Primary osteosarcoma of the skull

Management and outcome of unusual pediatric brain tumors: challenges experienced at a tertiary care center of a developing country

PURPOSE

Primary brain tumors are the most frequent solid pediatric tumors, accounting for 40-50% of all cancers in children. Eighty to ninety percent of the 250,000 new cases of pediatric cancer each year are discovered in low and middle-income nations, where nearly 88 percent of the world's children reside. This article aims to emphasize the unusual presentation, management, and surgical outcome of complex pediatric brain tumors.

METHODS

We performed a retrospective study of patients who were admitted to the neurosurgery department with unusual pediatric brain tumors between March 1, 2019, and March 1, 2022. The study included pediatric patients up to age 18 years. We included those pediatric brain tumors whose (i) location was uncommon, or (ii) presented with unusual clinical presentation, or (iii) histopathology suggested to be a rare tumor, or (iv) radiological features were atypical.

RESULTS

We included 9 cases of rare unusual pediatric brain tumors. Three out of 9 cases required preoperative embolization due to its hypervascular nature on digital subtraction angiography (DSA). All patients underwent surgical excision within 24-48 h of tumor devascularization. One out of 9 cases died in follow-up period due to pleural effusion and distant metastasis to lungs.

CONCLUSION

Treatment considerations for unusual pediatric brain tumors include a comprehensive multidisciplinary approach, including community-based screening and proper referral system for early treatment, a variety of treatment modalities, and sophisticated follow-up strategy. Government shall work in coherence with tertiary centers to spread social awareness and provide various financial scheme to prevent treatment dropouts.

Primary osteosarcoma of the parietal bone

Osteosarcoma is the most common primary bone tumor and usually involves the long bones. Osteosarcoma of the skull, on the other hand, is relatively rare. Here, we present a 29-year-old man with a growing mass in the skull he first noticed after a fall while skateboarding. The initial clinical diagnosis was hematoma. While undergoing an evacuation surgery for a hematoma, a suspicious mass was detected which was biopsied. Histopathological evaluation showed high-grade osteosarcoma. The patient was referred to our hospital where he underwent definitive resection followed by adjuvant chemotherapy. His course was complicated by wound infection. Even though osteosarcoma of the skull is a rare finding, it should be suspected in a patient with a skull mass, and the history of prior head trauma does not exclude the diagnosis.

Osteosarcoma of the frontal bone: a study of a rare case in a 17-year-old female

Head and neck osteosarcomas are infrequent and usually present in the third-fourth decades of life. However, they are extremely rare in the pediatric population. Primary involvement of the cranial vault, excluding the mandible and maxilla, is an exceedingly rare phenomenon; thus, the number of clinical studies published in the literature is limited. Because of the anatomy of the head, complete resection may be difficult to achieve. Furthermore, an aggressive surgical approach can cause a significant functional impairment or cosmetic defect. We report the case of a 17-year-old patient with an aggressive recurrence of multiple tumors in the left side of the skull accompanied with a severe headache and complete left-sided vision loss with no metastases at presentation. The recurrence of the tumor was preceded by pregnancy and delivery, which raised the question of whether pregnancy hormones were a provoking factor in the recurrence of the tumor or not.

Primary osteogenic sarcoma of the skull: Report of two cases with review of literature

Primary calvarial (excluding jaw) osteosarcoma is rare. We report two cases highlighting their unusual presentation and histopathologic variability – a 30-year-old female who presented with progressively increasing headache and a rapidly growing frontal swelling and a 16-year-old girl who had a rapidly growing mass in the left frontoparietal region which had recurred thrice but was otherwise asymptomatic. The lesions were osteolytic on neuroimaging and histopathological examination confirmed osteosarcoma. These two unusual cases are discussed along with a brief review of literature.

A review of forehead lipomas: Important tips for the training surgeon

BACKGROUND

Forehead swellings can be caused by a variety of different pathologies, including lipomas. These benign lesions are composed of mature fat cells and often result in a poor cosmetic appearance causing significant psychosocial distress. Surgical removal is therefore frequently requested and they are often listed on a training local anaesthetic list. Thus, it is essential that trainees understand the nature of these lesions, their anatomical location and management, as well as differential diagnoses.

METHODS

A review of the available literature on forehead lipomas and their management was performed. Searches of both MEDLINE and EMBASE were conducted, with all full text articles published in English being included for analysis.

RESULTS

14 papers were included for analysis. Forehead lipomas are slow growing lesions with 100% presenting as a solitary swelling. They are more prevalent in males with mean age at presentation being 48 years. Their aetiology is unknown, however, blunt trauma has been postulated to contribute to their formation. Differential diagnoses include cysts and extension of intracranial lesions. Surgical intervention is the only recognised treatment, with a transverse, forehead-crease incision most commonly being adopted under local anaesthetic. Exploration beneath the frontalis muscle is often required in order to achieve their excision.

CONCLUSION

Important differential diagnoses must be excluded prior to attempted surgical excision of forehead lipomas. Surgeons must also be aware that the correct anatomical plane for these lesions is often beneath the frontalis muscle.

Treatment and survival of osteosarcoma and Ewing sarcoma of the skull: a SEER database analysis

Background

Common primary bone tumors include osteosarcomas (OSC) and Ewing sarcomas (EWS). The skull is a rare site, and literature about their treatment and survival is scarce. Using the Surveillance, Epidemiology, and End Results (SEER) database, this study aims to assess the treatment and survival of skull OSC and skull EWS, as well as predictors for survival.

Methods

Skull OSC and EWS cases were obtained from the SEER database. Patient and tumor characteristics, treatment modalities, and survival were extracted. Overall survival (OS) was assessed using multivariable Cox proportional hazard regression stratified by tumor histology. Kaplan-Meier curves were constructed for OS comparing OSC and EWS, as well as histological subtypes in OSC.

Results

A total of 321 skull OSC and 80 skull EWS patients were registered from 1973 to 2013. EWS was more common in younger patients (p < 0.001). Resection was the predominant treatment strategy (80.1%), frequently in combination with adjuvant radiotherapy (30.4%). The 5-year survival rate varied significantly between OSC and EWS (51.0% versus 68.5%, p = 0.02). Kaplan-Meier curves show that EWS had a significantly better survival compared to OSC. Comparing histological subtypes of skull OSC, chondroblastic OSC had the best OS, Paget OSC the worst. Older age, tumor advancement, no surgical treatment, and the use of radiotherapy were identified as independent predictors of decreased OS in skull OSC.

Conclusion

Overall prognosis is better for EWS compared to OSC. Chondroblastic OSC have the best overall survival, while OSC associated with Paget’s disease of the bone has the poorest overall survival.

Primary osteosarcoma of frontal bone: A case report and review of literature

RATIONALE

Primary osteosarcomas of the skull and skull base are rare, comprising <2% of all skull tumors. Primary osteosarcomas of the skull are aggressive neoplasms composed of spindle cells producing osteoid which have poor outcome.

PATIENT CONCERNS

A 33-year-old woman was admitted to our hospital with a major complaint of a growing mass on her left frontal region of the skull for 10 months. Prior to the accurate diagnosis, the mass on her skull was considered to be eosinophilic granuloma.

DIAGNOSES

Computerized tomogram (CT) scan of skull revealed a lytic lesion causing destruction of left frontal bone with surrounding soft tissue mass. The histological examination of the lesion showed typical features of osteosarcoma.

INTERVENTIONS

The patient received 3 surgeries and adjuvant chemotherapy and radiotherapy for the frontal bone lesion.

OUTCOMES

At the last follow-up, after 4 years, the patient was free of disease both clinically and on imaging by magnetic resonance imaging (MRI) scan after 4 years.

LESSONS

Because osteosarcoma of skull is a rare disease, the early recognition and correct diagnosis are very important for a better prognosis. It is therefore imperative that clinicians recognize osteosarcoma early to make an accurate diagnosis and complete surgical resection followed by combined chemo-radiation is proved to be one of the most optimal treatment regimens.

Unique Image Characteristics of an Occipital Primary Chondroblastic Osteosarcoma: A Rare Case Report and a Brief Literature Review

Primary osteosarcomas of the skull and skull base are rare and comprise < 2% of all skull tumors. In head and neck osteosarcomas, the chondroblastic subtype occurs most frequently, which has an exceedingly poor outcome, but its image characteristic remains unknown. Herein, we report a case in the right occipital bone of the skull base and the unique characteristics of image. Pathologic examination of the surgical specimens led to the diagnosis of chondroblastic osteosarcomas. We believe those image characteristics can improve the understanding of skull chondroblastic osteosarcoma and the preoperative diagnosis.

Primary Bone Tumors of the Skull: Spectrum of 125 Cases, with Review of Literature

AIMS

Primary skull bone tumors, benign or malignant, are rare, and include a vast repertoire of lesions. These tumors are not reported systematically in the literature, with most studies being on individual entities or as single case reports.

METHODS

Primary bone tumors diagnosed over a period of 12 years were retrieved, histological diagnoses reviewed, and clinical parameters noted.

RESULTS

We identified 125 primary skull bone tumors. The mean age at diagnosis was 32 years (range: 2-65 years). Majority of patients were adults (82.4%); male preponderance was noted (72.8%). Malignant tumors were more frequent than benign tumors. Most common malignant tumor was chordoma (n = 37), while most common benign tumor was osteoma (n = 7). Tumors were most frequently located at the skull base, of which clivus was most common location. Chordomas accounted for majority of clival tumors, while chondrosarcoma predominated at other skull base locations. Benign tumors were extremely rare in skull base. Tumors of the vault bones were infrequent; with chondrosarcoma and osteoma being the most common malignant and benign tumors, respectively.

CONCLUSIONS

This is the largest series of primary skull bone tumors from India. Documentation of such a series will aid in approaching differential diagnosis of skull tumors in a systematic manner.

Osteosarcoma of the cranial vault and skull base in pediatric patients

Cranial osteosarcoma is very rare in children, rendering the development of optimal treatment algorithms challenging. The authors present 3 cases of pediatric cranial osteosarcoma: a primary calvarial tumor, a cranial metastasis, and a primary osteosarcoma of the cranial base. A review of the literature demonstrates significant variation in the management of cranial osteosarcomas and the outcome for patients with these tumors. This series and literature review is presented to improve the understanding of pediatric cranial osteosarcoma and to reinforce the importance of maximal resection in optimizing outcome.

Radiopathological evaluation of primary malignant skull tumors: a review

Skull tumors comprise a wide variety of entities, ranging from chronic inflammatory disease to primary and secondary neoplasms. There is no valid incidence or data about the incidence of skull tumors in general. Primary malignant skull tumors are rare, with most articles reporting single cases. We would discuss some of the frequent tumors in this group and review of the literature for the same.

Primary Skull Osteosarcoma: MDCT Evaluation and Histopathological Correlation in Two Cases

Osteosarcomas are typically long bone tumors and rarely affect the skull, with most articles reporting single cases. As elsewhere in the body, these lesions may be classified as primary or secondary, chiefly post-Paget and post-radiation therapy. We describe two cases of primary osteosarcoma of skull one presenting with cerebellar symptoms and another with giant skull swelling. Complete evaluation with 64 slice CT and histopathological correlation was carried out.

Imaging pattern of calvarial lesions in adults

Calvarial lesions often present themselves as clinically silent findings on skull radiographs or as palpable masses that may cause localized pain or soreness. This review aims to explore the radiographic, computed tomography (CT), and magnetic resonance imaging (MRI) characteristics of calvarial neoplastic, inflammatory, and congenital lesions that are common in adults in order to facilitate a structured approach to their diagnosis and limit the differential diagnosis. In addition to reviewing the literature, we reviewed the records of 141 patients of the Montreal Neurological Institute and Hospital with radiologically documented calvarial lesions between 2001 and June 2009. CT is ideal for detecting bony lesions and is helpful in precisely localizing a lesion pre-surgically. MRI is best at identifying intradiploic lesions before they affect the cortical tables and is able to establish extraosseous involvement, especially when paramagnetic contrast is employed.

A rare spontaneous osteosarcoma of the calvarium in a patient with long-standing fibrous dysplasia: CT and MR findings

A 52-year-old man with long-standing craniofacial polyostotic fibrous dysplasia (FD) and no history of prior radiation therapy developed a spontaneous right temporal bone osteosarcoma. Such spontaneous sarcomatous degeneration of FD is rare, particularly in the calvarium/skull, where, to our knowledge, only six prior cases have been reported in the literature. We report this case because it is a rare entity with well-documented CT and MR images, and to emphasize the importance of depicting imaging features of sarcomatous degeneration among the complex imaging findings of FD.