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case_images: Pre-operative imaging. (A and B) Axial and coronal computed tomography showing an intraosseous lytic lesion in the left frontal bone with destruction of the outer cortex. (C) Nuclear medicine scan (SPECT/CT) demonstrating mild radiotracer uptake indicative of osteoblastic activity, concerning for malignancy. (D-F) T1, T2, and T1 post-contrast magnetic resonance imaging demonstrating T1 iso-hypointensity, T2 iso-hyperintensity and heterogenous contrast enhancement. Dural thickening is observed deep to the lesion, concerning for invasion.
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case_images: Nuclear medicine scanning (SPECT/SPECT-CT) of the whole body confirmed a solitary, osteoblastically active lesion (Figure 1).
case_images: Post-operative imaging. (A and B) Axial and coronal computerised tomography showing the craniectomy site and surgical cranioplasty and expected post-surgical small volume pneumocephalus.
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case_images: The patient proceeded to undergo a craniectomy and resection of the lesion with duroplasty and titanium mesh cranioplasty (Figure 2).
case_images: Histopathology of the tumour. (A) Low powered haematoxylin and eosin stain highlighting bone involvement. (B) Highly cellular (Antoni A) and myxoid hypocellular (Antoni B) regions typical for schwannoma. (C and D) High powered H&E stain showing spindle cells. (E) Strong, diffuse positivity for S100 and (F) SOX10 suggestive of schwannoma.
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case_images: Histopathological analysis (Figure 3) of the specimen revealed moderately cellular, spindle cell tumour in patternless sheets and intersecting fascicles, with occasional Verocay bodies.