A case of ossifying fibroma of the skull

A 23-year-old woman was admitted to our hospital because of a soft, painful mass in the right parietal region for a month. Neurological examination revealed no abnormality. Laboratory data including serum Ca, P and alkaline phosphatase were normal. Skull x-ray film showed a partially osteolytic, not well circumscribed lesion in the right frontal, parietal and occipital bone. No remarkable sclerotic area was seen in the lesion. CT scan showed that the lesion was located in the diplo?, destroying both inner and outer tables of the bone. Right external carotid angiogram revealed that the lesion is supplied by the branches of superficial temporal artery and middle meningeal artery. 99mTc bone scan showed increased uptake in the lesion. The patient underwent a right parietal craniectomy. The skull bone was invaded by the tumor, which was yellow-brown in color, thickened and fragile. We could easily perforate it through. The tumor didn't invade the dura mater or periosteum. It was extensively removed with an airtome and rongeurs. A cranioplasty was carried out using a plastic resin. The pathological specimen showed that the tumor was mainly composed of mature, regularly-aligned bone and intermingled fibrous tissue. Neither mitosis nor atypical cellular features was seen. These findings were compatible with the diagnosis of ossifying fibroma. The postoperative course was uneventful and the patient was discharged in a good condition. There was no evidence of local recurrence 10 months later. Ossifying fibroma is a rare, benign bone tumor that mainly involves the craniofacial bone. The differential diagnosis of ossifying fibroma versus fibrous dysplasia is difficult. These diseases can be differentiated on combined clinical, radiological and morphological grounds.     

Monostotic fibrous dysplasia of the left parietal bone--case report

A 14-year-old female presented with a hard, painless mass, 5 x 5 cm, in the left parietal region. Skull x-rays showed a radiolucent skull tumor with a sclerotic margin in the parietal region. Computed tomography revealed an intradiploic multilocular mass separated by bony trabeculae. The outer table had thinned and protruded outward. The inner table was also thin and protruded inward slightly. External carotid angiography revealed a faint tumor stain and feeding from the middle meningeal artery. Bone scintigraphy revealed abnormal uptake in the lesion. Total removal of the skull tumor and cranioplasty were performed. The histological diagnosis was fibrous dysplasia. Fibrous dysplasia within the cranial vault is often expressed as painless bulging without neurological symptoms. Surgery is recommended when neurological symptoms and/or cosmetic problems are present. Histological confirmation of the diagnosis is also important.     

Monostotic fibrous dysplasia of the cranial vault: a case report

Fibrous dysplasia, when it occurs in the craniofacial region, mostly involves the skull base and is rarely localized in the cranial vault. Although there have been several reports on magnetic resonance imaging (MRI) findings of fibrous dysplasia involving the skull base, cases occurring in the cranial vault have seldom been reported. We describe here a rare case of monostotic fibrous dysplasia that occurred in the parietal bone and discuss the characteristics of the MRI findings. A 47-year-old female was admitted to our hospital with a complaint of vertigo. A computed tomography (CT) scan did not reveal any intraparenchymal lesions in either the infra- or supratentorium, and her vertigo improved immediately without any treatments. However, a solitary osteolytic lesion was found incidentally in the left parietal bone. MRI showed that the lesion demonstrated hypointensity on T1-weighted images and hyperintensity on T2-weighted images, and was enhanced heterogeneously following injection of Gadolinium-DTPA. Removal of the parietal bone containing the lesion was performed according to the patient's wishes. The histopathological findings of the removed tissues corresponded to fibrous dysplasia. Although it is well known that craniofacial fibrous dysplasia demonstrates iso- or hypointensity on T1- as well as T2-weighted images, in the present case, the lesion showed apparent hyperintensity on T2-weighted images. These findings suggest that fibrous dysplasia can display various MR intensities depending on its origin.     

Ossifying fibroma in the cranial vault. Case report]

Ossifying fibroma is relatively common in the maxilla, but rare in the cranial vault. A 10-year-old girl was referred for painful swelling of the left temporal region. On admission, she presented no abnormal physical and neurological findings except for the painful swelling. Plain skull X-ray films showed a radiolucent lesion of the left temporal bone about 4 cm in diameter, with a hyperostotic area of the parietal side. Computed tomography scan using bone window level also showed an abnormal density lesion in the same site. Curettage of this tumor was performed from a cosmetic point of view and at the family's petition. Histological examination showed vascular fibrous tissue in which lamellar bone was surrounded by osteoblasts.     

Surgical treatment of ossified cephalhematoma: a case report

We report a surgical case of ossified cephalhematoma which caused deformity of the skull. A boy was delivered with the aid of vacuum extractor at 40 gestational weeks. He presented with a big cephalhematoma in the left parietal region, and it remained and calcificated after 3 months. He was admitted after being diagnosed with ossified cephalhematoma. Plain skull radiograph showed a marginated radiolucent lesion with a protrusive outer table and a slightly invaginated inner table in the left parietal region. Plain CT scan showed a low density lesion between bony layers and the depressed inner table with irregular thickening. 3D-CT shows bony protrusion of the left parietal bone with thinning in the center. Magnetic resonance imaging revealed an old hematoma in the protruding bone and compression of the parietal lobe by the inner table. For cosmetic reasons and relief of compression of the brain, cranioplasty was performed at 7 months. The protruding bone was removed totally and was arranged to fit in the convex after being cut in pieces. Using bioabsorbable mini plates and screws, the bone was fixed firmly. For cranioplasty of a child, absorbable plates and screws are useful because of their non-interference with growth of the skull.     

An intradiploic epidermoid cyst of the skull in infancy: case report

An intradiploic epidermoid cyst of the skull in infancy is rare. We report a case of a 7-month-old girl with an intradiploic epidermoid cyst of the left parietal bone. The patient was admitted to the department of pediatrics in, our hospital in March, 2000, complaining of a lump in the scalp with a diameter of 1.5 cm. The pediatrician doubted that it was a case of Langerhans cell histiocytosis (LCH). In addition, as a result of further tests there were no systemic findings to suggest LCH. The skull x-ray showed round radiolucency of the left parietal bone. CT scans showed an iso density intradiploic mass with destruction of the outer table. Because of the fact that the mass was enlarging, the patient was admitted to our neurosurgical service in April, 2000. We excised the lesion to confirm the histological findings. The histological diagnosis was epidermoid cyst. We discuss the clinical feature and treatment strategy for intradiploic epidermoid cyst in infancy.     

Fibrous dysplasia of the skull presenting interesting neuroradiological findings

A case of fibrous dysplasia of the frontal bone in a 51 year-old male is described. He was admitted to our hospital with a hard, painless growing mass in the left frontal region. A symmetrical protrusion of his forehead has been observed since several years before. Neurological examination and laboratory data revealed no abnormalities. Skull x-rays demonstrated two different lesions. One showed a ground glass appearance in the supraorbital region, and the other showed a radiolucent lesion with marginal sclerosis crossing the left coronal suture CT scan revealed an intradiploic multilocular mass. T1 and T2 MR images showed an abnormal low-intensity mass, and heterogeneous gadolinium-enhancement was noticed in both lesions. Selective external carotid angiography showed tumor stain in the left coronal mass fed by middle meningeal and superficial temporal arteries mimicking intraosseous meningioma. On the other hand, a supraorbital hyperostotic lesion showed no apparent vascularity. An operation was performed on the left coronal lesion to verify the nature of the progressively enlarging mass, which was histologically confirmed to be a fibrous dysplasia rich in numerous vessels. Postoperative course was uneventful. Correlation with clinical activity and enhancement pattern was not known, however, careful observation is required in hypervascular fibrous dysplasia such as was observed in this case.     

Long-term outcome of fibrous dysplasia: reconstruction with dysplastic bone--case report

A 10-year-old girl presented with facial asymmetry associated with bulging of the right fronto-orbital region with no symptoms. Computed tomography demonstrated enlargement of the right zygomatic, frontal, ethmoid, and sphenoid bones. Abnormal proliferation of the bone had obliterated the sphenoid, right frontal sinus, and right ethmoid sinuses. These radiological findings suggested right optic nerve compression due to fibrous dysplasia. Right optic canal decompression was performed. In preparation for recurrence, the resulting bone defect in the right orbital roof was reconstructed using the outer table of the split lesion bone. The removed frontal bone was divided into intact and lesioned parts, and the intact part was returned. The lesioned part was split and the outer table graft used to reconstruct the frontal region. A temporal musculopericranial flap was used to form a barrier between the opened ethmoid sinus and cranial cavity. A protrusion appeared on the left forehead 10 years later, and was shaved to improve the aesthetic appearance. The patient was followed up for a total of 23 years. The use of dysplastic bone involves the risk of recurrence, but the period of recurrence is delayed and the progression stops after adolescence, so the second operation involved only shaving for aesthetic appearance. This procedure is one of the treatments of choice because of easy reconstruction, easy revision, and good results.     

Management of a large lesion of monostotic fibrous dysplasia with possible malignant transformation

A 50-year-old male presented with a large mass involving the left third rib following more than 30 years of a slow growing asymptomatic swelling in the chest wall. Computerised tomography (CT) scan showed a mass 7 × 10 cm expanding the left third rib and having a sclerotic outer margin which showed discontinuity and raising the possibility of malignancy arising in longstanding fibrous dysplasia (FD). Needle biopsy is confirmed fibrous dysplasia. Histological examination of the completely resected lesion confirmed the absence of malignancy. The patient made an uneventiful recovery.     

Radiographic characteristics of fibrous dysplasia of the clivus: a case report and review of the literature

Whereas fibrous dysplasia is a well-known, developmental skeletal disorder with a benign clinical course, fibrous dysplasia of the clivus is extremely rare and has seldom been reported. Differentiating this benign entity from more aggressive diseases involving the clivus is important for the proper management of lesions in this area. We here report a case of fibrous dysplasia of the clivus and discuss its radiographic features. The patient was 55-year-old male who had suffered from headache for months. Physical and neurological examinations found no abnormalities. The computed tomographic (CT) scan and magnetic resonance imaging (MRI) showed an abnormal mass lesion in the lower of the third clivus. On CT scan, the mass lesion exhibited a ground-glass appearance. The lesion was detected as hypointense and a mixture of hyperintense and isointense areas on T1-weighted and T2-weighted MRI, respectively. Heterogenous enhancement was noted after infusion of GD-DTPA. The patient underwent a transsphenoidal resection of the mass and the histopathologic diagnosis was fibrous dysplasia.     

A case of solitary bone cyst in the skull increasing in size after trivial head injury

A 12-year-old boy had been known to have a small swelling in the left high vertex for several years. After a trivial head hit to the site of the swelling, the swelling enlarged gradually. A bone window CT scan showed a lesion having bubble-like lytic change in the left parietal bone. Similar changes, but small, were able to be pointed out in a CT scan taken seven years previously. In the following 13 months CT scans eventually revealed sequential increases to 3.5 cm in diameter. Surgical exploratory resection of the mass was performed. Intraoperatively, partial destruction of the outer skull table and a simple cyst with serous yellowish brown colored fluid were identified. There was no finding adherent to the diploic structure. The bone defect after excision was reconstructed by using a titanium plate. The patient was followed up for 2 years after the surgery. Bone window CT showed bony development of normal appearance. Histological examination showed the cyst wall consisted of fibrous connective tissue but there were neither epithelial nor endothelial cells. The histopathological diagnosis of SBC was most likely. SBC is relatively common in long bones, but rarely in flat bones. Only several cases of the SBC of cranial bone have been reported. Although a craniectomy for total excision followed by cranioplasty by resin was common, in cases of children, cyst removal with titanium plate application would be an alterative. SBC increasing in size after head injury is extremely rare, but clinicians may need to be aware of cystic skull bone tumors increasing in size after head injury.     

A case of congenital skull defect complicated with arachnoid cyst]

A 3-month-old boy was referred to our hospital with left temporal bone defect and bulging skin. The skull defect had been recognized since birth. There was no family history of any congenital anomaly and his physical development was normal for his age. His bulged left temporal region was covered by normal skin and a skull defect measuring 2 x 2 cm in size was palpated at the center. CT scan revealed skull defect at the pterion accompanied with widening of the middle cranial fossa. Arachnoid cyst of the middle cranial fossa was also suspected. The skull defect gradually enlarged and especially on crying the left temporal skin bulging became more marked. The bone edge of the defect was thin and was deflected outward. The operation was planned and performed at the age of 11 months. After excision and fenestration of the arachnoid cyst, duraplasty and cranioplasty were performed using split-thickness calvarial bone graft. Splitting the frontal calvarial bone suitable for the defect, the outer table was returned to the donor site, and the inner table was fixed into the defect. Follow-up CT one year after surgery revealed a satisfactory cosmetic result and no bone resorption. Split calvarium cranioplasty is considered to be even more useful in an infant.     

Monostotic fronto-orbital fibrous dysplasia with convulsion--case report

A 28-year-old man presented with monostotic fronto-orbital fibrous dysplasia associated with convulsions. Signs of meningeal irritation were observed. Computed tomography (CT) showed right frontal sinusitis, and destruction from the inner to outer table with expansion of the diploic space. T1- and T2-weighted magnetic resonance imaging showed an abnormal low-intensity mass, with heterogeneous gadolinium enhancement. Although the meningitis resolved, signs of infection continued for 2 months due to sinusitis. Treatment of the right frontal sinusitis was undertaken, accompanied by open biopsy. The histological diagnosis was fibrous dysplasia. Once the infection had completely resolved, orbitofrontal reconstruction was undertaken. Cranioplasty was carried out using cranial bone cement. Three-dimensional CT was valuable to show the likely postoperative result.     

Idiopathic massive osteolysis of skull bone: a case report

A rare case of idiopathic massive osteolysis of the skull is reported. A 49 year-old male was admitted with a diagnosis of a skull tumor. The skull film taken for evaluation of the headache, showed a large lytic lesion with irregular margin in the left parietal area. CT showed that some of the bone had been destroyed, but the underlying brain was normal. Technetium 99m-MDP bone scan showed high activity around the margin of the lytic lesion. During surgery for this bone lesion no neoplastic or inflammatory changes were revealed. However, destruction of the bone without new bone formation could be seen. Idiopathic massive osteolysis of skull bone is extremely rare and the authors could find only 6 reported cases in the literature. It is characterized by the spontaneous onset of bone resorption without known causative factors. This destructive process continues for years until eventually it ceases spontaneously. In the case of skull lesion, there seems to be no need for surgery unless both the inner and outer tables are involved. This disease must be included in the differential diagnosis of lytic skull lesion.     

Monostotic fibrous dysplasia of the lumbar spine: case report and review of the literature

Monostotic fibrous dysplasia of the spine is extremely rare. We present a 57-year-old man who complained of persistent low back pain with monostotic fibrous dysplasia of the lumbar spine. Computed tomography revealed a lytic expansile lesion and marginal sclerosis in the L2 posterior element, although a bone scan did not reveal increased uptake in the lesion. The patient underwent total excision of the tumor via a posterior approach. Two years later, he is asymptomatic with no recurrence of the lesion, as confirmed by imaging.     

Polyostotic Fibrous Dysplasia with Craniofacial Localization Presenting with Frontal Lobe Compression in a 14-year-old Girl

Summary  We describe a rare case of polyostotic fibrous dysplasia with craniofacial localization associated with involvement of the spine and extremities. A 14-year-old girl presented with progressive headache, left frontal swelling, exophthalmos of the left eye, deformity and palpable mass in the left frontal area. Cranial computerized tomography revealed extensive involvement of all cranial bones except right frontal and right parietal bones. Most of the facial bones were invaded. Especially, there was the involvement of ethmoidal air sinuses and frontal sinus also. Computerized tomography showed left frontal lobe compression. In addition, the spine and bones of the extremities were involved in the patient. Craniofacial approach was planned. Cranial surgery was performed by an extradural frontal approach. Firstly, the frontal cyst was excised. For left frontal lobe decompression, we removed successfully all the abnormal bones causing mass effect and frontal deformity. Secondly, facial surgery was performed with external approach. An attempt to remove all of the involved bone is necessary, as the lesion may recur and grow if a portion of dysplastic bone is left in place. However, the present case suggests that removal of all the involved bones in the polyostotic fibrous dysplasia may be possible in spite of extensive involvement. In this situation, it may be removal of only abnormal bones responsible for compression of affected neural elements is indicated.     

A case of cerebral tuberculoma (author's transl)]

A 27-year-old woman was admitted to other hospital for acute pleuritis in May 1977. She suddenly had a focal epileptic seizure in the face with loss of consciousness on July 10, 1977. The same episodes of seizure occurred on Aug. 8, on Oct. 26, on Nov. 22, 1977. She was admitted to our hospital on Dec. 12, 1977. Neurological examinations showed no abnormality. Chest X-ray film showed bilateral severe thickening of the pleura. Plain skull films showed normal findings. Enhanced CT scanning showed a homogenous irregular contour of high density area surrounded by low density area in the right frontal region. The lateral ventricle was slightly shifted to the left side. 99mTc brain scan also detected a spherical abnormal uptake in this area. Right carotid angiography showed no abnormal vessels and increased vascularities. On Nov. 22, 1977, a craniotomy was made over the right fronto-temporal bone, and a walnut sized tumor in the frontal subcortex was totally removed successfully. Histologically, the tumor was diagnosed as brain tuberculoma. The antituberculous therapy (AB-PC, INAH, Rifampicin), high doses of gammabenin, and steroid were given. About four months later, she was in good health without neurologic deficits and returned to her work. The literature was reviewed, and the value of CT scan and RI scan in the diagnosis of cerebral tuberculoma was emphasized.     

胸腰椎骨纤维结构不良的影像学诊断

[目的]总结胸腰椎骨纤维结构不良的影像学特征,提高对本病的影像学诊断水平。[方法]回顾性分析5例胸腰椎骨纤维结构不良的X线、CT与MR I资料,总结其影像学特征。[结果]胸腰椎骨纤维结构不良X线表现为圆形或椭圆形囊状低密度影,有清晰的硬化带与周围正常骨组织间隔。CT表现为类圆形低密度影,边界清晰,边缘有完整骨质硬化带,骨皮质略微变薄但连续性未有破坏。MR I表现为T1W I中均匀长T1信号,T2W I中病灶呈混杂偏低信号,在T1W I、T2W I及质子像中病灶周围均有较完整的低或极低信号环状带;增强扫描时病灶信号明显强化。[结论]胸腰椎骨纤维结构不良具有独特的影像学特征,完全不同于骨纤维结构不良发生在脊柱以外的影像学表现,掌握这些特征是正确地做出影像学诊断的关键。     

8周龄中国实验用小型猪颧弓及顶骨三维测量

目的：获取8周龄中国实验用小型猪颧弓及顶骨三维测量数据,探索幼龄猪颅骨外板修复颧弓缺损的可行性。方法：对15头8周龄中国实验用小型猪进行头颅X线照相及头颅三维CT扫描,用Mimics10.01软件对头颅三维数据进行处理,对重建三维图像进行测量,获得30例颧弓的长度、高度、厚度数据及30例顶骨厚度数据,并将顶骨厚度与颧弓厚度进行比较。结果：8周龄中国试验用小型猪颧弓长度、高度及厚度分别为（28.18±0.94）mm、（12.80±1.56）mm及（3.00±0.51）mm,顶骨厚度为（3.68±0.86）mm。顶骨厚度明显大于颧弓厚度（P=0.004）。结论：8周龄中国实验用小型猪顶骨具有一定的厚度,具有制成颅骨外板的潜力,能够用来进行颧弓重建。     

Fibrous dysplasia.

The controversy is this case centers around the management of this lesion, not the differential diagnosis. All the consultants agreed that the history, physical, and CT findings were consistent with various fibroosseous lesions, the most likely being fibrous dysplasia. The need for additional tests varied with a bone scan (Dr. Kearns), a bone scan and CT scan (Dr. McGill), and MRI, MRI angiogram, bone survey, BUN, creatinine, calcium, and phosphorus (Dr. Potsic). Cosmetic and functional changes were considered priorities for the consultants, with orbital compression, malocclusion, tooth eruption, nasal obstruction, and sinusitis (Dr. Kearns), nasolacrimal duct obstruction and orbital compression (Drs. McGill and Potsic) being the concerns. Because this lesion is benign and slow-growing, the consensus is that surgery should be reserved for functional or cosmetic compromise. But how aggressive should one be and what approach should be used? The approaches varied with midface degloving or lateral rhinotomy (Dr. Kearns), midface degloving (Dr. McGill), or a Caldwell-luc and lateral rhinotomy (Dr. Potsic). Assessment of this tumor postoperatively should be with patient examinations and serial CT scans. None of the consultants worried about sarcomatous changes in this tumor.