Xanthoma of the Occipital Bone and With Preserved Inner and Outer Bone Cortex: Case Report

Abstract

Objective We present a unique case of a midline xanthoma of the occipital bone exhibiting atypical imaging characteristics with preserved bone cortex that has not previously been described.Participant This man presented with refractory headaches and suboccipital pain and a mass within the diploe of the occipital bone but with preserved inner and outer cortex of the bone. Magnetic resonance imaging showed a midline, enhancing, and marrow-replacing process in the occipital bone measuring 1.5 cm in anteroposterior (AP) diameter, resulting in mild indentation of the dorsal aspect of the cerebellar vermis.Results The patient underwent a suboccipital craniectomy. Tumor resection was from the foramen magnum to the inion and laterally until normal bone was encountered. The xanthoma was yellowish and bled a moderate amount upon resection.Conclusion An isolated cranial xanthoma with preserved inner and outer bone cortex involving the occipital bone and of midline location has yet to be described. The differential diagnosis of osteoexpansile skull lesion with preserved bone cortex should now include xanthoma. Given the broad spectrum of imaging characteristics exhibited by this unusual diagnosis, surgical intervention is indicated from a diagnostic as well as a therapeutic standpoint.

Primary mandibular xanthoma: case report

“…Bone xanthomas in the skull associated with hyperlipidemia and hypercholesterolemia are well described in the literature. 4,9,13 Multiple lesions are usually associated with systemic disease 6 ; however, our patient presented with a single lesion.…”

“…8 The solitary form of the disorder appears frequently in the diaphysis of long bones; however, the cranium can also be affected. 4,9,10 Other locations in the facial skeleton may be involved, including, as in our case, the mandible, which is a flat bone. The tumor appears around 20 years of age in a ratio of 2:1 in men and women, respectively, 3 Boisgard et al…”

“…It should preferably be radically removed, as it can cause significant morbidity, especially when there is facial and vestibulocochlear nerve involvement. 9 The symptoms are relieved after the lesion is removed. 4,9 Unlike xanthogranuloma, the solitary xanthoma of bone has no tendency toward aggressive behavior.…”

“…9 The symptoms are relieved after the lesion is removed. 4,9 Unlike xanthogranuloma, the solitary xanthoma of bone has no tendency toward aggressive behavior. 7 Surgical excision is the preferred treatment for a solitary xanthoma.…”