Presentation
Left frontal bulging, swelling in the left testicle, and neck pain.
Patient Data
A well-defined enhancing lesion measuring 6.5 x 4.0 x 4.4 cm with extra-axial T1 isointense and T2/FLAIR hyperintense lesion showing flow voids and few foci of calcification is seen along the left frontal convexity, causing mild compression of the underlying frontal lobe. It permeates the left frontal bone with preserved architecture and shows extra calvarial extension, elevating the scalp aponeurosis. The underlying dura shows enhancement (the dural tail sign is positive).
Case Discussion
K/C/O left testicular lesion with a left frontal bone lesion with extracranial and intracranial extraaxial components. Initial PET CT showed metabolically active lesions in the left scrotum, bony lesions with associated soft tissue components at the C7-D2 vertebra, and in the left frontal region.
A biopsy of epidural soft tissue at the D1 level showed tumor cells with high-grade nuclear features and frequent mitosis. On IHC, tumor cells expressed CK, SALL-4, and GLYPICAN-3 and were negative for CD117, SOX-2, B-HCG, CD30, D240, and OCT 3/4 - metastatic germ cell tumor - yolk sac tumor. Due to the advanced nature of the disease, the patient proceeded with chemotherapy without fertility preservation.
Blood-borne metastases to the skull are commonly described for a number of cancers, such as renal cell carcinoma, neuroblastoma in children, malignant melanoma in adults, and carcinomas of the lung, breast, and thyroid. Metastasis from a germ cell yolk sac tumor to the skull is rare. The lesion described is a circumscribed invasive type.
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