History
See the list below:
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Presentation may include any of the following:
Rapidly growing mass with pain and swelling
Mass without pain as in multiple myeloma and osteosarcoma
Nonspecific headache
Cranial nerve deficits: These are seen in giant cell tumors, angiosarcomas, and chordomas, as well as in tumors of the head and neck with propensity for perineural spread, such as tumors of salivary origin (eg, adenoid cystic carcinomas, adenocarcinomas, mucoepidermoid carcinomas).
Fever and malaise
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Location of the tumor
Although the location of the lesion is of little value in making the diagnosis, certain tumors prefer the convexity more than the skull base and vice versa; lesions of developmental origin have a propensity for the midline.
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Chondrosarcomas, giant cell tumors, angiosarcomas, and chordomas usually involve the skull base. [7]
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The remainder usually involve the calvaria.
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Patients may have a history of previous malignancy, fibrous dysplasia, or Paget disease.
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Multiple, small, nonmarginated lesions usually indicate metastatic disease.
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The absence of peripheral sclerosis strongly favors a malignant tumor.
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The differential diagnosis includes the following:
Benign skull tumors
Encephalocele, meningoencephalocele, venous lakes of the skull, pacchionian depression
Fractures, surgical defects
Osteomyelitis, tuberculosis, sarcoidosis, syphilis
Hyperparathyroidism, osteoporosis, congenital hemolytic anemia
Physical
See the list below:
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Signs include the following:
Soft or hard lesion
Cranial nerve deficits: These may include diplopia from involvement of cranial nerves III, IV, or VI; facial paralysis; hearing loss; vertigo; and sensation loss along the distribution of the trigeminal nerve. Voice changes and swallowing disorders, with or without tongue fasciculations/paralysis, signify involvement of the cranial base at the jugular foramen with medial extension.
Multiple findings related to the primary tumor
Tender or nontender lesion
Causes
See the list below:
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Little information is available concerning the etiology of the malignant skull tumors (except in the case of metastatic disease).
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Chondrosarcomas often are associated with abnormalities of chromosomes 10 and 22.
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Head CT scan of a 60-year-old man with a history of multiple myeloma for 2 years, showing multiple lytic lesions that involve both the inner and outer tables as well as the diploë.
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This head CT scan shows multiple lytic lesions of the skull involving both the inner and outer tables.
