A case of extensive hyperostosis frontalis interna in an 87‐year‐old female human cadaver

Abstract

Hyperostosis frontalis interna (HFI) is a condition that involves thickening of the inner surface of the frontal bone with sparing of the midline. Little is known about the etiology and clinical presentation of HFI. We report unusual findings in a woman with extensive Type D hyperostosis of the frontal bone and a large hyperostotic nodule in the parietal bone with impingement on the precentral gyrus, distinguishing this from the common form of HFI. The scalp was dissected from the cranial vault, and the calvaria and brain were removed and digitally imaged. Bone specimens were embedded in methyl methacrylate plastic, sectioned, and stained using the Von Kossa Method with MacNeal's tetrachrome. Medical records were reviewed, and additional history was obtained through interviews with the donor's family. The calvaria had extensive, bilateral thickening of the frontal bone with irregular topography and clearly demarcated borders. The dura was adherent to all hyperostotic regions. A 3.5-cm nodule was visible on the inner table of the left parietal bone. The dura and cerebrum showed compression in this region, but it was unclear if this resulted in clinical ramifications. Microscopic analysis revealed a larger proportion of cancellous bone was present in regions of macroscopic hyperostosis. Quantitative analysis of sections through areas of gross hyperostosis demonstrated a lower proportion of lamellar bone than in the control. The patient exhibited symptoms that have been correlated to HFI in previous studies. We suggest that the HFI disease process was responsible for the manifestation of these symptoms in this patient.

A change in paradigm: Giving back identity to donors in the anatomy laboratory

“…In this respect, information gained from radiographs (not otherwise available) or from direct communication with the patient's family, in addition to findings during dissection, can lead to additional opportunities for continued learning. In my own laboratory, examples of enhanced student learning that have resulted from discoveries in first patients include cadaver-based research that focuses on hyperostosis, malignant vaginal mucosal melanoma, renal cell carcinoma, dysexecutive syndrome, ineincephaly, diabetes, Lynch syndrome, Dandy-Walker malformation, intracerebral hemorrhage, and medical humanities (Talarico and Prather, 2007;Talarico et al, 2008;Talarico and Buchler, 2011;Talarico and Koveck, 2012).…”

Increased osseous thickening of the inner surface of the frontal bone

“…It was indicated by Talarico et al that area fraction of lamellar bone showed decrease in regions where extensive osseous thickening was observed in the ISFB (21). Compression of the left precentral gyrus in the location of the motor cortex was observed macroscopically.…”

“…In histological analysis, the osseous thickening is characterized by remodelling of the ISFB into a cancellous phenotype (13,21). Microscopic analysis revealed that a larger proportion of nonwoven mature bone was present in regions of macroscopic hyperostosis.…”

“…It is more likely that there is some undetected compression on the postcentral gyrus. This is because of the fact that damage to the posterior white columns is clearly associated with a Romberg sign (21). Therefore, it is of vital importance to recognize the existence of osseous thickening at these regions especially in surgical operations as bone thickening and the changes in the vascularization will probably alter the procedures adopted in the operation.…”

Hallazgo incidental de hiperostosis frontal interna o síndrome de Morgagni asociado a meningiomas

“…Como causas de hiperostosis craneal encontramos el síndrome de Klippel-Trenaunay-Weber, el sín-drome de Frölich, la enfermedad de Paget, la leontiasis ósea, el meningioma, el osteoma endosteal , los osteofitos asociados al embarazo, el síndrome de Morgagni y la displasia fibrosa 15,16 . Estas entidades deben centrar el diagnóstico diferencial con la hiperostosis frontal interna.…”