• Journal of Korean Neurosurgical Society
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• v.43 no.4
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• pp.201-204
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• 2008

Angiosarcoma of the brain, either primary or metastatic is extremely rare. Moreover, angiosarcoma metastazing to the brain is also highly unlike to occur when comparing with metastases to the other organs. Thus, an ideal treatment strategy has not been established. A 67-year-old man with past surgical history of a scalp angiosarcoma underwent surgical resection of intracranial invasion. Because of wide scalp flap excision and resultant poor vascularity of the scalp flap, additional radiation was not provided. Because adjuvant therapy is impossible due to poor scalp condition, more careful but ample resection of the primary lesion is essential to conduct initial operation.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.96-100
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• 2009

Purpose: Angiosarcoma of the scalp is unusual vascular tumor originating from endothelial cell. Angiosarcoma is an aggressive tumor with high propensity for both local recurrence and distant metastasis. We report 2 cases of angiosarcoma having poor prognosis recently. Methods: Case 1 was a 67 - year - old male patient. He visited the hospital with a $3{\times}5cm$ sized discolored mass in forehead. It began at one month ago from coming to the hospital. Case 2 was a 64 - year - old male patient. He visited for our hospital to remove a $4{\times}5cm$ sized scalp mass. He had a pruritis on scalp from 9 months ago before coming to the hospital. Despite of the conservative treatments, the wound was not healed and advanced necrotic lesion with hemorrhage. Results: Case 1 diagnosed as an angiosarcoma. He underwent a radical operation 5 times. But the tumor expanded multiple area in dura & frontal area of the brain. The patient rejected the treatment any more. And he died one month later. Case 2 diagnosed as an angiosarcoma and metastased to skull in MRI. He got a radical resection including cranium. Three months later, it recurred to ipsilateral Sternocleidomastoideus muscle. He got a additional operation & started radiotherapy. And now he is receiving chemotherapy, but the recurred lesion is expanding. Conclusion: Angiosarcoma is a highly malignant tumor. Especially it arises in vascularized area, it easily metastases. So it is the best to treat angiosarcoma with surgery included wide margins. Despite of the lesion is small, we remember that angiosarcoma is a tumor that consider to metastases.

• Korean Journal of Head & Neck Oncology
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• v.22 no.1
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• pp.47-50
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• 2006

Angiosarcoma is a rare and high aggressive malignant tumor originated from endothelial cell. Angiosarcoma has four clinical types that are in the scalp and face of old age, in chronic lymphedema, in previously irradiated sites, and malignant angioendothlioma. We report one case of angiosarcoma of the scalp in a 74-year-old male patient. The patient had $4.0{\times}4.5cm,\;4.0{\times}3.5cm$ sized, localized, asymmetric several dome-shaped nodule and plaque with crust and ulcer on the parieto-frontal area of the scalp. We performed wide excision and subsequently covered with split-thickness skin graft. Postoperatively the patient underwent radiotherapy for prevention of recurrence and he had been followed up for 1 year without evidence of recurrence.

• Korean Journal of Head & Neck Oncology
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• v.23 no.1
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• pp.37-40
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• 2007

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.

• Tuberculosis and Respiratory Diseases
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• v.64 no.5
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• pp.374-378
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• 2008

Angiosarcoma is a rare but highly malignant tumorthat usually arises in the scalp or face of elderly males. Distant metastases favor the lung, liver, lymph nodes and skin. Metastatic pulmonary angiosarcoma commonly takes the form of a nodule but can sometimes appear as a thin-walled cyst. We report a case of 65 years-old male with a spontaneous pneumothorax, who underwent excision and radiotherapy for an angiosarcoma of the scalp 2 years ago. A chest CT scan revealed multiple cysts in the lung. The video-assisted thoracoscopic lung biopsy demonstrated subpleural cysts without tumor cells. A skin biopsy of the scalp showed an angiosarcoma. This case was diagnosed as a recurrence of an angiosarcoma with a supposed lung metastasis. This case suggests that a spontaneous pneumothorax in elderly people may be secondary to a pulmonary metastasis from an angiosarcoma of the scalp.

• Radiation Oncology Journal
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• v.16 no.3
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• pp.351-355
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• 1998

Cutaneous angiosarcomas are uncommon malignancies which account about 1$\%$ of sarcomas. They are found most commonly in the head and neck regions, frequently on the scalp. Although preferred treatment has been combined surgery and postoperative radiation therapy, the extensiveness and multiplicity of the lesions set limits to such an approach and the patient is often referred for radiotherapy without surgery. As the entire scalp usually needs to be treated, radiation therapy is a challenging problem to radiation oncology staffs. We report a case of angiosarcoma of the scalp, which was treated successfully by radiation therapy with a simple and repeatable method using mixed Photon and electron beam technique. Using a bolus to increase the surface dose of the scalp and to minimize dose to the normal tissues of the brain desirable but difficult technically to be well conformed to the three dimensional curved surface such as vertex of the head. A helmet made of thermoplastics filled with paraffin was elaborated and used for the treatment, resulting of the relatively uniform surface doses along the several points measured on the scalp, the difference among the points not exceeding 7$\%$ of the prescribed dose by TLD readings.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.711-714
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• 2011

Purpose: Angiosarcoma is a rare malignant neoplasm of endothelial type cells that line vessel walls. It tends to occur in aged male and the prognosis of angiosarcoma is very poor because of frequent local recurrence and early metastasis. The treatment regimen is yet to be established from its rare occurrence but the wide excision in early stage is known to be the most effective. The authors report two cases of near totally excised angiosarcoma with more than a safety margin of 5 cm. Methods: The two subjects were aged male patients, one of the two was diagnosed with angiosarcoma from our institution confirmed by the biopsy. The other one went through the wide excision with a safety margin of 2 cm and split-thickness skin graft but local recurrence was observed. The two patients underwent near total excision with more than a safety margin of 5 cm, leaving only the periosteum. After confirming that the angiosarcoma had not infiltrated the excision margin, reconstruction with split-thickness skin graft was performed. Results: Based on 6 months and 24 months post-surgery assessment, no local recurrence or remote metastasis in the lungs, liver, bones, and lymph nodes at the neck, where remote metastasis is common, was reported by the two subjects who underwent near total excision with a safety margin of 5 cm. Conclusion: Angiosarcoma has very poor prognosis from its frequent recurrence and metastasis. To enhance the survival rate of angiosarcoma patients, early diagnosis, timely surgical treatment, and radiotherapy after surgery are critical. In addition, authors suggest that it is necessary to further study the efficacy of wide excision using a wider safety margin as much as possible, and to apply this to more cases.

• Journal of Chest Surgery
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• v.43 no.2
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• pp.228-231
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• 2010

An 80 year-old male with a medical history of angiosarcoma of the scalp visited the Emergency Department complaining of dyspnea, and the chest X-ray revealed pneumothorax. He has undergone scalp resection and radiotherapy three years ago due to angiosarcoma. Due to a persistent air leak, he underwent wedge resection of the lung and was pathologically diagnosed with metastatic angiosarcoma to the lung. He underwent radiotherapy following the lung resection, but he died from his disease at 15 month following surgery due to further aggravation of the lung metastasis. Angiosarcoma is a highly malignant tumor and it frequently occurs on the scalp and face in elderly patients. Angiosarcoma frequently metastasizes to the lung and it may cause pneumothorax as a consequence of a ruptured cavitary lesion. We report here on a case of pneumothorax that was caused by lung metastasis in an elderly patient with a history of angiosarcoma of the scalp.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.583-588
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• 2010

Purpose: Angiosarcoma is a tumor of mesenchymal origin with an extremely high rate of metastasis and invasiveness. This tumor is notorious for its very poor prognosis, although surgical excision followed by radiation therapy is considered to be effective by many. The authors experienced three angiosarcoma patients with their tumors removed and wounds covered with split-thickness skin grafts and/or latissimus dorsi free flaps. Methods: Three patients were admitted to our hospital showed plaques of different morphology. Based on their medical records, these patients were classified by sex, age, type of reconstruction, recurrence, and further treatment after surgical removal. Results: All patients were male, with a mean age of 72 years (range, 66 to 77 years). Split-thickness skin grafts with latissimus dorsi free flaps were performed on two cases, and of these two cases, cervical lymph node biopsy was done in one case, and radical neck dissection was done in the other. In all cases, radiation therapy was done within two weeks of tumor removal. Distant metastasis occurred without local recurrence in two of the cases. Lung was the first organ affected by metastasis. In the remaining case, the tumor recurred locally 6 times, and additional excision was necessary. All patients died due to local recurrence and lung metastasis. Conclusion: Irregular margins and high recurrence and metastasis rates cause a poor prognosis in large angiosarcoma of the scalp. Radiotherapy and chemotherapy should be strongly considered in large angiosarcomas.

• Archives of Craniofacial Surgery
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• v.17 no.4
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• pp.233-236
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• 2016

Scalp defect management is complicated secondary to reduced laxity in the scalp and forehead area. For reconstruction of larger defects with exposed bone and loss of the periosteal layer, free flap reconstruction is one option for single-stage surgery, although the procedure is lengthy and includes the possibility of flap loss. We successfully performed a single-stage reconstruction of a large scalp defect using a combination of artificial dermis, split-thickness skin graft, and full-thickness skin graft following wide excision of a cutaneous angiosarcoma, and present our method as one option for the treatment of large oncologic surgical defects in patients who are poor candidates for free flap surgery.