Eccrine Spiradenoma of the Scalp

Eccrine spiradenoma is an uncommon benign adnexal tumor originating from the eccrine sweat gland. We diagnosed a eccrine spiradenoma on a 55-year-old man with histopathologic confirmation upon biopsy followed by complete resection, who had visited our clinic with a chief complain of occipital scalp mass. The solitary eccrine spiradenoma occurring in the scalp is rarely to be seen and should be considered as a differential diagnosis for a solitary cystic mass of the scalp.

Sensory Complications in Patients after Scalp Mass Excision and Its Anatomical Considerations

OBJECTIVE: To evaluate the incidence of postsurgical sensory complications in patients with scalp masses and classify the locations of them from a surgical standpoint according to anatomical considerations. METHODS: A total of 121 patients who underwent surgery for scalp mass were included in this study. The authors reviewed medical records and preoperative radiologic images. We investigated the complications related to sensory changes after procedure. Enrolled patients have been divided into three groups. Group A included patients with tumors above the superior nuchal line (SNL), Group B with tumors within the trapezius muscle area and patients who had tumors on the lateral trapezius muscle area were assigned to Group C. We compared the incidence related to postoperative sensory complications and summarized their additional treatments for these with clinical outcome. RESULTS: There were 12 patients (10%) with sensory complications related on the mass excision site (Group A: 1 patient, Group B: 2 patients, Group C: 9 patients). Six patients were affected with lesser occipital nerve (LON), 2 patients on greater occipital nerve (GON) and 4 patients on GON and LON. Over 6 months after surgery, two of the twelve patients with sensory complications did not have complete recovered pain in spite of proper medications and local chemical neurolysis with 1.0% lidocaine and dexamethasone. CONCLUSION: Occipital neuropathy should be considered as a complication related excision of scalp mass. The sensory complications are more frequent in Group C because of the anatomical characteristics of the occipital nerves and there were no statistical difference for other variables.

Primary Malignant Lymphoma of the Cranial Vault with Extra- and Intracranial Extension

Bone involvement is a common finding in many types of lymphomas, particularly in advanced stages. However, cranial vault affliction has been regarded as an exceedingly rare presentation. Here, we report the case of a patient with cranial vault lymphoma who presented with a scalp mass. An 81-year-old woman presented with a gradually growing and non-painful frontal scalp mass that she noticed one month before admission. It was a flatly elevated, round mass measuring about 6x4x4 cm. Computed tomography and magnetic resonance imaging of the brain revealed a contrast-enhancing intracranial extradural mass at the counter-location of the scalp mass. The superior sagittal sinus was involved at the tumor site. Cerebral angiography showed that the tumor feeding vessels originated from the bilateral external carotid arteries. An operation was performed and the tumors were removed together with the involved bone. The pathologic diagnosis was malignant diffuse large B-cell type lymphoma. The patient was transferred to the Hemato-Oncology department for chemotherapy. Primary lymphoma of the cranial vault with scalp mass is very rare but it should be considered in the differential diagnosis of scalp masses. Although the results of reported cases are variable, the combination of surgery, radiation, and chemotherapy appears to offer favorable outcomes.

Malignant Peripheral Nerve Sheath Tumor of Scalp

PURPOSE: Malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, usually arising from somatic soft tissues or peripheral nerves. Primary MPNST of the scalp is extremely rare. The case is being reported for its rarity. METHODS: A 53-year-old female was presented with a scalp mass on vertex area. The tumor was localized in scalp skin and did not invade underlying periosteum or skull and treated with complete surgical excision followed by adjuvant chemotherapy and radiotherapy. RESULTS: Histologically, the tumor showed malignant spindle cells with focal S-100 positivity on immunohistochemistry and a diagnosis of MPNST was made. CONCLUSION: Authors experienced a rare case of primary scalp MPNST and report the case.

Atretic Cephalocele

We report a case of atretic cephaloce in a 7-month-old girl who presented with a growing left parietal painful mass, which was covered with excessive growth of thick scalp hairs and purplish discolored skin. Preoperative radiological studies revealed the left parietal round skull defect and epidural well enhancing mass without significant intradural parenchymal and vascular malformation. Total excision was done and histological diagnosis of atretic cephalocele was done. Characteristic histopathological features of this rare congenital anomaly with pertinent review of literatures were presented.

Atretic Cephalocele

We report a case of atretic cephaloce in a 7-month-old girl who presented with a growing left parietal painful mass, which was covered with excessive growth of thick scalp hairs and purplish discolored skin. Preoperative radiological studies revealed the left parietal round skull defect and epidural well enhancing mass without significant intradural parenchymal and vascular malformation. Total excision was done and histological diagnosis of atretic cephalocele was done. Characteristic histopathological features of this rare congenital anomaly with pertinent review of literatures were presented.

Two Cases of Sinus Pericranii

The "sinus pericranii" is a rare vascular anomaly involving an abnormal communication between extracranial and intracranial venous system, which usually involves the superior sagittal sinus, sometimes the transverse sinus. It is found beneath or in the periosteum of the cranial vault and is connected with an intracranial sinus through anomalous diploic veins of congenital or acquired origin. It is benign scalp mass, and should be differentiated from vascular anomalies of the scalp and cystic masses of the scalp communication with the cerebrospinal space. The authors present 2 cases of sinus pericranii which was spontaneously developed without any history if head injury. The lesion was found to be changed in it's volume according to patient's head position. Clinical characteristics of sinus pericranii is discussed.

A Case of Dermoid in the Cerebellar Hemisphere

Dermoid cysts of the posterior fossa are benign, mostly midline, congenital brain neopasm, usually located above or behind the vermis or adjacent meninges2)18)20), Dermoid lesions are slow growing and may become quite large before producing signs and symptoms12). We have recently experienced a case of dermoid which arised in cerebellar hemisphere. A 32-year old woman who had a history of chronic headache at morining was visited in our department and she was also complained of a egg-sized plapable mass which was growing nature, non-tender, soft, and movable on the right occipital area. On admission, there were no specific localizing and lateralizing neurological abnormalities. Unenhanced CT scan shows hypodense mass in the left cerebellar hemisphere and cystic mass at the right occipital scalp(Fig. 1. A). T1-weighted MR image shows hypointense mass in the left cerebellar hemisphere(Fig. 2. A). The Carotid angiography shows non-specific findings. Paramedian suboccipital approach was performed and mass was removed from the lleft cerebellar hemisphere. The cystic scalp mass was removed totally from the left cerebellar hemisphere. The cystic scalp mass was removed totally from the right occipital area. Diagnosis of dermoid cyst was confirmed pathologically by the specimens obtained from two different sites, left cerebellar hemisphere and right occipital ccalp.