Presentation
Presents with enlarging mass on the head.
Patient Data
There is a granular, mineralized mass present on the occipital bone of the skull and projecting caudally. The cortical margins are lytic in the region of the mass. Although the calavarium appears normal, the mass may penetrate it, which would be better assessed on CT images. The soft tissues dorsal to the mass are distorted. The remainder of the osseous and soft tissue structures of the head are normal.
Multilobular tumor of bone.
Case Discussion
Fine needle aspirate revealed a sarcoma, however further differentiation was not possible. The radiographic appearance is definitive for multilobular tumor of bone.
Multilobular tumor of bone typically arises from the temporo-occipital region, however additional sites of orgin in the skull can be seen such as the mandible, maxilla, orbit, and hard palate. The characteristic of the tumor that is specific is the granular appearance of the lesion, sometimes termed stippled or popcorn in appearance. The pattern is better seen on CT and MRI but is often visible on radiographs. The tumors are often slow growing and large in size, and tend to recur after surgery.
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