Background
Calvarial lesions are rare and can be the presenting lesion of a wide variety of diseases.
The lesions are usually palpable on the skin and cause local pain or/and paraesthesia.
Depending on the location, some neurological deficits can also be a presenting
manifestation. This study aims to present our experience with incidental skull masses as
a manifestation of systemic metastasis.
Methods
We report 12 cases with presenting calvarial masses. These lesions were later proven to
be metastatic lesions of a primary veiled lesion. This was either proven by documented
histopathological examination following excision or an incidental body scan. Therefore,
our study only included such lesions, excluding any other primary neoplastic or nonneoplastic skull lesions.
Results
Of our 12 patients, most of the cases were females (58.3%). The patients’ mean age was
50.5 years (range 21-70 years). Six lesions were mounting from the frontal bone, 5 in the
parietal bone, and one in the occipital lesion. While all lesions did not invade the integrity
of the brain parenchyma; hence in 1 case, the lesion invaded the dural venous sinus
(Superior sagittal sinus), and another invading the frontal dura. All cases presented with
scalp swelling, whereas 3 cases had additional manifestations of increased intracranial
tension. Two cases reported ER admission at the first diagnosis. One presented with
recurrent attacks of convulsions, and the other case came with a disturbed conscious
level. The most discovered primary tumor was lung carcinoma (4 cases). This was
preceded by hepatocellular carcinomas (HCC) (in 3 cases) and breast carcinoma in 2
cases. Renal cell carcinoma (RCC), multiple myeloma, and diffuse B-cell lymphoma each
presented with one case.
Conclusion
The skull is a susceptible site for metastasis. Therefore, it is recommended that any
patient with a skull mass be further investigated for a lookout for potential metastasis.