Answer for BIR CoW 27 Jun 2021
Skull Metastasis
Findings
Ill defined T2 / FLAIR hyperintense lesion noted extraaxially in right cerebello pontine angle causing mass effect and vasogenic edema and adjacent right pons. It measures1.5 (antero-posterior) x0.8 (transverse) x 0.8(craniocaudal) cms Signal intensity alterations also noted in adjacent petrous part of right temporal bone. Multiple FLAIR hyperintense calvarial lesions noted. On contrast administration, the lesion shows heterogenous enhancement and extending along the preganglionic segment right trigeminal nerve. Post contrast enhancement also noted along the intracanalicular segment of right facial nerve, right masseter muscle. Known case of CA breast post surgery with multiple calvarial metastasis also involving right petrous apex.
Discussion
Metastases to the skull are very common in patients with disseminated skeletal metastatic disease, although they are often asymptomatic. Skull metastases are seen in ~20% (range 15-25%) of all cancer patients. Clinical presentation Although over half of all skeletal metastases are asymptomatic, they can cause symptoms in a number of scenarios mass effect on adjacent structures compression of brain/brainstem focal neurological deficits seizures compression of exiting cranial nerves compression/invasion/occlusion of dural venous sinuses dural venous sinus thrombosis proptosis mechanical instability occipital condyle compression fracture temporomandibular joint instability Pathology Primary tumours most frequently encountered as metastases to the skull include : breast cancer lung cancer melanoma prostate cancer thyroid cancer (usually follicular) renal cell cancer lymphoma leukaemia multiple myeloma intrahepatic cholangiocarcinoma In children both neuroblastoma (skull metastases are not infrequently the first sign of disease) and Ewing sarcoma are encountered. Radiographic features Skull metastases have the same range of appearances as skeletal metastases elsewhere, and in 90% of cases other skeletal metastases are evident: lytic metastases: most common sclerotic metastases can particularly occur from breast and prostate cancers mixed lytic and sclerotic metastases It is worth remembering that occasionally a solitary skull metastasis may be the only evidence of metastatic disease. This is particularly the case with renal cell carcinoma and thyroid carcinoma.
Findings
Ill defined T2 / FLAIR hyperintense lesion noted extraaxially in right cerebello pontine angle causing mass effect and vasogenic edema and adjacent right pons. It measures1.5 (antero-posterior) x0.8 (transverse) x 0.8(craniocaudal) cms Signal intensity alterations also noted in adjacent petrous part of right temporal bone. Multiple FLAIR hyperintense calvarial lesions noted. On contrast administration, the lesion shows heterogenous enhancement and extending along the preganglionic segment right trigeminal nerve. Post contrast enhancement also noted along the intracanalicular segment of right facial nerve, right masseter muscle. Known case of CA breast post surgery with multiple calvarial metastasis also involving right petrous apex.
Discussion
Metastases to the skull are very common in patients with disseminated skeletal metastatic disease, although they are often asymptomatic. Skull metastases are seen in ~20% (range 15-25%) of all cancer patients. Clinical presentation Although over half of all skeletal metastases are asymptomatic, they can cause symptoms in a number of scenarios mass effect on adjacent structures compression of brain/brainstem focal neurological deficits seizures compression of exiting cranial nerves compression/invasion/occlusion of dural venous sinuses dural venous sinus thrombosis proptosis mechanical instability occipital condyle compression fracture temporomandibular joint instability Pathology Primary tumours most frequently encountered as metastases to the skull include : breast cancer lung cancer melanoma prostate cancer thyroid cancer (usually follicular) renal cell cancer lymphoma leukaemia multiple myeloma intrahepatic cholangiocarcinoma In children both neuroblastoma (skull metastases are not infrequently the first sign of disease) and Ewing sarcoma are encountered. Radiographic features Skull metastases have the same range of appearances as skeletal metastases elsewhere, and in 90% of cases other skeletal metastases are evident: lytic metastases: most common sclerotic metastases can particularly occur from breast and prostate cancers mixed lytic and sclerotic metastases It is worth remembering that occasionally a solitary skull metastasis may be the only evidence of metastatic disease. This is particularly the case with renal cell carcinoma and thyroid carcinoma.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!