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A rare ossifying fibroma in the occipital bone is described, and the available literature reviewed. The rapid growth seen in this case was remarkable and led us to believe this was a malignant osteogenic tumor. Full knowledge and the correct diagnosis of ossifying fibroma should have prevented an unnecessarily extensive operation for this benign lesion.
We present a case of benign osteoblastoma of the occipital bone. Benign osteoblastoma is an uncommon primary bone tumor, which usually involves the vertebrae and the long bones. This tumor rarely develops in the calvaria, showing a preference for the temporal and frontal bones when it does. To the best of our knowledge, this case is only the eighth reported case of benign osteoblastoma confined to the occipital bone. A 20-year-old male presented with a mild tender mass lesion of the occipital area, just below the lambda. Plain X-ray films and CT scans demonstrated an osteolytic mass surrounded by the sclerotic rim within the diploic space. MRI proved to be effective for the evaluation of the intracranial and intraosseous extensions of the tumor. However, it was very difficult to formulate a differential diagnosis against other osteoblastic tumors, or osteoid osteoma, in view of its radiological appearance. The final diagnosis was obtained by careful consideration of the histopathological characteristics of the tumor combined with its clinical and radiological features. Although generally regarded as benign, a complete resection is preferred over conventional curettage as this can guard against possible recurrence and malignant transformation.
A 12-year-old boy presented with primary Ewing's sarcoma of the occipital bone manifesting as intermittent high fever and local pain in the occipital region. Plain skull x-ray films disclosed an unclear lytic lesion in the occipital bone. Computed tomography and magnetic resonance imaging demonstrated the irregularly enhanced mass. The tumor was removed totally. He received intensive chemotherapy and radiation therapy postoperatively. No recurrence or metastasis has been noted, and he was in good condition 18 months after the operation.
Monostotic fibrous dysplasia of the occipital bone is an unusual finding. A case is presented and the differential diagnosis is discussed.
A technique is described of using autologous occipital bone for posterior atlantoaxial fusions. The advantages include the ease of harvest, the lack of postoperative discomfort, and the suitability of occipital bone for the fusion.
Brown tumor is a focal lesion of the bone caused by primary or, less commonly, secondary or tertiary hyperparathyroidism (HPT). While the mandible is the most frequently involved bone in the head and neck region, atypical involvement of the cranium in the area of the sphenoid sinus is exceedingly rare. In the literature, a unique case of brown tumor of the sphenoid sinus was reported in a patient with primary HPT. We present a case of sphenoid sinus and occipital bone brown tumor associated with primary HPT. A 47-yr-old woman presented a 2-yr history of headaches, dizziness, diffuse body and articular pain, fatigue, and a 6-month history of intermittent nausea and vomiting, polydipsia, and polyuria. Magnetic resonance imaging (MRI) demonstrated an expansive mass lesion in the sphenoid sinus with erosion of the sellar floor and medial wall of the right orbit, and expansion in the medulla of bone. Examination of biopsy specimens obtained from sphenoid sinus mass confirmed the diagnosis of brown tumor. The biochemical laboratory studies showed elevation of parathyroid hormone and confirmed the diagnosis of primary HPT. Excision of a parathyroid adenoma affected the metabolic status into normalizing. At the follow-up of 12 months postoperatively, the size of sphenoid sinus brown tumor decreased and the mass of occipital bone disappeared. In conclusion, this is a first report of primary HPT masquerading as a destructive fibrous sphenoid sinus brown tumor associated with a mass lesion of occipital bone and hypercalcemia in the literature.
Giant cell reparative granuloma (GCRG) is a non-neoplastic fibrous lesion with unevenly distributed multinucleated giant cells, areas of osseous metaplasia and hemorrhage. The small bones of the hands and feet are the most common sites, followed by the vertebral bodies and craniofacial bones. In the craniofacial bones GCRG has been reported in the temporal bone, in the frontal bone and paranasal sinus. However, to the best of our knowledge no case has been reported in the occipital bone. We report on the imaging findings and pathological features of a GCRG of the occipital bone and discuss the differential diagnosis of this entity in this particular location, especially with giant cell tumor because of the therapeutic and prognostic implications.
An uncommon case of benign osteoblastoma of the occipital bone is presented. Poor vascularity of the tumor, as confirmed by the CT scan, operative and histopathological findings, was in contrast to its characteristic high vascularity. Radical resection produced an excellent result.
The authors present a rare case of malignant fibrous histiocytoma originating in the cranial bone. A 72-year-old male was admitted with a diffuse painless swelling in the left occipital region but no neurological abnormality. Plain skull x-ray films and computed tomographic scans showed a large tumor in the left temporo-occipital bone. The tumor invading subcutaneous tissue was totally excised and histologically diagnosed as malignant fibrous histiocytoma. Postoperatively, 40-Gy irradiation was given to the left temporo-occipital region. Several months later, however, the tumor recurred in the posterior fossa. Neuroradiological examination showed tumor extension into the occipital bone and muscle and the subdural space of the posterior fossa. A second operation extirpated all tumors except in the cerebellum. He died of pneumonia on the 14th postoperative day. Autopsy revealed malignant fibrous histiocytoma invading into the bilateral cerebellar hemispheres. Radiation and chemotherapy should be given as soon as possible following extensive surgery for malignant fibrous histiocytoma of the cranial bone.
Primary cranial Ewing's sarcoma is rare. We describe an exceptionally rare case of primary Ewing's sarcoma of the occipital bone, presenting as spontaneous acute epidural hematoma. A 19-year-old female was admitted to our hospital complaining of sudden onset of severe headache. There were no neurological deficit and no abnormal laboratory findings. Computerized tomographic (CT) scan revealed a lentiform shaped high density lesion at the left occipital epidural space. Magnetic resonance imaging (MRI) showed the lesion as iso to low intensity on T1-weighted image (T1WI) and mixed signal intensity on T2-weighted image (T2WI). There were no pathological findings at the adjacent brain. Cerebral angiography demonstrated mass effect. Right occipital craniotomy was performed. We found the tumor arising from the occipital bone and located at the epidural space. The tumor was resected totally. Histological examination revealed the tumor as Ewing's sarcoma with intratumoral hemorrhage. The postoperative course was uneventful. Radiation therapy (50Gy) was given. Follow-up examination six years after the treatment found no evidence of tumor recurrence or distant metastasis. It should be born in mind that primary Ewing's sarcoma of the skull can cause spontaneous acute epidural.
Contusion of the brain at the site of the injury and by the contrecoup mechanism as well as vascular dysfunction in the vertebrobasilar basin may occur in craniocerebral injury with fracture of the occipital bone. In view of this, it is necessary to analyse the neurological manifestations of the brain injury carefully, carry out radiography of the occipital bone, and rule out the presence of hematoma at the site of the injury and one of a contrecoup mechanism. Procaine hydrochloride block of points of the vertebral arteries in indicated because of the dysfunction in the vertebrobasilar basin.
A comparative study of the cranial morphologies of cetaceans and of rodents that use their incisors for burrowing brings out morphological convergences concerning the supra-occipital bone. These phyletically very remote groups are both subject to the same mechanical constraint, viz. the need for the spinal column to be aligned with the anteroposterior axis of the skull. This constraint, which is related to swimming in cetaceans and burrowing in rodents, entails three major points of convergence: 1) a clearly backward facing foramen magnum; 2) a shortened or even greatly shortened neck, sometimes with cervical vertebrae fused together; and 3) an uprighted or even forward tilted supra-occipital bone.
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A database of over 1300 cavalier King Charles spaniels spanning 20 generations was established by obtaining pedigree information from 45 dogs with syringomyelia secondary to occipital bone hypoplasia. These data were supplemented with published information from the breed club. The incidence of syringomyelia was very high in certain families and lines which had been extensively inbred. The affected dogs could be traced back to one bitch born in 1956 and the two offspring from her single litter. Four key dogs representing four major breeding lines consistently occurred within the individual pedigrees. If a dog had more than five of its eight great-grandparents descended from these four lines there was a greater chance of it having syringomyelia. The data from this preliminary study suggest that occipital bone hypoplasia is hereditary in the cavalier King Charles spaniel and that its inheritance is more likely to be autosomal recessive because both dam and sire must be inbred descendants from certain lines. However, the inheritance is more likely to be of variable penetrance or oligogenic than simple.
The juvenile occipital bone from the site of Malladetes in Valencia (Spain) is described and compared with other European Pleistocene representatives of the genus Homo. This specimen derives from a Gravettian cultural context and has been AMS radiocarbon-dated to 25,120 +/- 240 years BP. As such, it provides evidence on early modern human anatomy from the Central Mediterranean region of the Iberian peninsula. The clear evidence for a late survival of Neandertals in southern Iberia, has led to considerable debate surrounding the biological and cultural interactions between these Pleistocene humans and their early modern human successors, and it is within this context that the Malladetes specimen represents an important contribution to the discussion. The recently discovered Upper Paleolithic infant from the site of Lagar Velho in Portugal is said to show a mosaic of Neandertal and early modern human characteristics throughout the skeleton and is argued to represent the strongest evidence yet recovered in favor of hybridization between these two Pleistocene populations. Our analysis of the Malladetes occipital, however, reveals no evidence of Neandertal genetic influence.
A case of occipital ossifying fibroma in a 13-year-old girl is presented. Ossifying fibroma is a rare, benign, primary bone tumour that occurs most commonly in the mandible. Cranial vault location is extremely rare. To our knowledge, our patient is the second case of occipital location reported. Total surgical excision is the treatment of choice.
A new anomalous apperture has been identified by the author in association with the occipital bone. It was situated in the interval between the jugular fossa and the occipital condyles. Out of 118 skull bases examined four instances of this anomalous apperture were found (2 complete and 2 incomplete). The author speculates that they may transmitting the posterior condylar emissary vein in the absence of the condylar canal or in its abrrent course to the jugular foramen. In view of its topographical location the author proposes the name--'Paracondylar foramen' to this anomalous apperture.
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