Imaging findings of cutaneous angiosarcoma of the scalp: Comparison with cutaneous squamous cell carcinoma

Abstract

Purpose This study aimed to evaluate imaging findings of cutaneous angiosarcoma (cAS) of the scalp compared with those of cutaneous squamous cell carcinoma (cSCC). Methods This study included 15 patients with primary cAS and 10 with primary cSCC of the scalp. Seven patients with cAS and eight with cSCC underwent magnetic resonance imaging, and 11 patients with cAS and eight with cSCC underwent 18F-fluorodeoxyglucose–positron emission tomography/computed tomography imaging. Imaging findings for both pathologies were retrospectively reviewed and compared. Results All 15 cAS cases were elevated lesions with an obtuse angle, invading the subcutaneous fat tissue. Multiple lesions were observed in only five cAS cases (33%) and no cSCC cases. Maximum diameter-to-height ratio was significantly higher in cAS than in cSCC (3.3 ± 1.0 versus 2.3 ± 0.6; p < 0.01). On T2-weighted images, intratumoral hypointensity (86% versus 13%; p < 0.01) and mixed hyper- and hypointensity (71% versus 0%; p < 0.01) were observed more frequently in cAS than in cSCC. No significant differences were observed between cAS and cSCC regarding flow void (29% versus 25%; p = 0.656). Maximum standardized uptake values were marginally significantly lower in cAS than in cSCC (5.6 ± 3.1 versus 10.5 ± 6.6; p = 0.078). Conclusions Cases of cAS of the scalp always exhibited flat elevated lesions with invasion of the subcutaneous fat tissue. Compared with cSCC, intratumoral hypointensity and mixed hyper- and hypointensity on T2-weighted images were more frequent in cAS. These findings will help with the differential diagnosis of cAS.

Assessing the accuracy of computed tomography in detecting bony invasion and thickness of squamous cell carcinoma of the scalp

“…This was in keeping with height measurements for scalp SCC as measured on MRI in a similar study. 33 Using the limits of agreement method, it can be seen that the results of thickness assessment on CT are consistent with histological thickness at the 95% level. One possible explanation for the high correlation is the small cohort size and high variability in thickness measurements taken (SD = 7.3 mm on CT and 6.5 mm on histology).…”

Imaging findings of trichilemmal cyst and proliferating trichilemmal tumour

“…Unlike TCs and PTTs, cutaneous angiosarcoma appears as a flat elevated lesion with invasion of subcutaneous fat tissue. 24 There are several limitations to this study. First, this was retrospective study with a small sample size from a single institution.…”

“…3 Cutaneous squamous cell carcinoma exhibits a flattened configuration, superficial ulceration, protrusion and ill-demarcated deep margins. 23,24 Cutaneous angiosarcoma also occurs predominantly on the scalp and demonstrates hypointensity on T2-weighted images similar to TCs. Unlike TCs and PTTs, cutaneous angiosarcoma appears as a flat elevated lesion with invasion of subcutaneous fat tissue.…”

Significantly Elevated FDG Activity in Neurothekeoma

“…The findings suggested a malignant cutaneous and likely sarcoma, for which FDG PET/CT was performed for staging. [1][2][3][4][5][6] The maximum intensity projection (MIP) image (A) showed a solitary intense activity in the right shoulder (arrow). On the axial images of the shoulders (B: PET, C: CT, D: fusion), the activity (arrow) was in the posterior right shoulder with maximum standardized uptake value (SUVmax) of 18.3 in comparison to hepatic SUVmax of 2.8, which corresponded to a lobulated soft tissue mass about 5.2 Â 3.4 Â 3.7 cm (arrow) without adjacent muscle or bone involvement.…”

“…An MRI scan of the right shoulder (images not shown) from an outside institution reported that the mass was T1 isointense, T2 hyperintense to muscle with diffusion restriction and significant enhancement on postcontrast images. The findings suggested a malignant cutaneous lesion and likely sarcoma, for which FDG PET/CT was performed for staging 1–6 . The maximum intensity projection (MIP) image ( A ) showed a solitary intense activity in the right shoulder (arrow).…”