Benign Skull Tumors Clinical Presentation

  • Author: Draga Jichici, MD, FRCP, FAHA; Chief Editor: Tarakad S Ramachandran, MBBS, FRCP(C), FACP   more...
 
Updated: Feb 3, 2012
 

History

  • The challenge is to differentiate the varying types of bone tumors. Imaging studies and the appearance of the lesion are the primary differentiating factors. The location of the lesion is of little differential diagnostic value, although lesions of developmental origin have a strong midline propensity.
  • Single, small, grossly round and oval lesions are more likely to be benign. The presence of peripheral sclerosis strongly favors a benign tumor. The margin of a lesion is of no diagnostic value.
  • Intralesional calcifications are more common in benign tumors. Peripheral bone vascularity also indicates a benign process.
  • The differential diagnosis includes encephalocele, meningoencephalocele, venous lakes of the skull, pacchionian depression, fractures, surgical defects, osteomyelitis, tuberculosis, syphilis, osteoporosis, and congenital hemolytic anemia.
  • The following tumors manifest as slow-growing painless masses: osteoma, ossifying fibroma, chondroma, nonossifying fibroma, xanthoma, hemangioma, epidermoid, dermoid, meningioma, and fibrous dysplasia.
  • Other tumors include osteoid osteoma, osteoblastoma, chondroblastoma,[6] chondromyxoid fibroma, desmoplastic fibroma, giant cell granuloma, eosinophilic granuloma, and aneurysmal bone cyst.
  • Associated headache is nonspecific in nature.
  • Lymphangioma manifests as a painless cystic defect.
  • Osteoid osteoma manifests with nocturnal local tenderness that is relieved by aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Cranial nerve deficits are observed in chondroblastoma, giant cell granuloma, epidermoid, dermoid, fibrous dysplasia, and Paget disease.
  • A rapidly growing mass is observed in desmoplastic fibroma and giant cell granuloma.
  • Tumor location is unreliable for diagnosis. However, certain tumors appear at the convexity more than the skull base and vice versa.
  • Osteomas usually involve the frontal bone.
    • Ossifying fibromas favor the frontotemporal region.
    • Cartilage tumors involve the skull base.
    • Giant cell granuloma affects the sphenoid, temporal, and ethmoid areas.
    • Eosinophilic granuloma affects the frontoparietal area.
    • The globular variety of hemangiomas affects the skull base, and the sessile type affects the frontotemporal region.
    • Epidermoids and dermoids usually involve the cerebellopontine angle, parapituitary region, and calvaria. Dermoids prefer the midline.
    • Ossifying meningiomas involve the frontal parietal area.
    • Paget disease usually involves the skull base.
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Physical

Physical findings vary according to tumor type.

  • The lesion may be tender or nontender.
  • It may be soft or hard.
  • Cranial nerve deficits (eg, diplopia, hearing loss, vertigo, sensation loss) may be seen.
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Causes

Benign skull tumors are sporadic in occurrence. However, specific syndromes involving skull tumors have been described.

  • Gardner syndrome is the triad of the following:
    • Multiple osteomas of the skull, sinus, and mandible
    • Soft tissue tumors of skin
    • Colon polyps
  • McCune-Albright syndrome comprises the triad of the following:
    • Polyostotic fibrous dysplasia
    • Hyperpigmented skin macules
    • Precocious puberty
  • Hand-Schüller-Christian disease consists of the following:
    • Diabetes insipidus
    • Exophthalmos
    • Bone lesions
  • Multiple enchondromas is known as Ollier syndrome.
  • Maffucci syndrome consists of the following:
    • Enchondromas
    • Dyschondroplasia
    • Cavernous hemangiomas of soft tissues or viscera
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Contributor Information and Disclosures
Author

Draga Jichici, MD, FRCP, FAHA  Associate Clinical Professor, Department of Neurology and Critical Care Medicine, McMaster University School of Medicine, Canada

Draga Jichici, MD, FRCP, FAHA is a member of the following medical societies: American Academy of Neurology, Canadian Congress of Neurological Sciences, Canadian Congress of Neurological Sciences, Canadian Congress of Neurological Sciences, Canadian Critical Care Society, Canadian Medical Protective Association, Canadian Neurocritical Care Society, Neurocritical Care Society, Royal College of Physicians and Surgeons of Canada, and Society of Critical Care Medicine (USA)

Disclosure: Nothing to disclose.

Specialty Editor Board

Spiros Manolidis, MD  Associate Professor of Otolaryngology and Neurological Surgery, Columbia University

Spiros Manolidis, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Head and Neck Society, American Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Society of University Otolaryngologists-Head and Neck Surgeons, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jorge C Kattah, MD  Head, Associate Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge C Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences

Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP  Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine

Disclosure: Abbott Labs None None; Teva Marion None None; Boeringer-Ingelheim Honoraria Speaking and teaching

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Efstathios Papavassiliou, MD to the development and writing of this article.

References

  1. Wilkins RH, Rengachary SS. 2nd ed. Neurosurgery. New York, NY: McGraw-Hill; 1996:1503-1528.

  2. Huvos AG. Bone Tumors: Diagnosis, Treatment and Prognosis. Philadelphia, Pa: WB Saunders Company; 1979.

  3. Yuca K, Kiris M, Avcu S, Bayram I, Cankaya H, Kiroglu AF. A giant paediatric mandibular aneurysmal bone cyst and reconstruction with bilateral iliac bone graft. B-ENT. 2009;5(1):39-42. [Medline].

  4. Nasser MJ. Psammomatoid ossifying fibroma with secondary aneurysmal bone cyst of frontal sinus. Childs Nerv Syst. May 30 2009;[Medline].

  5. Docquier PL, Delloye C, Galant C. Histology can be predictive of the clinical course of a primary aneurysmal bone cyst. Arch Orthop Trauma Surg. May 9 2009;[Medline].

  6. Konishi E, Okubo T, Itoi M, Katsumi Y, Murata H, Yanagisawa A. Chondroblastoma of trapezium with metacarpal involvement. Orthopedics. Apr 2008;31(4):395. [Medline].

  7. Schmitz-Feuerhake I, Pflugbeil S, Pflugbeil C. Radiation Risks from Diagnostic Radiology: Meningiomas and other Late Effects after Exposure of the Skull. Gesundheitswesen. Jun 23 2009;[Medline].

  8. Wootton-Gorges SL. MR imaging of primary bone tumors and tumor-like conditions in children. Magn Reson Imaging Clin N Am. Aug 2009;17(3):469-87, vi. [Medline].

  9. Yucel E, Akkaya H, Gürkanlar D, Ergun T. Congenital cavernous hemangioma of the skull. Turk Neurosurg. 2011;21(4):645-7. [Medline].

  10. Bloch O, Kaur G, Jian BJ, Parsa AT, Barani IJ. Stereotactic radiosurgery for benign meningiomas. J Neurooncol. Oct 18 2011;[Medline].

  11. Dassoulas K, Schlesinger D, Yen CP, Sheehan J. The role of Gamma Knife surgery in the treatment of skull base chordomas. J Neurooncol. Mar 11 2009;[Medline].

  12. Burger PC, Scheithauer BW, Vogel FS. 4th ed. Surgical Pathology of the Nervous System and its Coverings. New York, NY: Churchill Livingstone; 2002:1-66.

  13. Keyserling H, Peterson K, Camacho D, Castillo M. Giant cell angiofibroma of the orbit. AJNR Am J Neuroradiol. Aug 2004;25(7):1266-8. [Medline].

  14. Mirra JM. Bone Tumors: Clinical, Radiological and Pathological Correlations. Philadelphia, Pa: Lea and Febiger; 1989.

  15. Morris JM, Lane JI, Witte RJ, Thompson DM. Giant cell reparative granuloma of the nasal cavity. AJNR Am J Neuroradiol. Aug 2004;25(7):1263-5. [Medline].

  16. Thomas JE, Baker HL Jr. Assessment of roentgenographic lucencies of the skull: a systematic approach. Neurology. Feb 1975;25(2):99-106. [Medline].

  17. Unni KK. 5th ed. Dahlin's Bone Tumors: General Aspects and Data on 11,087 Cases. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996.

  18. Youmans JR. 5th ed. Neurological Surgery. Philadelphia, Pa: WB Saunders Company; 2004:3227-3268.

 
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Composite CT scan, MRI, and angiogram of a symptomatic ossifying fibroma with extensive involvement of the skull base in a 12-year-old girl whose primary symptom was exophthalmos and loss of vision bilaterally.
Lateral skull radiograph of a 73-year-old patient with a slow-growing nontender skull lesion. Note the typical honeycomb appearance.
Head CT scan of a 73-year-old patient with a slow-growing nontender skull lesion shows a well-defined nonenhancing lytic lesion with calcification and honeycomb appearance.
Sagittal magnetic resonance imaging (MRI) section of the brain of a 73-year-old patient with a slow-growing nontender skull lesion showing a nonenhancing soft tissue mass. This lesion proved to be a hemangioma.
Lateral skull radiograph of a 17-year-old adolescent male with a painless slow-growing mass. The single round lytic lesion was found to be an epidermoid.
Fibrous dysplasia involving the sphenoid sinus and pterygoid plates as well as the sella. This is an asymptomatic lesion; observation was recommended.
Head CT scan of a 78-year-old woman with Paget disease. Note the cotton wool appearance of the lesion, with varying degrees of bone formation and no clear edges. Observation was recommended.
 
 
 
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