Sarcoma De Craneo

Neoplasm

Primary Osteogenic Sarcoma of the Skull
Bikash Bose, M.D., F.A.C.S., F.I.C.S. Department of Neurosurgery, Christiana Care Health Care System, Newark, Delaware and Jefferson Medical College, Philadelphia, Pennsylvania

Bose B. Primary osteogenic sarcoma of the skull. Surg Neurol 2002;58:234 – 40. BACKGROUND

An osteogenic sarcoma of the skull is rare, particularly as a primarytumor. The incidence of primary osteogenic sarcomas of the skull is about 1 to 2% of all skull tumors.
CASE DESCRIPTION

incidence of 2% (21 of 1000) for skull osteosarcomas, and in their series, 14 patients had de novo tumors [6]. Because of the rarity of this type of tumor, we present another case of a primary osteogenic sarcoma of the skull.

A 21-year-old male was initially evaluated becauseof a large mass that had been growing for 7 months. The patient had been experiencing frequent headaches and tenderness at the site of the lump for about a month before being seen by the neurosurgeon. A computed tomography scan revealed a large mass, 12 cm 7 cm, involving the scalp extending from the right temporal region to the vertex. A magnetic resonance imaging (MRI) scan showed a large massarising from the posterolateral aspect that was 90% extracranial and 10% intracranial on the right side of the skull. The MRI showed marked vascularity and neovascularity of the tumor. An angiogram was performed, which demonstrated that the mass was fed by the branches from the right external carotid artery. The patient subsequently underwent surgery for embolization of the right occipital andsuperficial temporal arteries and removal of the mass. Pathology evaluation of a specimen revealed a high-grade osteoblastic osteosarcoma.
CONCLUSION

Case Report
A 21-year-old male was initially evaluated because of a large mass on his head and a headache. The patient stated the mass had been growing for 7 months. He had seen a primary care physician who believed the lump was an abscess. Thephysician performed cystic aspiration, which revealed a negative result. For the past month, the patient had been experiencing frequent headaches and tenderness at the site of the lump. The patient had no family history of cancer, but the patient stated he used tobacco and alcohol and occasionally used cocaine. A computed tomography (CT) scan, with and without contrast, was obtained of the brain,which revealed a large mass involving the scalp extending from the right temporal region to the vertex. Its maximum anteroposterior dimension was 12 cm and in the transverse dimension, the mass was 7 cm. Without contrast, the CT showed irregular calcification and low attenuation areas, which represented necrosis (Figure 1A). With contrast administration, the mass was found to be eroding the rightparietal bone, and there was extension through the bone to the right parietal dural surface. There was some compression of the adjacent brain parenchyma (Figure 1B). A magnetic resonance imaging (MRI) scan was performed, and it showed a large mass arising from the posterolateral aspect of the skull on the right side. The mass was 90% extracranial and 10% intracranial (Figure 2). There was a calcifiedhemorrhagic part of the mass. The MRI showed marked
© 2002 by Elsevier Science Inc. 360 Park Avenue South, New York, NY 10010 –1710

We review the literature of reported cases of primary osteogenic sarcomas of the skull to discuss the common clinical presentation, evaluation methods, and recommended treatment plans. © 2002 by Elsevier Science Inc.
KEY WORDS

Osteosarcoma, skull neoplasm,primary tumor.

n osteogenic sarcoma of the skull is rare, particularly as a primary tumor. Huvos et al reported that of 1200 patients found to have osteogenic sarcomas over 60 years’ time, 19 patients (1.6%) had tumors of the skull, and only 10 of those were de novo tumors [3]. Nora et al. reported an

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Address reprint requests to: Dr Bikash Bose, C-79 Omega Drive, Newark, DE. Received...