The Unicorn Syndrom: Case of a Giant Skull Invasive Metastasis of a Pulmonary Cancer

Background: Tumors of cranial vault are quite uncommon but represent a major diagnostic and therapeutic issue. Skull involvements are rarely primitive tumors. Mostly, cranial vault tumors are metastases of lung, breast, thyroid, kidney and prostate cancers. These lesions often grow quickly and sometimes become infected, which raises the issue of how to manage them. Patient: We operated a patient of 64 years old for a large, painful and sweating tumor of the frontal cranial vault with subcutaneous, meningeal and cerebral parenchyma dissemination. The lesion grew rapidly following a frontal shock within 3 months. Initially, according to history, we thought of an infected abscess. However, thanks to MRI, the possibility of a tumor is quickly suggested. We choose to operate quickly in order to obtain a histological tissue which permits to orient the additional medical treatment. This also allows us to perform a plasty at the same time. Histological analysis assets a metastasis of a pulmonary adenocarcinoma undiagnosed at this time. Therefore, we were able to refer the patient to oncology for the rest of medical exams and treatment. The aesthetic result is satisfactory too. Conclusion: We report this case to explain our care. We also submit this article to emphasize that careful skin examination can provide valuable clues to guide the diagnosis.