete (n=14) resection. Intraoperative major bleeding occurred in 15 % of cases, all with macroscopic high vascularization; hemodynamically relevant (n=1), requiring LAE (n=1). Histologically most common were adenocarcinoma of the lung (n=5), mamma (n=3), prostate (n=2), sigma (n=1), rectum (n=1) and gastric (n=1). Melanoma (n=3), neuroblastoma (n=1) and clear cell renal carcinoma (n=2) were less common. Other rare primaries were carcinoma of the parotid (n=1), SCLC (n=1) and follicular thyroidal cancer (n=1). Postoperatively, further treatment was initiated depending on the primary tumour. Conclusion: Above mentioned clinical symptoms or the staging of a cancer leads to the diagnosis of calvarial metastasis. Preoperative imaging shows localisation and the degree of infiltration into adjacent tissues. Imaging results and the clinical symptoms determine the surgical strategy. But definitive diagnosis can only be made by histological analysis. After surgery, the histology, the extension of the primary tumour and the clinical condition of the person influence the kind of further treatment initiated.

MILIARY METASTATIC ADENOCARCINOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Miliary opacities are defined as innumerable 1- 4mm pulmonary nodules scattered throughout the lung fields. Differential for miliary pattern is wide including tuberculosis, fungal infection and distinct organ metastasis. We present a case of a 37 year old male with miliary pattern seen on the chest radiograph and CT scan with ostial lesion in his L2 vertebrae, who was initially thought to have miliary TB with Pott's disease later diagnosed with primary adenocarcinoma of the lung with spinal, brain and calvarium metastasis. CASE PRESENTATION: A 37-year-old male with no significant medical history presented to the ED with 2 months of lower back pain. He endorsed shortness of breath and 40 pound unintentional weight loss over 3 months. He was incarcerated 5 years ago at which time his PPD was negative.Chest x-ray showed diffuse bilateral infiltrates with micronodular pattern. Following this, CT scan was obtained to evaluate for lower back pain which showed pathological compression deformity in L2 and innumerable pulmonary nodules consistent with miliary pattern and also showed left upper lobe lung mass.Given his history of incarceration, weight loss, shortness of breath and deformity in his lumbar vertebra, miliary tuberculosis and Potts disease was considered. QuantiFERON gold and AFB sputum were obtained. After AFB x3 negative on sputum studies it was decided to proceed with bronchoscopy with bronchoalveolar lavage (BAL).Lymph node biopsies and BAL pathology reports came back positive for adenocarcinoma. Upon further investigation with MRI of the brain and the spine it was also noted that the patient had Cavalier metastasis, left frontal lobe metastasis and numerous enhancing bone lesions in lumbar and sacral spine with osseous metastasis.Oncology and radiation oncology were consulted and he was started on stereotactic radiation therapy to the left frontal lobe metastasis as well as a right calvarial metastasis and systemic chemotherapy and immunotherapy. DISCUSSION: Miliary opacities are seen in a wide array of conditions including infectious etiologies like miliary TB, histoplasmosis, other fungal infections and noninfectious etiologies including miliary metastasis from thyroid, renal, breast carcinomas, metastatic melanoma. There has also been documentation of miliary patterns seen in Langerhans' cell histiocytosis, hypersensitivity pneumonitis and a few cases of primary pulmonary lung cancers.History is a key component in diagnosis especially for patients coming from areas and populations where TB and other infectious disease are prevalent. Once infectious etiologies have been ruled out approach to rule out malignancies and metastasis should be perused. CONCLUSIONS: It is impossible to distinguish between infectious etiologies and malignancies solely based on CT scan in patient with miliary pattern, hence when definitive diagnosis is uncertain, tissue diagnosis should be perused. REFERENCE #1: Khan D, Danjuma M, Saddique M, U, Murshed K, A, H, Yassin M, A: Adenocarcinoma of the Lung Mimicking Miliary Tuberculosis. Case Rep Oncol 2020;13:139-144. doi: 10.1159/000505685 DISCLOSURES: No relevant relationships by Sarasi Jayaratne, source=Web Response No relevant relationships by Gaurang Prabhu, source=Web Response No relevant relationships by Gaurav Prabhu, source=Web Response

Percutaneous CT-Guided Skull Biopsy: Feasibility, Safety, and Diagnostic Yield.

Although percutaneous musculoskeletal biopsies are routinely performed in the axial and appendicular skeleton, there are no published data on the systematic evaluation of the feasibility, safety, and diagnostic accuracy of percutaneous skull biopsy. In certain clinical encounters such as patients with primary skull tumors or patients with known cancer and isolated skull lesions suspected of calvarial metastasis or synchronous primary tumor, percutaneous skull biopsy may be considered a viable option. The purpose of this study was to evaluate the feasibility, safety profile, and diagnostic yield of percutaneous CT-guided skull biopsy. Percutaneous CT-guided skull biopsy was performed in 14 patients. Patient demographics, cancer history, indication for initial imaging, imaging technique of diagnosis, skull tumor anatomic location, and final histologic diagnosis were documented. Preprocedural imaging of each skull lesion was reviewed to determine tumor size and characteristics. Procedural notes were reviewed to determine the total conscious sedation time or anesthesia time, type of biopsy needle, and the number and length of obtained core specimens. Procedure-related complications were also documented according to the Society of Interventional Radiology classification. All CT-guided percutaneous skull biopsy procedures were performed as preoperatively planned and were technically successful. Procedures were performed with the patient under conscious sedation in 93% (13/14) of cases. Definitive histologic diagnosis was achieved in 86% (12/14) of cases. There were no acute or delayed procedure-related complications. The results of this retrospective initial study suggest that percutaneous CT-guided skull biopsy is feasible with an excellent safety profile, affords a high diagnostic yield for histologic characterization, and may obviate more invasive open skull biopsies.

Giant Calvarial Ewing's Sarcoma: A Case Report

Ewing's sarcoma (EWS) is the second most common primary bone tumor seen in children and adolescents, first being osteosarcoma. Skull lesions are seen in 6 to 9% of cases. The tumor tends to reside most frequently on frontal and parietal bones. In the literature, majority of papers on calvarial EWS present cases with intracranial involvement; extracranial extension is reported in only eight cases. The case that we are presenting in this report is a 23-year-old male patient with multiple infiltrations in femur, costal bones, and calvarium which had been diagnosed radiologically and histopathologically as EWS. The calvarial metastasis had reached a very huge size with dimensions of approximately 7.5 × 7.5 × 9.5 cm and was successfully excised totally. Twelve months of follow-up revealed no recurrence in the surgical site showing that total removal of giant cranial EWS may improve morbidity of these patients.

An interesting case of malignant paraganglioma of the mandible with calvarial metastasis

Paraganglioma is a rare neuroendocrine tumor arising from the neuroectodermally derived paraganglionic cells scattered throughout the body. Other neuroendocrine tumors include carcinoids, islet cell tumors, medullary carcinoma of thyroid, melanoma, mastocytoma, merkel's cell tumor of the skin, neurocytomas, oat cell carcinoma, pinealoma, and pituitary adenoma. Very few cases have been reported intraorally. Only few cases of neuroendocrine tumor of mandible have been reported till date. This is an interesting case of malignant paraganglioma of the mandible in a 30-year-old male patient with metastasis to the calvarium.

Low-grade Endometrial Stromal Sarcoma with Unusual Metastasis to the Skull

Background Endometrial stromal sarcomas (ESSs) are the second most common uterine sarcomas. Although ESSs are often indolent, they have metastatic potential. To the best of our knowledge, there are only three reports of brain metastasis, and the present report is the first to describe a late skull metastasis of an ESS. Case Report We describe the case of a 51-year-old woman who presented abnormal vaginal bleeding 14 years ago; she was diagnosed with an uterine mass and submitted to a hysterectomy. One year ago she presented ESS lung metastasis followed by a left parietal calvarial metastasis. The optimal treatment for metastatic ESS is controversial, but the use of progesterone and aromatase inhibitors is advisable.

A Rare Subcutaneous Manifestation of Metastatic Renal Cell Carcinoma.

We report a rare case of advanced metastatic renal cell carcinoma which initially presented to the clinic with back and forehead lumps. Ultrasound imaging of the lumps and later of the abdomen picked up a right renal tumour which led to further computed tomography and bone scans. The bone scan confirmed that the forehead lump was a calvarial metastasis and such a presentation for metastatic RCC is very rare which bears a significantly poorer prognosis.

Isolated Dural and Calvarial Metastasis in a patient with Breast Carcinoma: a Case Report

Literaturde malign neoplazmlarin dural metastazlari ile ilgili az bilgi bulunmaktadir. Kesin etyopatogenezleri ve tedavi stratejileri tartismalidir. Dura matere en sik metastaz meme kanserinden olmaktadir. 41 yasinda bayan hasta klinigimize bas agrisi ve sol parietalde sislik sikayeti ile basvurdu. Hasta 3 yil once infiltratif duktal kanser nedeni ile opere edilmisti. Sol kalvaryal ve dura metastazi tespit edildi ve sol parietal kraniotomi ile cerrahi rezeksiyon uygulandi. Hasta operasyondan sonra tum beyin radyoterapi aldi. Bu yazida kafatasi ve duraya metastaz yapan bir kanser vakasini ve bu nadir hastaligin ana ozelliklerini tartistik.

Cytodiagnosis of calvarial metastasis of renal cell carcinoma masquerading as a cavernous hemangioma after a long latency

Renal cell carcinoma (RCC) is noted for its unpredictable clinical behavior. It can present with metastatic disease at many unusual sites, even after a long latency. It can thus mimic many other lesions and pose a diagnostic challenge, especially in cases where prior history of RCC is not available. Fine-needle aspiration cytology (FNAC) can be very useful in arriving at a correct diagnosis of these lesions. We present an unusual case of RCC in a 55-year-old female who presented with frontal soft tissue mass. A history of nephrectomy 10 years back was not given at the initial presentation. Computed tomography suggested a diagnosis of cavernous hemangiomas. FNAC was suggestive of RCC. Avascular osteolytic lesion in the calvarium should raise the suspicion of metastatic RCC as one of the differential diagnosis.

English

Bone metastases are common but serious complication of aggressive thyroid carcinoma, but calvarial metastasis is relatively uncommon complication of the primary tumor of thyroid gland. We are presenting an unusual case report of large calvarial metastasis which had both intracranial and extra cranial components of a previously diagnosed and operated case of follicular carcinoma of INTRODUCTION:Metastases to the skeletal system from thyroid carcinoma are a well-known event, constituting the second most common systemic site of involvement after lungs. The poor prognosis associated with bone metastases of differentiated thyroid cancer might partly be due to the fact that they are rarely detected at an early stage. Carcinoma of the thyroid gland is one of the possibly curable cancers. At the time of initial diagnosis, 1%-3% of patients with thyroid cancer may have distant metastases, whereas another 7%-23% will develop distant metastases during the disease course2, 12, 16.The distant metastases, especially those involving bone, increase mortality rate, compromise quality of life and shorten patient survival. After lung, bone is the most common site of systemic metastasis from thyroid carcinoma 1, 2 , the overall reported incidence ranging from 1% 3 to more than 40% 4 . This incidence varies according to the primary tumour type, with follicular carcinoma showing a much higher frequency than the papillary or anaplastic subtypes in most reported series 1, 2, 5-8.Approximately 90% of non-medullary thyroid malignancies are well differentiated and are classified as papillary or follicular. Patients with differentiated thyroid carcinoma (DTC) have a high 10-year survival rate (80%-95%), except in the presence of metastatic disease (40% 10-year survival). Incidence of bone metastases is Vertebrae (54%), Pelvis (50%), Ribs (31%), Femur (21%), Skull (13%) and Humerus (11%). Among the different histologic subtypes, follicular carcinoma is most likely to show bone metastases, with reported incidences ranging from 7% to approximately 28%. The poor prognosis associated with bone metastases of differentiated thyroid cancer might partly be due to the fact that they are rarely detected at an early stage. The influence of the microscopic tumor type and tumor differentiation on survival after bone metastasis primarily appears to be due to the much worse prognosis among anaplastic and medullary carcinomas. Age at diagnosis of bone metastases does not influence survivals.

Calvarial metastasis from papillary thyroid carcinoma: A case report

A large variety of metastatic tumors can be found in the skull; breast, prostate, lung carcinoma, multiple myeloma, neuroblastoma and sarcoma are among those that have been reported in the literature. In the current case, a very rare case of metastasis to skull from papillary thyroid carcinoma is reported. A 45-year-old man was admitted to our service with head trauma. Computed tomography and magnetic resonance imaging revealed lytic mass lesions in the right frontal and occipital bone extending through the dura mater and subcutaneous tissue. Right frontal, suboccipital craniectomy, tumor excision were performed and microscopic examination revealed papillary thyroid carcinoma metastasis. There is no consensus on treatment protocols for patients with central nervous system metastases from papillary thyroid carcinoma, most likely because of the rarity of cases. In the present case, we suggest that the best option for treatment of papillary thyroid carcinoma metastasis to skull would be surgery followed by radiotherapy. Pam Med J 2013;6(2):104-106

Qualitative diagnosis of calvarial metastasis by neural network and logistic regression 1

Rationale and Objectives. To simplify the diagnostic features used by an artificial neural network compared with logistic regression (LR) in the diagnosis of calvarial metastasis with computed tomography and analyze their accuracy. Materials and Methods. Twenty-one of 167 patients with calvarial lesions were found to have metastasis. Clinical and computed tomography data were used for LR and neural network models. Both models were tested with the leave-one-out method. The final results of each model were compared using the area under receiver operating characteristic curve (A z). Results. The neural network identified metastasis significantly more successfully than LR with an A z of 0.9324 ± 0.0386 versus 0.9192 ± 0.0373, P = .01. The most important features selected by the LR and neural network were age and edge definition. Conclusion. Neural networks offer wide possibilities over statistics for the study of calvarial metastases other than their minimum clinical and radiologic features for diagnosis.

Calvarial metastasis of a paraganglioma: Case report and review of the literature

Background Metastasis of a paraganglioma (PRG) to the calvarium is very rare. In this paper, the case of a 25-year-old male with metastasis of a PRG to the frontoparietal bone is described. Case Description The patient presented with bulging on the left side of the head, headache, and weight loss. Magnetic resonance imaging (MRI) revealed a mass lesion in the left frontoparietal region that had destroyed both the external and internal table of the bone, extending under the skin and above the dura mater. After a frontoparietal craniotomy the tumor was removed totally. Histopathological examination revealed the “Zellballen,” which are pathognomonic for a PRG. Systemic examination and radiological investigation revealed no primary tumor source. Conclusion Metastasis of a PRG to the calvarium is possible; radical removal of the tumor will provide a cure.

Preoperative evaluation with radionuclide brain scanning and computerized axial tomography of the brain in patients with breast cancer

To determine the roles of radionuclide brain scanning and computerized tomography of brain in the pretreatment evaluation of patients with primary and locoregional recurrence of breast cancer, we reviewed the clinical and radiologic findings in 226 patients with breast cancer who underwent one of these scans either preoperatively or within 6 weeks of operation and in 34 patients presenting with locoregional recurrence. Four of 131 radionuclide brain scans in primary breast cancer suggested calvarial metastasis, and the findings were confirmed with bone scans and skull radiographs. One of 95 computerized tomographic scans of the brain showed brain metastasis, and this patient had profound neurologic deficits. With respect to locoregional recurrence, the results of 2 of 23 radionuclide scans and 1 of 11 computerized tomographic scans were positive. All three patients had clinical evidence for brain metastasis. We conclude that in the absence of signs and symptoms, routine evaluation for brain metastasis is not justified in primary and locoregional recurrence of breast cancer.