An asymptomatic hypertrophic pacchionian granulation simulating osteolytic lesion of the calvaria

Neurosurg Rev. 1999 Oct;22(2-3):149-51. doi: 10.1007/s101430050052.


Osteolytic lesions can be seen in various diseases. We present a rare case of symptomatic hypertrophic pacchionian granulation mimicking bone tumor in the calvaria. A 50-year-old woman suffered from a previous VII cranial nerve peripheral paresis accompanied by headache. A plain radiograph revealed a punched-out paramedial occipital lesion. Precontrast-enhanced computed tomographic scans demonstrated a hypodense mass, with a defect of both tables of the left occipital bone. Magnetic resonance imaging (MRI) demonstrated a hypointense mass on the T1-weighted image and isointense to cerebrospinal fluid on the T2-weighted image, with capsule-like contrast enhancement by gadolinium. A biopsy was performed. Histologically, hypertrophic pacchionian granulation was diagnosed. The patient has had no growth for 2 years. This case suggests the need to include hypertrophic pacchionian granulation in the differential diagnosis of punched-out lesions.

Publication types

  • Case Reports

MeSH terms

  • Arachnoid / pathology*
  • Biopsy
  • Diagnosis, Differential
  • Female
  • Granulation Tissue / pathology*
  • Humans
  • Hypertrophy
  • Magnetic Resonance Imaging
  • Middle Aged
  • Occipital Bone / pathology*
  • Skull Neoplasms / diagnosis*
  • Skull Neoplasms / pathology