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JAMA Oncology Clinical Challenge
December 22, 2016

A Rapidly Expanding Scalp Mass

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Oncol. Published online December 22, 2016. doi:10.1001/jamaoncol.2016.5090

A woman in her 80s presented to the emergency room (ER) with a 2-week history of enlarging left parietal scalp mass. She initially was seen by her primary care practitioner, where neurological examination was nonfocal. The mass continued to enlarge and she developed progressive generalized weakness, slowed speech, and focal right-handed weakness. Acute onset of headache and decline in mental status prompted presentation to the ER. On examination an 8-cm left parietal mass was tender to palpation. Treatment with 4 mg of dexamethasone was initiated intravenously. All biochemical laboratory results were normal. Brain magnetic resonance imaging showed a large enhancing left frontal-parietal mass extending both extracranially and intracranially into the superior sagittal sinus (Figure). There was left frontal, parietal, and temporal bone involvement, and left dural thickening. Intracranially, there was adjacent vasogenic edema and associated mass effect. Computed tomographic (CT) scans of the chest, abdomen, and pelvis revealed a ground-glass sclerotic lesion of the right sacrum. Owing to involvement of the superior sagittal sinus and progressive growth, an ultrasound-guided core needle biopsy was performed.

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