Journal of General and Family Medicine

2016, vol. 17, no. 2, p. 168169.

Images in Clinical Medicine

Huge Protruded Metastatic Skull Tumor

Anu Neerukonda, MD,1 Takeshi Saraya, MD, PhD,2
Naoki Tsujimoto, MD,2 Kosuke Ohkuma, MD,
Masachika Fujiwara, MD, PhD,3 and Hajime Takizawa, MD, PhD2
1
2
3

SUNY Stony Brook Department of Internal Medicine, NY, USA

Kyorin University School of Medicine, Department of Respiratory Medicine
Kyorin University School of Medicine, Department of Pathology

Keywords: skull tumor, lung cancer, MRI

A previously healthy 65 year-old man was referred to

our hospital due to a protruding central head mass. This

cT1aN0M1b, stageIV. After the completion of radiation

and 4 cycles of intravenous chemotherapy with

mass had drastically increased in size over the previous

carboplatin (660 mg/body, AUC = 6), albumin-bound

few months to as large as 5 cm (Fig. 1A). The

gadolinium-enhanced magnetic resonance imaging

paclitaxel (nab-paclitaxel) (100 mg/m2), and Bevacizumab (15 mg/kg/day) followed by maintenance

taken on admission demonstrated a heterogeneously

enhancing mass measuring 8 cm in diameter involving

therapy with Bevacizumab (15 mg/kg/day) every 3

weeks for a total of 11 courses, the head mass had

the parietal bone (Fig. 1B), with areas of degeneration

almost disappeared (Fig. 1C, D).

gured as low intensity areas, and compressing the

underlying brain parenchyma through the thickened

Metastases to the skull are seen in 1525% of cancer

patients and are often asymptomatic. Physicians

enhanced dura (Fig. 1B, arrow). However, he had no

neurological symptoms. Biopsy specimens obtained

should keep in mind that metastatic skull tumours

can be derived from breast, lung, prostate, thyroid,

from the parietal tumour showed adenocarcinoma, and

renal cell cancer, malignant lymphoma, melanoma,

non-enhanced thoracic computed tomography showed

8 mm spiculated nodule in the left upper lobe. PET-CT

leukemias, and multiple myeloma1,2 and that these

lesions may be the only evidence of metastatic

taken prior to admission showed no evidence of a

metastatic site except for in the parietal bone. He was

disease, especially with renal cell carcinoma and

thyroid carcinoma.

thus diagnosed with primary lung adenocarcinoma

Corresponding author: Takeshi Saraya MD, PhD

Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo
181-8611, Japan
E-Mail: sara@yd5.so-net.ne.jp
Received for publication 31 March 2015 and accepted in revised form 10 July 2015
2016 Japan Primary Care Association

168

Huge Protruded Metastatic Skull Tumor

Figure 1.

References

239245.

1 Mitsuya K, Nakasu Y, Horiguchi S, et al: Metastatic skull tumors: MRI features and a new conven-

Bradley WG: Neurology in Clinical Practice: The

neurological disorders Taylor & Francis, 2004.

tional classication. J Neurooncol. 2011; 104(1):

169