AJR Teaching File: Lump on the Head

摘要

A 23-year-old man presents with a lump on the left side of his head. The patient had undergone enucleation and radiation therapy for retinoblastoma (RB) as a child.Unenhanced axial CT images of the head through the level of the foramen magnum using soft-tissue (Fig. 1A) and bone (Fig. 1B) algorithms show an aggressive, densely ossified bone-forming tumor that involves portions of the left temporal and greater sphenoid bones. The right globe prosthesis is a significant finding because it is suggestive of the cause of the mass. The left-sided mass is consistent with the provided clinical history of a palpable lesion. An axial T1-weighted gadolinium-enhanced image through the same level (Fig. 1C) confirms a large mass with an ill-defined enhancing soft-tissue component.The lesion shows dense mineralization and an ill-defined soft-tissue component suggestive of a high-grade malignancy. The right globe prosthesis reminds us that the patient has a significant medical history and that the cause of this skull-based tumor may be primarily or secondarily related to the history of retinoblastoma-for example from metastasis, treatment-related malignancy, or de novo neoplasm.