Neuroblastoma with skull metastases

Case contributed by Tamir Abdeljawad Ajeez


Patient presenting with head swelling. Parents deny a history of head trauma

Patient Data

Age: 11 months
Gender: Female

Moth-eaten osteolytic lesions, with hair-on-end appearance, and sun-ray spiculation. Diffusely widened sutures is also noted.

  • diffuse moth-eaten osteolytic lesions
  • soft-tissue-density intra- and extra- cranial mass lesions
  • sun-ray spiculations, directed intra- and extracranially, and traversing the previously depicted masses.

CT Abdomen.

  • heterogeneously enhancing right suprarenal mass lesion showing areas of calcification and breakdown
  • bilateral paraaortic enlarged lymph nodes showing evidence of calcification, and breakdown
  • left hepatic lobe hypodense focal lesion (segment IVa)

Case Discussion

In this case, the skull 'sun-ray' spiculation, and the subpericranial metastatic deposits leaves no room for error. Indeed it has been stated that there is no differential diagnosis in the pediatric group.

Cranial sutures diastasis is due to suture metastatic invasion.

This is a stage 4 neuroblastoma, with contralateral nodes, and distant, skull cortex metastasis.

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