~ffitlIK KYflom4IJn Large, Solitary Bone Lesion of the Skull |
C. A. Leftridge, Jr., MD Gainesvilpe Finridia
Figure 1. Skull Series Showing Mass in Right Occipital Area.
History The patient, known to have Down's syndrome, presented with a painless mass under her scalp. The lesion had been present for some time, and was noted to be increasing in size, but at a slow rate. The patient's clinical picture was otherwise unremarkable.
Radiologic Findings A skull series was obtained and an 8 X 9 cm mass was noted in the right occipital area. The margins of the advancing lesion were minimally sclerotic but, for the most part, were ill-defined. The mass itself, has a "sunburst" or "hair-on-end" appearance.
Discussion The lesion presented proved to be a Dr. Leftridge is Assistant Professor of Pediatric Radiology, Shands Teaching Hospital,
Gainesville, Florida. Requests for reprints should be addressed to Dr. C. A. Leftridge, Jr., Shands Teaching Hospital, Gainesville, Florida.
Figure 2. Skull Series Showing Sclerotic Margins of the Mass
hemangioma of the skull. The fact that the patient had Down's syndrome had no bearing on the presence of the mass. These lesions are benign and histologically conform to similar hemangiomas found within soft tissues. The skull and vertebral column are the usual sites where one would expect to encounter hemangiomas of bone; they are rare in the axial skeleton. The course of these lesions is such that their detection may be purely by accident, the patient presenting for roentgen evaluation for some other unrelated problem. This is most true of the hemangiomas which arise in the vertebral column, however, they can cause vertebral collapse producing signs and symptoms of cord compression. If symptomatic, vertebral hemangiomas may be confused with multiple myeloma, metastatic carcinoma, lymphoma, or Paget's disease. 1 Hemangiomas of the skull are most commonly noted in the frontal bone, though any of the bones of the skull may be affected. A curious phenome-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 69, NO. 1, 1977
Figure 3. Skull Series Showing "Sunburst" or "Hair on End" Appearance.
non is noted in skull hemangiomas when compared to those in the vertebral column. The former tend almost always to be singular and osteoblastic with the latter, not infrequently, being multiple and osteolytic. The most characteristic, and perhaps, diagnostic feature of the skull hemangioma is that of a smooth convex mass protruding from the outer table, revealing fine vertical stri-
ations.2 In his text, Sante,3 states that these may be associated with angiomas of the scalp and brain. Occasionally, one might confuse the hemangioma of the skull with osteogenic sarcoma, but the slow growth of the mass and lack of symptoms tend to steer one toward the correct diagnosis. Literature cited 1. Edeiken J, Hodes P: Roentgen Diagnosis of Diseases of Bone. Baltimore, Wil-
liams and Wilkins, 1967 2. Paul L, Juhl J: Essentials of Roentgen Diagnosis of the Skeletal System, ed 2. New York, Harper and Row, 1967 3. Sante LR: Principles of Roentgen Interpretation, ed 12. Ann Arbor, Edwards Brothers, 1961
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C. A. Leftridge, Jr., MD Gainesvilpe Finridia
Figure 1. Skull Series Showing Mass in Right Occipital Area.
History The patient, known to have Down's syndrome, presented with a painless mass under her scalp. The lesion had been present for some time, and was noted to be increasing in size, but at a slow rate. The patient's clinical picture was otherwise unremarkable.
Radiologic Findings A skull series was obtained and an 8 X 9 cm mass was noted in the right occipital area. The margins of the advancing lesion were minimally sclerotic but, for the most part, were ill-defined. The mass itself, has a "sunburst" or "hair-on-end" appearance.
Discussion The lesion presented proved to be a Dr. Leftridge is Assistant Professor of Pediatric Radiology, Shands Teaching Hospital,
Gainesville, Florida. Requests for reprints should be addressed to Dr. C. A. Leftridge, Jr., Shands Teaching Hospital, Gainesville, Florida.
Figure 2. Skull Series Showing Sclerotic Margins of the Mass
hemangioma of the skull. The fact that the patient had Down's syndrome had no bearing on the presence of the mass. These lesions are benign and histologically conform to similar hemangiomas found within soft tissues. The skull and vertebral column are the usual sites where one would expect to encounter hemangiomas of bone; they are rare in the axial skeleton. The course of these lesions is such that their detection may be purely by accident, the patient presenting for roentgen evaluation for some other unrelated problem. This is most true of the hemangiomas which arise in the vertebral column, however, they can cause vertebral collapse producing signs and symptoms of cord compression. If symptomatic, vertebral hemangiomas may be confused with multiple myeloma, metastatic carcinoma, lymphoma, or Paget's disease. 1 Hemangiomas of the skull are most commonly noted in the frontal bone, though any of the bones of the skull may be affected. A curious phenome-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 69, NO. 1, 1977
Figure 3. Skull Series Showing "Sunburst" or "Hair on End" Appearance.
non is noted in skull hemangiomas when compared to those in the vertebral column. The former tend almost always to be singular and osteoblastic with the latter, not infrequently, being multiple and osteolytic. The most characteristic, and perhaps, diagnostic feature of the skull hemangioma is that of a smooth convex mass protruding from the outer table, revealing fine vertical stri-
ations.2 In his text, Sante,3 states that these may be associated with angiomas of the scalp and brain. Occasionally, one might confuse the hemangioma of the skull with osteogenic sarcoma, but the slow growth of the mass and lack of symptoms tend to steer one toward the correct diagnosis. Literature cited 1. Edeiken J, Hodes P: Roentgen Diagnosis of Diseases of Bone. Baltimore, Wil-
liams and Wilkins, 1967 2. Paul L, Juhl J: Essentials of Roentgen Diagnosis of the Skeletal System, ed 2. New York, Harper and Row, 1967 3. Sante LR: Principles of Roentgen Interpretation, ed 12. Ann Arbor, Edwards Brothers, 1961
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