[Subcutaneous mass as initial manifestation of an osteolytic metastasis]

A 69-year-old woman was admitted for evaluation of a left occipital subcutaneous tumour which had grown during the preceding eight weeks from 2 × 2 cm to 4 × 4 cm.

Sonography revealed a pressure-sensitive subcutaneous mass with osteolytic destruction in the occipital bone. Cranial magnetic resonance imaging confirmed the osteolytic lesion. Thoracic computed tomography showed a lesion in the upper left lobe of the lung with metastases in the hilar lymph nodes.

Transbronchial biopsy revealed a bronchial carcinoma. After resection of the osteolytic lesion its histology was confirmed to be an osseous metastasis of the carcinoma. Palliative chemotherapy and cranial irradiation were initiated.

Solitary osteolytic lesions of the skull occur in the context of osseous metastases. Other possible causes include solitary plasmocytoma and eosinophilic granuloma.