Osteoblastic skull metastasis invading the brain

Case contributed by Dr Roberto Schubert

Presentation

Re-staging bone scan for advanced metastatic prostate carcinoma under hormone suppression therapy. Low back pain and headaches. PSA 250 ng/ml.

Patient Data

Age: 70
Gender: Male
Nuclear medicine

The bone scan shows (among others) a large circumscribed activity zone in the right posterior calvarium due to disseminated bone metastases. Images courtesy of Caroline Mommsen, MD

Pre- and post-contrast soft window CT images of the brain show a hypervascular mass extending from the calvarium into the brain. The borders towards the brain are irregular, suggesting direct invasion rather than displacement (Fig. 2). There are liquid inclusions at the tumour periphery, probably from previous haemorrhage. 

Case Discussion

Prostate cancer, in spite of its distant location, is the second most common primary tumour metastasising to the skull. Invasion beyond the dural border into the neuroaxis is however extremely rare.

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Case information

rID: 17233
Case created: 28th Mar 2012
Last edited: 1st Nov 2015
Inclusion in quiz mode: Included

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