Brain Pathology Case of the Month - July 2007

Contributed by Guy D. Eslick, PhD1 and Kevin Seex, FRCS2
1 Department of Medicine, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.
2 Department of Neurosurgery, Nepean Hospital, Penrith, New South Wales, Australia.


A 49-year-old female, who suffered trauma to the left fronto-parietal region from a gymnasium weight two years previously, presented with a 12-month history of an enlarging lump in the same area. There were no associated visual, sensory or neurological symptoms. On examination there was a large smooth, non-tender, bony hard mass measuring 8 x 6 centimetres at its base, with mild to moderate overlying alopecia. It was non-pulsatile with no bruits. The lesion was percussion dull and there was no regional lymphadenopathy.


Computed Tomography (CT) scan showed a non-enhancing area of diffuse sclerosis involving both the inner and outer tables, consistent with a healing fracture (Figures 1, 2 and 3). Repeat CT and bone scan (Figures 4 and 5) suggested fibrous dysplasia, sarcoma or Paget's disease.


A portion of skull (50x39 up to 10mm in thickness) and three specimens of dura (40x17 up to 9mm in thickness; 30x10x2mm; 75x25 up to 5mm in thickness) were received for examination. Sections of the skull bone showed hyperostosis composed of bony trabeculae and. islands of benign looking cells were found in the marrow spaces (Figures 6, 7, 8, 9, 10 and 11).


International Society of Neuropathology