Male, 79 years old, with angiosarcoma of the scalp. A defect of the cutaneous and subcutaneous tissues is seen at the midline forehead compatible with prior surgery. The underlying frontal bone, mainly to the left of midline, demonstrates abnormal marrow replacement which could reflect prior surgery or prior tumor invasion.Beginning at the left edge of the surgical defect, the cutaneous and subcutaneous tissues of the scalp are thickened and edematous. Cutaneous thickening continues posteriorly to the parietal region. Within the parietal scalp, there is a dominant cutaneous nodule measuring 33 x 31 x 12 mm which appears to extend in depth to the level of the galea. Numerous additional small scattered nodules are seen within the subcutaneous tissues between this dominant nodule and the anterior surgical resection bed. All of these lesions demonstrate mild diffusion restriction. Subgaleal fluid or edema is demonstrated along the left frontal scalp, possibly reactive. Apart from findings in the left frontal bone as above, no clear osseous involvement is seen.The cutaneous layer of the right scalp is also thickened but to a lesser degree than that of the left. Within the posterior right frontal scalp, at least two subcentimeter subcutaneous nodules are demonstrated (see image 32 series 501) which also demonstrate mild diffusion restriction.Intracranially, no evidence of parenchymal edema or mass effect is seen. A few scattered small foci of FLAIR hyperintensity are demonstrated within the cerebral hemispheres which are nonspecific as is mild periventricular hyperintensity. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is suspected. The ventricles are normal in size and morphology.
Sequelae of prior tumor resection are demonstrated at the midline forehead. The frontal bone underlying this surgical defect demonstrates marrow replacement which could be postoperative in nature but may also reflect prior or current tumor invasion.Beginning at the surgical defect margin, the left scalp cutaneous layer is diffusely thickened extending posteriorly to the parietal region which may reflect prior treatment change but could also indicate diffuse tumor spread. Within the parietal region, there is a dominant subcutaneous soft tissue nodule which correlates with the hypermetabolic lesion on PET compatible with tumor.Between the resection bed and this dominant parietal nodule, there are numerous scattered smaller subcutaneous nodules which are also suspicious for tumor spread. Within the right posterior frontal scalp, at least two small similar-appearing nodules are demonstrated which are nonspecific, but given the overall imaging context, are suspicious for sites of tumor spread as well.