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Case of the Month

November 2016

Patient Data: 7 year old male

Clinical Info: Palpable mass on the skull


64966-Afbeelding1.jpg
Lump in the skull


64967-Afbeelding2.jpg
Image in the other direction


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The mass is vascularized


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X ray of the skull showing the lesion


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This is another patient (an 11 year old boy) also with a lump on the head


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This mass is also vascularized


64972-Mijn_Film_1.swf MRI 1


64973-Mijn_Film_2.swf MRI 2


64974-Mijn_Film_3.swf MRI 3


64975-Mijn_Film_4.swf MRI 4 The lesion enhances after gadolinium


64976-Mijn_Film_6.swf MRI 5


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The first two lesions must be diiferentiated from the next 2. This is a mass on the skull of a 14 year old female


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Another image of the same lesion in the other direction


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This mass is not vascularized


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X ray of the skull


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MRI 1


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MRI 2


64983-Mijn_Film_1.swf MRI 1


64984-Mijn_Film_2.swf MRI 2


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This is an example of an identical lesion in a 3 year male


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In this lesion there is also no flow detectable

The first two patients with the vascularized mass had a Langerhans cell histiocytosis of the skull. The 2 patients with the non vascularized lesion had an epidermoid cyst.
Langerhans cell histiocytosis (LCH) is a rare disease involving clonal proliferation of Langerhans cells, abnormal cells deriving from bone marrow and capable of migrating from skin to lymph nodes. Clinically, its manifestations range from isolated bone lesions like the skull to multisystem disease. LCH is part of a group of clinical syndromes called histiocytoses, which are characterized by an abnormal proliferation of histiocytes
Dermoids and epidermoids are slow-growing benign cysts that typically occur in the scalp and the skull of infants and young children. These result from a part of the scalp, either the epidermis (top layer) or dermis (bottom layer) being misplaced underneath the scalp. This causes the formation of a small cyst filled with normal skin componentst


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