Surgical treatment of rare giant malignant tumors of the scalp: A report of 3 cases with different tumor types

Abstract

The scalp is the most frequent site of occurrence of malignant tumors. As an area that is generally neglected by the patient and not closely monitored during physical examinations, scalp tumors can go unnoticed until they become malignant. The present study reports 3 cases of rare giant malignant tumors of the scalp, namely a peripheral nerve sheath tumor, a fibrous tumor and a malignant proliferating trichilemmal tumor, that were treated at The First Bethune Hospital of Jilin University (Changchun, China). Vascularized free anterolateral thigh flap surgery was performed in 2 of the 3 cases. A local flap repair was applied to the third case. The implanted skin grafts remained viable post-operatively and wound repair was uneventful. No signs of malignancy were detected on the edge of the pathological section upon closer pathological examination. In the follow-up period, no recurrence was detected in any of the cases.

Keywords: malignant tumors of the scalp; surgical treatment.

Figure 1.

Case 1: Peripheral nerve sheath tumor. (A) Tumors were characterized by reddish-brown mass spots and a clear boundary, and were located in the right forehead, temporal and occipital bones. (B) A magnetic resonance imaging scan revealed extensive growth of spots or lichen-like tumors outside of the right frontal, temporal and occipital bones. (C) The cellular morphology was non-uniform and tumor cells were fusiform with oval nuclei and a uniform arrangement in bundles. Mitotis was also observed (hematoxylin and eosin staining; magnification, ×200); (D) Immunohistochemical staining for S-100 was positive (magnification, ×200). (E) The flap had survived at 4 months postoperatively.

Figure 2.

Case 2: Fibrous tumor. (A) Tough tumors were located on top of the occipital lobe with a clear boundary. (B) The magnetic resonance imaging scan revealed irregular tumors with a wide base. (C) Hematoxylin and eosin staining showed that the tumor cells were fusiform with oval nuclei; mitosis was also observed (magnification, ×200); (D and E) Immunohistochemical staining for (D) cluster of differentiation 99 and (E) vimentin was positive (magnification, ×200). (F) The flap had survived at 3 months postoperatively.

Figure 3.

Case 3: Malignant proliferating trichilemmal tumor. (A) A tough tumor with a clear boundary was found to be located on the top of the occipital lobe. (B) A head computed tomography scan revealed a lichen-like irregular giant malignant tumor. (C) The tumor cells had an irregular arrangement with numerous transparent cells. Regions of the basal cells around the tumor exhibited a palisade arrangement. Keratosis sheath of outer hair root and cell atypia were observed. Mitotis was also observed (hematoxylin and eosin staining; magnification, ×200). (D) Immunohistochemical staining for cluster of differentiation 34 was positive. (E) The flap had survived at 4 months postoperatively.