HYPEROSTOSIS OF THE FRONTAL, TEMPORAL, AND SPHENOID BONES: CASE REPORT AND REVIEW OF LITERATURE

Int J Anat Res 2015, 3(1):817-20. ISSN 2321-4287 817

Case Report

HYPEROSTOSIS OF THE FRONTAL, TEM PORAL, AND SPHENOID

BONES: CASE REPORT AND REVIEW OF LITERATURE

Austin Huy Nguyen

_{, M allory M oore}

_{, and W illiam Hunter III *}

_.

ABSTRACT

Address for Correspondence: Dr W illiam Hunter III, Depart ment of Pat hology, Creight on Univer-sit y School of M edicine, 2500 California Plaza, Omaha, NE 68178. E-M ail: hunt er@creight on.edu

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* 1 _{Creight on Universit y School of M edicine, Omaha, Nebraska.}

* 2 _{Depart ment of Pat hology, Creight on Universit y School of M edicine, Omaha, Nebraska.}

Hyperost osis of t he int ernal table of t he f rontal bone is not an uncom m on phenom enon. How ever, such hyperost osis of t he t em poral and/ or sphenoid bone is rar ely discussed in t he available lit erat ure, especially in t he absence of m eningiom a. We r eport a case of hyperost osis of t he f ront al, t em por al, and sphenoid bones found during rout ine cadaver ic dissect ion of an 81 year-old fem ale. Hist ology revealed t hickening and increased densit y of t he lam ellar bone. The periost eum w as unaffect ed. Possible et iology is discussed.

KEY W ORDS: Calvarial hyper ost osis, hyperost osis front alis int erna, spenoid bone, t em poral bone, m eningiom a.

INTRODUCTION

Int ernat ional Journal of Anatomy and Research, Int J Anat Res 2015, Vol 3(1):817-20. ISSN 2321- 4287 DOI: 10.16965/ ijar.2014.485

Received: 04 Aug 2014

Peer Review : 04 Aug 2014 Published (O):31 Jan 2015 Accept ed: 27 Aug 2014 Published (P):31 M ar 2015

Internat ional Journal of Anat omy and Research ISSN 2321-4287

w w w.ijmhr.org/ ijar.ht m

DOI: 10.16965/ ijar.2014.485

Hyperost osis of t he endocranial plat e has been charact erized as non-neoplast ic benign lesions [1] w it h rem odeling int o a m ore cancellous phenotype [2]. An affect ed front al bone, t ermed hyperost osis front alis int erna (HFI), comprises a majorit y of cases w it h part icular prevalence in post menopausal females. HFI is usually an incident al finding and is not know n t o cause clinical disease [2], alt hough excessive grow t h can be sympt omat ic upon brain tissue compres-sion and/ or cr an ial ner ve ent r apm ent [ 3] . Hyperost osis of t he sphenoid bone or ot her bones comprising t he floor of t he cranium are r ar e and ar e gener ally seen unilat er ally in associat ion w it h int raosseous m eningiom as [ 4,5] . Pr esen t l y, w e di scuss a r are case involving hyper ost osis of t he sphenoid and t em poral bones found dur ing rout ine gross anat omy laborat ory cadaveric dissect ion. This

hyperost osis w as not found in associat ion w it h evident or report ed meningioma. Possible et iol-ogy is furt her discussed

CASE REPORT

The pat ient was an 81 year-old Caucasian female w it h a past medical hist ory of ost eoporosis, Alzheimer ’s disease, art hrit is, cholelit hiasis and a surgical hist ory of hyst erect omy and part ial hip replacement . Deat h w as report edly caused by com plicat ions secondary t o Alzheim er ’s disease.

Int J Anat Res 2015, 3(1):817-20. ISSN 2321-4287 818 Aust in Huy Nguyen et al.. HYPEROSTOSIS OF THE FRONTAL, TEM PORAL, AND SPHENOID BONES: CASE REPORT AND REVIEW OF

LITERATURE.

t han t he average of 7.603 (SD = 2.013, Range = 4.570-12.740 m m ) [ 6] . Hy p er o st osi s w as observed (Figure 1 and 2) in t he frontal bones w it h sparing of t he midline, t he sphenoid bone (average diameter of 19.6 mm), and the temporal bones (average diamet er of (left ) 23.0 mm and (right ) 24.5 mm). The hyperost osis w as bilat eral and symm et rical, except t he t emporal bone, w hich w as observed t o have more prominence o n t h e r i ght sid e. Th e gr o w t h s w er e charact erized by smoot h, ossified ridges and nodules prot ruding from t he int ernal table of the cranium . Hyperost ot ic infringem ent int o t he m axi llar y, and spheno id si nuses w ere n ot apparent . Hyperost osis w as not present on t he ext er nal sur face of t he skull. No signif icant anom alies of t he dur a w er e obser ved. The cerebrum present ed w it h enlarged sulci and diminished gyri, most not ably in t he t emporal l o bes, as is char act er ist i c o f Al zhei m er ’s disease. Coronal sect ioning of t he brain revealed enlargement of t he vent ricles. No abnormalit ies w ere observed in t he cerebellum under gross inspect ion.

Port ions of t he hyperost ot ic t issue w ere fixed in 10% formalin, decalcified, embedded in paraffin and sect ioned t o prepare hemat oxylin and eosin st ai n ed sli d es. M icr o sco p ical ly t hi cken ed com pact bone w as observed. No hist ological bony abnormalit ies w ere seen.

Fig. 1:Superior view. Hyperost otic growths were observed bi lat er all y i n t he sp henoi d and t em po r al b ones as sm oot h, ossif ied ridges and nodules pr ot r uding fr om t he int ernal t able of t he cranium .

Fig. 2: Inferior view of anterior skull cap. The hyperost ot ic grow t hs cont inued along t he frontal bones, bilat erally. The m idline w as spar ed.

DISCUSSION

Hyperost oses in gener al are non-neoplast ic benign lesions w it h obscur e pat hogenesis. M oore [7] characterized t his t hickening as an over gr ow t h or deposit of cancellous bone. Fur t her m o r e, n o i nf l am m at or y p r ocess i s associat ed. Occurrence in t he skull is rare (3% t o 6% of cases) [1] w it h a majorit y occurring at t he front al bone, or HFI. According t o a st udy by M oore [7] involving examinat ion of 6,650 human skulls, 74.1% of hyperost ot ic cases occurred sp eci f ical ly i n t h e f r on t al b o ne, w i t h t h e rem ain der bei ng t hickeni ng o f t he o verall cal v ar i a or f r o n t op ar iet al h y per o st o sis. Hershkovit z et al. [8] classified HFI int o different t ypes based on ot her bone involvement , degree of severit y, and phenot ype. HFI in part icular is associat ed w it h post -m en opausal w om en, report ed t o be 40% t o 60% incidence rat e in t his populat ion [ 2]. Pr im ar y hyperost osis of t he sphenoid and t em poral bones are rare, w it h sph en oi d hy p er o st osi s gen er al ly b ei n g secondary t o meningiomas. While remodeling of t he inner t able of bones other t han t he frontal can be associat ed w it h ot her diseases such as Paget ’s an d o st eo sarco m a [ 9] , t hese pat hologies w ere ruled out in t he present case based on r epor t ed hist or y and hist ological examinat ion.

Int J Anat Res 2015, 3(1):817-20. ISSN 2321-4287 819 Aust in Huy Nguyen et al.. HYPEROSTOSIS OF THE FRONTAL, TEM PORAL, AND SPHENOID BONES: CASE REPORT AND REVIEW OF

LITERATURE.

sympt oms depending on ext ent and locat ion. Overgrow t h could pot ent ially cause int racranial hypert ension [1], localized headache [10], and cranial nerve ent rapment [3].

The et iology of hyperost osis is unclear. The clearest associat ion is w it h post m enopausal females [9]. M uch evidence has been posit ed t ow ard num erous at t empt s at explaining t his pat hology. M etabolic causes seem t o be t he most support ed, including possible connect ions w it h lept in [11] and obesit y [7]. The associat ion bet w een hyperost osis and meningiomas is w ell know n [12]. Whet her t he bony change is due t o t umor invasion or react ionary change, how ever, r em ai n s co nt r o ver sial [ 13] . Ext r ad ur al meningiomas, has been discussed as a possible cause of hyperost osis in t he skull w it h mult iple p o ssi b le m ech ani sm s. Th ese m ay b e subclassified int o int raosseous meningiomas if t he t umor does not involve eit her t he inner or out er t able of t he skull [10]. Head t rauma has been discussed [ 14] as pot ent ially causing ent rapment of arachnoid cap cells in fract ure sites and leading t o meningioma formation [15]. The present pat ient , how ever, presented w it h no evidence of or report ed hist ory of head t r au m a. Cr aw f o r d et a l. [ 10] d iscu sses a development al origin of t hese hyperost oses in w hich dur ing fusion of t he cranial sut ur es, arachnoid cells become ent rapped causing lat er in t r aosseous m eni ngi om as. How ever, t h is hypothesis is not coherent wit h t he present case in w hich t he sphenosquamosal suture is spared. Furthermore, a majorit y of the primary sphenoid ext radural meningiomas found in t he lit erat ure are unilat eral [16,17,4,10]. The current pat ient p r esen t ed w i t h b il at er al sp hen ot em p o r al hyperost osis. Ult imately, malignancy as a cause w as ruled out by hist ological examinat ion.

No pat hological findings w er e m ade during hist ological examinat ion, ot her t han t hickening of t he lamellar bone. We conclude t hat t hese sphenot em poral hyperost oses are sim ilar in charact er t o t he more common HFI, generally asympt omat ic, slow grow ing, benign lesions.

In sum m ary, HFI is a com m on phenom enon present ing in elderly post menopausal w omen. Generally, HFI is a unique, benign lesion w it h unclear cause but may be relat ed t o met abolic or hormonal influences. Based on past report ed

hist ory and hist ological and gross examinat ion, w e co n cl u d e t h at t h e sp hen o t em p or al hyperost oses found in t he present pat ient are a r ar e case n o t associ at ed w i t h ext r ad u r al meningioma and are similar in charact er t o HFI.

Acknow ledgement: None

Conflicts of Interests: None

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Int J Anat Res 2015, 3(1):817-20. ISSN 2321-4287 820 Aust in Huy Nguyen et al.. HYPEROSTOSIS OF THE FRONTAL, TEM PORAL, AND SPHENOID BONES: CASE REPORT AND REVIEW OF

LITERATURE.

How to cite this article

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Aust in Huy Nguyen, M allory M oore, and William Hunt er III. HYPEROSTOSIS OF THE FRONTAL, TEM PORAL, AND SPHENOID BONES: CASE REPORT AND REVIEW OF LITERATURE. Int J Anat Res 2015;3(1):817-820. DOI: 10.16965/ ijar.2014.485

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hyperost osis in int racranial m eningiom a signifiy t u m o r i n vasi o n ? A r ad i o - p at h o l o gi c st u d y. Neurology India 2012;60(1):50-54.

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