RIGHT PARIETAL SKULL XANTHOMA CHARACTERISED AS A METASTATIC DEPOSIT – A CASE REPORT

Abstract Background Xanthomas are benign lipomatous deposits that can be found systemically in various tissues including bones. Their presence in skull remains a rare entity. Despite their benign characteristics, imaging modalities are often unable to distinguish them from malignant lesions. This leads to diagnostic dilemma in patients with underlying malignancy. This case report highlights such a case where clinical history of prostate cancer and image findings were concordant with that of metastatic deposit in the parietal skull region. Case Description This 65-year-old gentleman was diagnosed with prostatic adenocarcinoma. During systemic work up for his tumour, he was found to have a right parietal skull lesion. MRI brain as well as bone scan were consistent with that of a metastatic deposit. As treatment would be drastically affected by the diagnosis, an excision biopsy was performed. The histology was consistent with that of a bone xanthoma. Conclusion Xanthomas are benign lesions that can be seen deposited in appendicular and axial skeleton. Skull lesions are rare with most case descriptions focussing on their presence in the fronto-orbital regions, mandible and temporal bone. They usually have a benign course but may present with symptoms due to localised mass effect. Surgical intervention and histological diagnosis may still be required in these lesions due to their lack of imaging characteristics that confirm their diagnosis through non-invasive methods.