Findings

Bone scintigrams at initial presentation were reported as normal. Asymmetric hyperostosis (arrow) of the frontal bone was reported on bone schintigraphy at the time of her recurrence and correlative skull radiograph was obtained. Retrospectively, this asymmetry was present on the initial bone scintigram. There was no scintigraphic change in the cranial asymmetry on routine follow-up scintigraphy.

At the time that she complained of headache, nausea, and personality change, a mass was seen on CT in the right frontal area (arrow) which enhanced with contrast. The irregular low density around the mass was not typical for a meningioma or metastatic breast cancer. Changes in the bone at the tumor base suggested that it had been present for some time. The patient underwent a craniotomy and biopsy of the lesion which was a meningioma containing a focus of metastatic breast carcinoma.

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J. Anthony Parker, MD PhD, jap@nucmed.bih.harvard.edu