Osteopoikilosis Occurring in the Skull.

A 51-year-old man was referred to our hospital due to ground-glass opacities on a chest computed tomography scan with no symptoms. Video-assisted thoracic surgery revealed adenocarcinoma. Preoperative brain magnetic resonance imaging revealed a low-signal intensity on both T1-weighted (Picture 1A) and T2-weighted images (Picture 1B). An X-ray of the skull (Picture 2) and pelvis (Picture 3) revealed multiple sclerotic areas in the bones, and an 18F-fluorodeoxyglucose positron emission tomography scan (FDG-PET) was normal.

Picture 1.

Picture 2.

Picture 3.

Osteopoikilosis is a rare bone disorder incidentally observed on X-rays. This disorder is typically asymptomatic and generally autosomal dominantly inherited (1). There is a predilection for epiphysis and metaphysis of the long tubular bones, carpus, tarsus, pelvis and scapula, but it rarely occurs in the skull. Although this condition is typically inactive on scintigraphy or FDG-PET, sclerotic bone metastasis must be ruled out. It is therefore important to be aware of this rare and benign condition to prevent making a misdiagnosis.