Tumor and Tumor-Like Lesions of the Skull Flashcards
Osteoma, hemangioma, dermoid, epidermoid, chondroma, meningioma, and aneurysmal bone cyst are benign tumors of the skull. Malignancy of skull is suggested by a single large lesion or multiple > 6 osteolytic lesions of the skull. These tumors
are ragged, undermined, and lack sclerosis. Which of the following are malignant tumors of the skull?
● A. Bone metastasis to the skull like prostate, breast, lung, kidney, thyroid, and lymphoma
● B. Chondrosarcoma
● C. Osteogenic sarcoma
● D. Fibrosarcoma
● E. All of the above
E. All of the above
A 55-year-old female patient presents with a swelling on cranial vault which she noticed was slow growing. On skull X-ray, it comes out as round, sclerotic, well-demarcated, homogenous dense projection arising from the outer table of the skull.
On nuclear bone scan it comes out to be hot spot. Osteomas are asymptomatic lesions requiring surgery only for cosmetic reasons or pressure on adjacent structures. Which of the following is not included in the triad of Gardner’s syndrome?
● A. Increased density or hyperostosis of calvaria
● B. Multiple cranial osteomas of calvaria, sinuses, or mandible
● C. Colonic polyposis
● D. Soft tissue tumors
● E. None of the above is related to the triad of Gardner’s syndrome
A. Increased density or hyperostosis of calvaria
Hemangiomas are benign tumors which commonly occur in the skull and spine and constitute 7% of the skull tumors. These are of two types, namely, cavernous (common) and capillary (rare). Which of the following is the imaging characteristics of
these tumors?
● A. X-rays show a circular lucency with honeycomb or trabecular pattern (seen in 50% of cases) or radial trabeculations producing a sunburst pattern (seen in 11% of cases), while sclerotic margins are evident in only 33% of cases
● B. CT of brain shows hypodense lesion with sclerotic spaced trabeculations
● C. This lesion is nonenhancing on brain CT
● D. Bone scan is typically hot
● E. All of the above
A. X-rays show a circular lucency with honeycomb or trabecular pattern (seen in 50% of cases) or radial trabeculations producing a sunburst pattern (seen in 11% of cases), while sclerotic margins are evident in only 33% of cases
The gross appearance of hemangioma is a hard tumor with blue doomed mass beneath the pericranium. What is the recommended treatment option for these tumors?
● A. En block excision or curettage with radiation considered for inaccessible tumors
● B. Radiation has no role in these tumors
● C. These tumors require no treatment and resolve on their own
● D. Partial excision is adequate for these tumors
● E. The goal of surgery is decompression only
A. En block excision or curettage with radiation considered for inaccessible tumors
A patient presents with a mass over the calvarium. On X-ray, there appears to be an osteolytic lesion with well-defined and sclerotic margins. CT of brain shows nonenhancing hypodense lesion and on MRI, these are like CSF low intensity on T1 and high signal intensity on T2 but unlike CSF they are high signal
intensity on DWI. What could be the most likely diagnosis in this patient?
● A. Epidermoid tumor of the skull
● B. Dermoid tumors of the skull
● C. Osteoma of brain
● D. Osteosarcoma
● E. Both A and B
E. Both A and B
Epidermoid or dermoid occurs when ectodermal rests are entrapped in the development of skull which causes these tumors to arise from the diploe and expand into both inner and outer tables. What is the recommended option for these tumors?
● A. Radiotherapy
● B. Chemotherapy
● C. Surgical treatment with curettage
● D. Endoscopic treatment
● E. All of the above
C. Surgical treatment with curettage
Which of the following is not a non-neoplastic skull lesion?
● A. Osteopetrosis
● B. Paget’s disease
● C. Hyperostosis frontalis interna
● D. Fibrous dysplasia
● E. Hemangioma
E. Hemangioma
A patient presents with hypertension, seizures, headache, dementia, and irritability. Plain skull X-ray shows thickening of the frontal bone with characteristic sparing of the midline. CT demonstrates a 10-mm bony thickening, and bone scan shows up moderate uptake. What are the most likely conditions associated with hyperostosis frontalis interna?
● A. Morgagni’s syndrome, which includes headache, obesity, virilism and neuropsychiatric disorders
● B. Endocrine abnormalities like acromegaly or hyperprolactinemia
● C. Metabolic abnormalities like hyperphosphatemia and obesity
● D. Diffuse idiopathic skeletal hyperostosis (DISH)
● E. All of the above
E. All of the above
Fibrous dysplasia is a non-neoplastic benign condition in which normal bone is replaced with fibrous connective tissue. Most lesion occurs in ribs, proximal femur, and craniofacial bones?
● A. Cystic, sclerotic, or mixed
● B. Monostotic fibrous dysplasia which is most common
● C. Polyostotic fibrous dysplasia
● D. Polyostotic fibrous dysplasia as part of McCune Albright syndrome (which include the triad of cafe au lait spots, endocrinopathy, and polyostotic fibrous dysplasia)
● E. B, C, and D
E. B, C, and D
A patient presents with local swelling with pain and tenderness over it. He/she also has pathological fracture, decreasing hearing function, seizures, and darkened hair pigmentation.
Management includes which of the following?
● A. Removal of dysplastic bone, curettage, and cranioplasty
● B. Acute visual deterioration is treated with high dose glucocorticosteroids and decompression
● C. Involvement of multidisciplinary team for skull base lesions
● D. Copious amount of irrigation during drilling to avoid thermal injury
● E. All of the above
E. All of the above
Which of the following is not a benign tumor of skull?
● A. Osteoma
● B. Hemangioma
● C. Chondroma
● D. Osteogenic sarcoma
● E. Meningioma
D. Osteogenic sarcoma
What is the most common primary bone tumor of the calvaria?
● A. Osteoma
● B. Hemangioma
● C. Chordoma
● D. Osteogenic sarcoma
● E. Meningioma
A. Osteoma
Skull X-ray showing circular lucency with honeycomb, trabecular, or sunburst pattern is most commonly seen with which of the following?
● A. Osteoma
● B. Hemangioma
● C. Chordoma
● D. Osteogenic sarcoma
● E. Meningioma
B. Hemangioma
Which of the following is a primary malignant tumor of clivus or sacrum showing physaliphorous cells on histopathology?
● A. Osteoma
● B. Hemangioma
● C. Chordoma
● D. Osteogenic sarcoma
● E. Meningioma
C. Chordoma
Fibrous dysplasia is associated with which of the following?
● A. MISME syndrome
● B. McCune-Albright syndrome
● C. Post traumatic
● D. X-linked inheritance
● E. Autosomal dominant inheritance
B. McCune-Albright syndrome
