Pitfalls of Distinguishing Skull Metastases from Paragangliomas: A Case Report of a “Pseudo-angioma” Bone Metastasis

Abstract

A 22-year-old woman with persistent headaches was diagnosed with a right parietal bone lytic lesion with a sunburst pattern, suspected to be either an intraosseous hemangioma or a Langerhans cell histiocytosis. Five years later, progressively increased skull bone destruction, identification of retroperitoneal and lumbar vertebra lesions, and a biopsy of the skull led to the diagnosis of a retroperitoneal paraganglioma with bone metastases. Genetic testing identified an SDHBmutation. This case underscores the diagnostic challenge of metastases of paraganglioma mimicking hemangiomas and thus delaying appropriate management.

Key Points

• - Skull metastases from paragangliomas can present with a pseudoangiomatous appearance that mimics a hemangioma.

• - The presence of an SDHB mutation is associated with more aggressive forms of paraganglioma with higher rates of metastasis and disease-specific morbidity.

• - Lifelong monitoring for paraganglioma is essential due to the risk of late metastasis, especially bone metastasis.

Keywords

paraganglioma - angioma - SDHB

Publication History

Article published online:
16 July 2025

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