Osteolytic lesions of the skull cap

Abstract

We report the case of a caucasian 71 years-old female, with history of schizophrenia, who presented to the emergency room due to fall with traumatic brain injury, initially observed by general surgery that requested an x-ray to the skull, which revealed multiple lytic injuries in the skull cap (Figure 1). With this finding, the patient was admitted in the Internal Medicine service in order to study these lesions.
On the physical examination the patient presented skin and mucous paleness, as well as a nodule on the upper exterior quadrant of the right breast, irregular, with poorly defined edges with approximately 5x3cm dimensions and a palpable ipsilateral axillary adenopathy. Under these findings, the patient did an abdominal-pelvic-thorax computerised tomography, which revealed diffuse involvement of the whole skeleton covered by mixed type injuries with suspicion of neoplasia and prove the nodule detected on the physical exam. Given the suspicion of breast tumour with bone metastasis, the patient was forwarded for a breast biopsy conducted by an echography, which confirmed the presence of invasive carcinoma “No Special Type”. The patient began hormonotherapy with letrozol choosing palliative measures.
The bone is one of the most common metastasis areas. Osteolytic injuries of the skeleton are present on patients with multiple myeloma and other solid tumours such as breast and lung. Differential diagnose of the lytic bone lesions can include primary malign bone injuries, bone metastasis or even benign bones injuries. Considering this, the evaluation of a patient with bone metastasis becomes a challenge. This clinical case pretends to highlight the importance of conducting a physical exam, which is the key in the diagnostic orientation, allowing to anticipate the final diagnostic. Most bone metastasis are asymptomatic, however, usually the oncological pain emerges on the course of evolution of the disease and when present it becomes a sign of already an advanced disease.

© 2021 Galicia Clínica.