Neuroblastoma (craniocerebral metastases)
Updates to Article Attributes
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Neuroblastoma is the 3rd most common malignancy after leukemia and primary CNS tumors, it arises in the adrenal gland or along the sympathetic chain 2.
Metastasis occurs in about 70% of patients at the time of diagnosis 3.
Craniocerebral metastasis usually involve the calvaria, orbits, skull base and the dura.
Please refer on the article neuroblastoma for a general discussion on this entity.
Clinical presentation
- proptosis
- periorbital ecchymosis "raccoon eyes"
- palpable calvarial masses
Radiographic findingsfeatures
CT
- spiculated periorbital bone mass, typically involving the roof or lateral wall/sphenoid wings
- "Hair on end" spiculated periostitis of orbits and skull usually associated with bone destruction
- sutural separation: non uniform sutural separation with indistinct sutures margins
- cranial metastasis nearly always extra-dural (may mimic epidural or subdural hematoma)
MRI
-
T1
WI: hypointense to muscles -
T2
WI: heterogeneous usually hyperintense to muscles -
T1
WI C+C+ (Gd): vigorously enhances, may be heterogeneous - MRV: may narrow or invade adjacent dural sinuses
Nuclear medicine
-
MIBG (meta
-iodobenzylguaidine-iodo benzyl guanidine): avid uptake by neural crest tumors - TC-99-m-MDP: shows increased uptake from calcium metabolism of tumor
- PET: shows high sensitivity and specificity for recurrent tumors
Clinical profileDifferential diagnosis
proptosis-
periorbital ecchymosis "Raccon eyes" palpable calvarial masses
leukemia
Differential diagnosis
-
Leukemia:dural or calvarial based masses
, usually associated with intraparenchymal masses
Langerhanslangerhans cell histocytosishistiocytosis:
lytic bone lesions without periosteal bone formation
-<p><strong><a href="/articles/neuroblastoma">Neuroblastoma</a></strong> is the 3<sup>rd</sup> most common malignancy after leukemia and primary CNS tumors, it arises in the adrenal gland or along the sympathetic chain <sup>2</sup>.</p><p>Metastasis occurs in about 70% of patients at the time of diagnosis <sup>3</sup>.</p><p>Craniocerebral metastasis usually involve the calvaria, orbits, skull base and the dura.</p><h4>Radiographic findings</h4><h5>CT</h5><ul>- +<p><strong>Craniocerebral neuroblastoma metastases </strong>usually involve the calvaria, orbits, skull base and the dura.</p><p>Please refer on the article <a title="Neuroblastoma" href="/articles/neuroblastoma">neuroblastoma</a> for a general discussion on this entity. </p><h4>Clinical presentation</h4><ul>
- +<li>proptosis</li>
- +<li>periorbital ecchymosis "raccoon eyes"</li>
- +<li>palpable calvarial masses</li>
- +</ul><h4>Radiographic features</h4><h5>CT</h5><ul>
-<li>"<strong>Hair on end</strong>" spiculated periostitis of orbits and skull usually associated with bone destruction</li>- +<li>"<a title="Hair on end sign" href="/articles/hair-on-end-sign">Hair on end</a>" spiculated periostitis of orbits and skull usually associated with bone destruction</li>
-<strong>T1 WI</strong>: hypointense to muscles</li>- +<strong>T1</strong>: hypointense to muscles</li>
-<strong>T2 WI</strong>: heterogeneous usually hyperintense to muscles</li>- +<strong>T2</strong>: heterogeneous usually hyperintense to muscles</li>
-<strong>T1 WI C+</strong>: vigorously enhances, may be heterogeneous</li>- +<strong>T1 C+ (Gd)</strong>: vigorously enhances, may be heterogeneous</li>
-<li>-<strong>MIBG </strong>(meta-iodobenzylguaidine): avid uptake by neural crest tumors</li>-<li>-<strong>TC-99-m-MDP</strong>: shows increased uptake from calcium metabolism of tumor</li>-<li>-<strong>PET</strong>: shows high sensitivity and specificity for recurrent tumors</li>-</ul><h4>Clinical profile</h4><ul>-<li>proptosis</li>-<li>periorbital ecchymosis "<strong>Raccon eyes</strong>"</li>-<li>palpable calvarial masses</li>-</ul><h4>Differential diagnosis</h4><ul>-<li>Leukemia: dural or calvarial based masses, usually associated with intraparenchymal masses</li>-<li>-<a href="/articles/langerhans-cell-histocytosis">Langerhans cell histocytosis</a>: lytic bone lesions <em>without</em> periosteal bone formation</li>-<li><a title="Spiculated periosteal reaction" href="/articles/spiculated-periosteal-reaction">Spiculated periosteal reaction</a></li>-<li>Extra-axial hematoma</li>-<li>Ewing sarcoma</li>- +<li>MIBG (meta-iodo benzyl guanidine): avid uptake by neural crest tumors</li>
- +<li>TC-99-m-MDP: shows increased uptake from calcium metabolism of tumor</li>
- +<li>PET: shows high sensitivity and specificity for recurrent tumors</li>
- +</ul><h4><span style="font-size:1.5em; line-height:1em">Differential diagnosis</span></h4><ul>
- +<li>
- +<p>leukemia</p>
- +<ul>
- +<li><p>dural or calvarial based masses</p></li>
- +<li><p>usually associated with intraparenchymal masses</p></li>
- +</ul>
- +</li>
- +<li>
- +<p><a href="/articles/langerhans-cell-histocytosis">langerhans cell histiocytosis</a> </p>
- +<ul><li><p>lytic bone lesions without periosteal bone formation</p></li></ul>
- +</li>
- +<li><a href="/articles/spiculated-periosteal-reaction">spiculated periosteal reaction</a></li>
- +<li>extra-axial haematoma</li>
- +<li>ewing sarcoma</li>
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