Benign Skull Tumors Clinical Presentation

Updated: Dec 18, 2014
  • Author: Draga Jichici, MD, FRCP, FAHA; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Presentation

History

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  • 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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