Calvarial Mass as a Presenting Symptom of Metastatic Diseases

Abstract Background: Calvarial lesions can be the presenting lesion of a wide variety of malignancies. The lesions are usually palpable on the skin and cause local pain and/or paraesthesia and in some advanced cases large enough to be a reason for skin dehiscence. Depending on the lesion location and its aggressiveness, some may present with neurological deficits. Aim of Study: This study aimed to present our experience with incidental calvarial mass as a possible manifestation of systemic metastasis. Patients and Methods: This study retrospectively report 12 cases with presenting calvarial masses for a metastatic pathology. These lesions were proven to be metastatic lesions of a primary veiled lesion at time of first diagnosis of the calvarial mass. This was either proven by documented his-topathological examination following excision or an incidental finding in pre-operative investigations. Our study only included such lesions, excluding any other calvarial primary neoplastic or non-neoplastic calvarial lesions. Results: Of our 12 patients, most of the cases were females (58.3%). The patients' mean age was 50.5 years (range 31-70 years). Six lesions were mounting from the frontal bone, 5 in the parietal bone, and one in the occipital region. While all lesions did not invade the integrity of the brain parenchyma; hence in 2 cases, the lesion invaded the dural venous sinus (Superior sagittal sinus, SSS), and another invading the frontal dura. All cases presented with scalp swelling, to an extent of causing skin dehiscence in 3 and was the main reason of excision of the calvarial lesion. On the other hand, 3 cases had neurological deficits, with 1 case reporting to ER with uncontrolled convulsions. Nine of the 12 reported cases underwent surgery for excisionof calvarial mass which showed a metastatic pathology. In other cases, the primary pathology was diagnosed, yet surgery was not done as oncologist avowed any benefit from surgery. The most discovered primary tumor was lung carcinoma (4 cases). This was followed by hepato-cellular carcinomas (HCC) (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 calvaria is a potential site for metastases. Not only that, but it might also be the primary presentation for metastasis. We suggestthat any calvarial mass should be alerting, puttingthe possibility of metastases when managing.Further workup is mandatory for suchpatients and inte-grated consultation with oncologist, when metastatic, to determine surgical decision.