This is a 52 year old female patient, with no previous history of interest, referred to our department for surgical assessment. She had presented, for four years, with a small tumour on the right side of her forehead, which had been slowly increasing in size. On examination, a hard, painless, non-mobile mass was palpable under normal-appearing skin.
Plain X-ray and CT scan of the skull showed a right frontal intraosseous lesion with osteolytic features. Radiological differential diagnosis included metastases, myeloma and haemangioma. Systemic tumour screening studies (haemogram, haematological smear, tumour markers, proteinogram and cervico-thoracic-abdominal CT scan) were negative. A bone scan with HDP-Tc99M was performed, showing a rounded deposit in the area of the lesion. Percutaneous fine needle puncture-aspiration of the tumour was inconclusive for the diagnosis, as only haematic fragments were obtained.

Finally, it was decided to operate on the patient on the basis of the clinical progression of the lesion, with its aesthetic implications, as well as to obtain a definitive histological diagnosis. During surgery, a bone-dependent tumour was identified, with multiple dilated vascular channels in its sinus, expanding the external table. To avoid manipulation of the lesion, it was decided to include it in a craniectomy specimen with a circumferential margin of 1 cm of apparently healthy bone. The resulting bone defect was reconstructed by means of a methylmethacrylate cranial plasty, which was fixed to the surrounding bone with titanium mini-plates. The postoperative period was uneventful. The definitive anatomopathological diagnosis was intraosseous cavernous haemangioma.