Lytic Skull Lesions: A Comparative Review of Pathological Entities | Chapter 3 | An Overview of Disease and Health Research Vol. 10

 

Background: Skull lesions constitute an uncommon yet diagnostically demanding group of conditions that span traumatic, infectious, benign and malignant etiologies. Despite their diverse origins, these lesions commonly manifest with overlapping clinical features, most notably scalp swellings, osteolytic calvarial defects, and non-specific radiological findings. Such similarities often obscure diagnostic clarity, although their underlying pathophysiological mechanism, therapeutic requirements, and prognostic implications differ substantially. Accurate differentiation is therefore essential to ensure timely and appropriate management.

 

Objectives: This chapter aims to present a structured comparative review of three representative skull lesions—tubercular calvarial osteomyelitis, angiomatous meningioma, and metastatic follicular thyroid carcinoma—by integrating individual case presentations with relevant contemporary literature. The goal is to emphasise distinguishing features across epidemiology, pathogenesis, clinical presentation, imaging characteristics, histopathology, treatment approaches, and outcomes.

 

Methods: A focused literature review was conducted following PRISMA 2020 principles for study identification, screening, and reporting. Three illustrative clinical cases were selected: Calvarial tubercular osteomyelitis in a 14-year-old female; Angiomatous meningioma (WHO Grade I) in a 72-year-old male; Metastatic follicular thyroid carcinoma involving the skull in a 54-year-old female. Each case was analysed in conjunction with published evidence to highlight comparative and contrasting attributes of these pathologies. Key parameters reviewed included epidemiology, disease mechanisms, clinical manifestations, radiological patterns, histopathological hallmarks, treatment strategies, and prognostic outcomes. A diagnostic framework was synthesised to support practical clinical decision-making.

 

Findings: Tubercular osteomyelitis typically affects younger individuals and presents with granulomatous inflammation and lytic skull lesions; Early identification and initiation of anti-tubercular therapy, with or without surgical debridement, generally yield an excellent prognosis. Radiological findings often demonstrate lytic bone destruction without aggressive periosteal reaction. Angiomatous meningioma, a rare WHO grade 1 subtype, shows prominent vascularity and peritumoral oedema. Despite its striking radiological appearance, it remains histologically benign. Complete surgical excision is curative in the majority of cases, with recurrence being exceptionally uncommon when total removal is achieved. Conversely, Skull metastasis from follicular thyroid carcinoma is an infrequent and clinically aggressive manifestation of differentiated thyroid cancer. Patients typically present with expansile osteolytic lesions and a hypervascular mass. Management requires a multimodal approach including wide surgical excision, radioactive iodine therapy, and thyroid-stimulating hormone suppression. Prognosis remains guarded due to the advanced nature of metastatic disease.

 

Conclusion: These three cases exemplify the wide pathological spectrum encompassed by skull lesions and underscore the necessity for meticulous diagnostic evaluation. Although clinical and radiological presentations may overlap, the biological behaviour, therapeutic interventions, and expected outcomes vary markedly among infectious, benign, and metastatic entities. Accurate early diagnosis—supported by detailed imaging and confirmatory histopathology—is vital to guide optimal treatment strategies and improve patient outcomes. This comparative review reinforces the importance of sustained clinical vigilance and structured diagnostic algorithms in the management of rare calvarial lesions.

 

 

Author(s) Details

Md. Humayun Rashid
Department of Neurosurgery, East-West Medical College, Dhaka, Bangladesh.

 

Munaiba Ahmad
Chittagong Medical College, Chittagong, Bangladesh.

 

Md. Rahad-Ul-Islam
Department of Neurosurgery, East West Medical College Hospital, Bangladesh.

 

Mushtaq Mutashid Muhib
East West Medical College Hospital, Bangladesh.

 

Rashed Mahmud
Department of Neurosurgery, East West Medical College Hospital, Bangladesh.

 

Md. Wasiul Alam Taufique
Department of Neurosurgery, East West Medical College Hospital, Bangladesh.

 

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