Adenoid basal cell carcinoma of the skin invading the superior sagittal sinus with metastases

Case contributed by Dr Ammar Haouimi


Surgical excision of a cutaneous mass at the parietal region 5 years ago. Presented with a history of progressive paraplegia.

Patient Data

Age: 80 years
Gender: Male

The MRI sequences demonstrate an extra-axial midline parietal mass adjacent to the craniotomy. It displays an intermediate signal on T1, slight inhomogeneous high signal on T2/FLAIR with heterogeneous enhancement on postcontrast sequences. The adjacent segment of the superior sagittal sinus is invaded with thickening and enhancement of the adjacent dura well-visualized on the postcontrast coronal sequence.

Collapsed T3 vertebral body with an abnormal T2 high signal and heterogeneous enhancement of T2 and T3 vertebral bodies. There is a circumferential epidural thickening with enhancement at T2-T3 level, compressing the adjacent segment of the spinal cord which shows an intramedullary T2 hyperintensity, indicating compressive myelopathy. Note also thickening with the enhancement of the prevertebral soft tissues.

The axial sequences show multiple bilateral parenchymal nodules, indicating lung metastases.

Case Discussion

MRI features of an adenoid basal cell carcinoma of the skin (recurrence 5 years after total excision), invading the superior sagittal sinus with vertebral metastasis compressing the spinal cord as well as lung metastases.

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