Pitfalls of Distinguishing Skull Metastases from Paragangliomas: A Case Report of a “Pseudo-angioma” Bone Metastasis

A 22-year-old woman with persistent headaches was diagnosed with a right parietal bone lytic lesion with a sunburst pattern, suspected to be either an intraosseous hemangioma or a Langerhans cell histiocytosis. Five years later, progressively increased skull bone destruction, identification of retroperitoneal and lumbar vertebra lesions, and a biopsy of the skull led to the diagnosis of a retroperitoneal paraganglioma with bone metastases. Genetic testing identified an <i>SDHB</i>mutation. This case underscores the diagnostic challenge of metastases of paraganglioma mimicking hemangiomas and thus delaying appropriate management. · - Skull metastases from paragangliomas can present with a pseudoangiomatous appearance that mimics a hemangioma.. · - The presence of an SDHB mutation is associated with more aggressive forms of paraganglioma with higher rates of metastasis and disease-specific morbidity.. · - Lifelong monitoring for paraganglioma is essential due to the risk of late metastasis, especially bone metastasis..