PMC4754594_01
63-year-old man with angiosarcoma of the scalp. Low power (A, x100) and high power (B, x400). Hematoxylin-eosin stain shows pleomorphic endothelial cells, and immunohistochemical staining (C, x400) shows positive for CD31 antibody staining.
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F1
Tumor cells were strongly positive for CD31 antibody staining (Fig. 1).
Coronal view of T2 (A) and contrast enhanced T1 (B) weighted MR image shows a diffuse thickening of the scalp, invading subcutaneous fat with reticular patterns of high signal intensity (asterisk) due to angiosarcoma. Superficial fascia (arrows) shows diffuse thickening and enhancement, covering normal signal intensity of temporalis muscles (small arrow). Sagittal view of T2 (C) and contrast enhanced T1 (D) weighted image show tumor involvement of superficial fascia (arrows), overlying the occipital belly and galea aponeurotica (arrowheads). Color coding image according to signal intensity of coronal (E) and sagittal (F) views of T2 weighted MR image demonstrate the occipital belly of the occipitofrontalis muscle becomes the red colored galea aponeurotica (arrow head) and inserts into the underside of the green colored superficial musculoaponeurotic system (arrows), composed of the frontal belly of occipitofrontalis and temporoparietal fascia. Ga : galea aponeurotica, fb : frontal belly, ob : occipital belly, tpf : temporoparietal fascia.
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F2
Beneath the superficial fascia, the occipital belly of the occipitofrontalis muscle becomes the galea aponeurotica and inserts into the underside of the frontal belly (Fig. 2).
PET-CT show diffuse uptake in the scalp (arrowheads) but invisible increased uptake on epicranial muscle (A). Faint uptake is visible in lymph nodes (arrows) at the level VA (B). On the 6 months follow-up PET-CT, hot uptake were visible in the level VA lymph nodes (arrow) which showed faint uptake initial study (C), and multiple lymph node metastases of both neck (arrows) are seen (D).
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F3
PET-CT showed diffuse uptake in the scalp and faint uptake in both level VA lymph nodes (Fig. 3A, B). After wide resection and reconstruction surgery, multiple lymph node metastases were detected on PET-CT (Fig. 3C, D).