case_images: PMC6834395_01
case_images: Brain MST (12.04.17): In the left parietal region, there is a solid lesion that replaces the bone marrow, measuring approximately 5.2 cm x 2 cm, infiltrating the dura mater, subcutaneous cellular tissue and adjacent skin.
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case_images: Brain MST was performed, indicating the presence of a solid lesion at the left parietal level, which replaced the 5 cm x 7 cm bone marrow and compromised the dura mater, subcutaneous cellular tissue and adjacent skin (Figure 1).
case_images: Brain MRI (06.06.17): Neoformative tissue, which infiltrates the bone marrow of the cranial calotte, in the right frontal bone, left occipital with bilateral parietal bone to left predominance, the latter infiltrates the adjacent soft parts, necrotic and ulcerated in the adjacent subcutaneous plane associated with osteolysis of the calotte, infiltrates the adjacent pachymeninges and the posterior aspect of the interhemispheric furrow, without infiltration of the parenchyma.
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case_images: The patient lost her sight, and in June 2017, magnetic resonance imaging (MRI) was performed (Figure 2), showing bilateral parietal lesion with predominantly ulcerated, necrotic left that infiltrated the pachymeninges and a new lesion at the right frontal level.
case_images: Photo of 04.07.17, with evidence of injury at the parietal level with the destruction of the cranial shell exposing the meninges.
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case_images: Surgery, being catalogued as non-surgical. She was evaluated in the Radiotherapy department, where an ulcerated parietal level lesion with raised edges on scalp with extensive involvement was found, and with the diffuse of soft tissues with destruction of the skull of approximately 9 cm exposing the meninges at the parietal level and an elevated lesion of 3 cm at the right frontal level of hard, non-ulcerated consistency was also found (Figures 3 and 4).
case_images: Brain MST (05.07.17): Expansive lytic lesion in the left parietal bone measuring approximately 8.37 cm x 3 cm, infiltrating the meninges. Another lesion of the same characteristics which measures 2.3 cm x 0.95 cm at the level of the right frontal bone.
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case_images: figure4
case_images: Surgery, being catalogued as non-surgical. She was evaluated in the Radiotherapy department, where an ulcerated parietal level lesion with raised edges on scalp with extensive involvement was found, and with the diffuse of soft tissues with destruction of the skull of approximately 9 cm exposing the meninges at the parietal level and an elevated lesion of 3 cm at the right frontal level of hard, non-ulcerated consistency was also found (Figures 3 and 4).
case_images: Opposite lateral treatment field covering the two lesions at 51Gy in 17 sessions with photons.
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case_images: In a multidisciplinary meeting, it was decided to treat with radiotherapy in opposite lateral fields, covering the two lesions of the cranial cap at a dose of 5,100 cGy in 17 sessions at 300 cGy per fraction (Figure 5).
case_images: Photo of 09.08.17, 10 days after radiotherapy treatment. Borders of ulcers in reepithelialisation, no bleeding.
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case_images: Eighteen months later, she is currently under follow-up, resulting in daily healing and complete pain relief (Figure 6).