Angiosarcoma of the Scalp: Metastatic Pulmonary Cystic Lesions Initially Misinterpreted as Benign Findings on 18F-FDG PET/CT

Diagnostics
Kim Francis AndersenAnnika Loft

Abstract

Angiosarcomas are rare and only represent about 2% of all soft tissue sarcomas. They arise from vascular or lymphatic endothelial cells and are most commonly located in the heart, liver, breast, and skin. Cutaneous angiosarcoma of the scalp is highly malignant and with dismal prognosis. Reported five-year survival is <30%. The mainstay of treatment is surgical resection and adjuvant radiation therapy, but failure rates following local therapy are high. Cutaneous angiosarcoma of the scalp has a predilection for pulmonary metastases with a variety of morphologic patterns on imaging. Metastatic disease in terms of pulmonary thin-walled, cystic lesions, may not be hypermetabolic on (18)F-FDG PET and, as such, could be misinterpreted as benign findings. We present a case demonstrating the diagnostic uncertainty and delay in an elderly male with angiosarcoma of the scalp presenting with metastatic lung lesions following failure of local therapy.

References

Jan 1, 1987·Virchows Archiv. A, Pathological Anatomy and Histopathology·M KitagawaT Kasuga
May 1, 1993·Chest·A M Patel, J H Ryu
May 23, 2003·AJR. American Journal of Roentgenology·Ukihide TateishiNoriyuki Moriyama
Nov 7, 2008·International Journal of Dermatology·S GkalpakiotisM Arenbergerova
Jul 16, 2013·Current Oncology Reports·Vinod Ravi, Shreyaskumar Patel

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Citations

Feb 7, 2019·Acta Clinica Belgica·Mike RalkiKristof Cuppens

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Methods Mentioned

BETA
biopsy
surgical resection

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