Frontoparietal primary osteosarcoma mimicking parasagittal meningioma: A case report

Although Osteosarcoma is the most common primary malignant bone tumor, it rarely occurs in the craniofacial region. The incidence of primary craniofacial osteosarcoma is 0.33 to 0.41 per million.

A 44-year-old male presented with a mass over the head for 5 months, blurring of vision for 1 month, and weakness of the left lower limb for 1 month. On physical examination, a mass of 10∗10 cm over the frontal region of the head with normal overlying skin without any tenderness. CT and MRI scans showed a mass centered around the midline cranium with both intracranial and extracranial components, with perilesional edema in adjacent brain tissue, with mass effect. Subtotal excision of the tumor was performed, and the patient was referred to another centre for radiotherapy and chemotherapy.

Osteosarcoma, being rare in the skull region, can often be confused with a much more common condition like meningioma. Osteosarcoma may resemble meningioma clinically and radiologically, particularly when meningioma has an extensive intraosseous component, either due to primary intraosseous origin or secondary bony invasion. Histopathology is the key to differentiating the two conditions. Surgery, along with radiotherapy and chemotherapy, is the key to management.

Osteosarcoma is a rare but important differential diagnosis in patients presenting with skull masses.