두피에 발생한 혈관육종의 수술시 Mapping Biopsy의 유용성

Surgical Treatment of Cutaneous Angiosarcoma of Scalp:Usefulness of Preoperative Mapping Biopsies

  • 강민구 (서울대학교 의과대학 성형외과학교실) ;
  • 박종림 (서울대학교 의과대학 성형외과학교실) ;
  • 김명국 (서울대학교 의과대학 성형외과학교실) ;
  • 민경원 (서울대학교 의과대학 성형외과학교실) ;
  • 고경석 (울산대학교 의과대학 성형외과학교실) ;
  • 장학 (서울대학교 의과대학 성형외과학교실)
  • Kang, Min-Gu (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Park, Jong-Lim (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Kim, Myung-Good (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Minn, Kyung-Won (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Koh, Kyung-Suck (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chang, Hak (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine)
  • 발행 : 2007.05.31

초록

Objectives:Cutaneous angiosarcoma is an infrequent but aggressive neoplasm involving the skin of the face and scalp. Unfamiliarity with the clinical manifestations of cutaneous angiosarcoma frequently leads to misdiagnosis and delay in treatment. Complete surgical resection requires the performance of preoperative staging biopsies to determine the true extent of the neoplasm. Intraoperative frozen section analysis to determine the adequacy of the surgical resection is unreliable due to the high false negative rate. Material and Methods:In five scalp angiosarcoma cases, mapping biopsies were performed at far from the suspected edge of the neoplasm. On permanent pathology, we obtained tumor free margin with occasional focal involvement of the tumor. Results:Frozen-section analysis of the resected margins is inconclusive, for the subtle diagnostic features of angiosarcoma are distorted by the tissue processing required for frozen-section analysis. The characteristic dermal vessels lined by their malignant cells are collapsed by the freezing process. This results in a high rate of false-negative reports and possibly leads to incomplete resection of the neoplasm. Conclusion:Our recommendation is to establish the margins of the tumor by performing preoperative evaluations by mapping biopsies.

키워드

참고문헌

  1. Bullen R, Larson PO, Landeck AE, et al: Angiosarcoma of the head and neck managed by a combination of multiple biopsies to determine tumor margin and radiation therapy. Dermatol Surg. 1998;24:1105-1110 https://doi.org/10.1016/S1076-0512(98)00080-6
  2. Hodgkinson DJ, Soule EH, Woods JE: Cutaneous angiosarcoma of the head and neck. Cancer. 1979;44:1106-1113 https://doi.org/10.1002/1097-0142(197909)44:3<1106::AID-CNCR2820440345>3.0.CO;2-C
  3. Barttelbort SW, Stahl R, Ariyan S: Cutaneous angiosarcoma of the face and scalp Plast Reconstr Surg. 1989;84:55-59 https://doi.org/10.1097/00006534-198907000-00011
  4. Liu AC, Kapp DS, Egbert B, Waters L, Rosen JM: Angiosarcoma of the face and scalp. Ann Plast Surg. 1990;24:68-74 https://doi.org/10.1097/00000637-199001000-00013
  5. Kacker A, Antonescu CR, Shaha AR: Multifocal angiosarcoma of the scalp: a case report and review of the literature. Ear Nose Throat Journal 1999;78:302-305
  6. Pawlik TM, paulino AF, Mcginn CJ, et al: Cutaneous angiosarcoma of the scalp. Cancer. 2003;98:1716-1726 https://doi.org/10.1002/cncr.11667
  7. Fedok FG, Levin RJ, Maloney ME, Tipirneni K: Angiosarcoma: Current review Am J Otolaryngol. 1999;20:223-231 https://doi.org/10.1016/S0196-0709(99)90004-2
  8. Morgan MB, Swann M, Stomach S, Eng W, Smoller B: Cutaneous angiosarcoma: a case series with prognostic correlation. J Am Acad Dermatol. 2004;50:867-874 https://doi.org/10.1016/j.jaad.2003.10.671