Angiosarcoma lesion in the right scalp with lymph node metastasis. Brain: There is an infiltrative heterogeneous mass with prominent vessels in the right frontal, parietal, and temporal scalp with extension into the retroauricular, preauricular, and supraorbital regions. There appears to be infiltration of tumor into the superior right parotid gland as well. The tumor extends to the periosteum of the underlying calvarium, but there is no definite gross tumor extension into the diploic space. There are scattered areas of cerebral white matter T2 hyperintensity, as well as small foci of encephalomalacia in the posterior right external capsule, left caudate head, and left cerebellar hemisphere. There is also patchy areas of T2 hyperintensity with faint marginal enhancement in the right thalamocapsular region and left lateral thalamus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbital contents are grossly unremarkable. There is a small right mastoid effusion.Neck: There is an enlarged and hyperenhancing right level 2B lymph node that measures 17 x 23 mm. There are subcentimeter, but nevertheless abnormal appearing lower level 2B, lower parotid, and supraclavicular lymph nodes. There is no significant left cervical lymphadenopathy. The thyroid gland, left parotid, and bilateral submandibular glands appear to be unremarkable. The upper aerodigestive tract is intact. There is mild multilevel degenerative cervical spondylosis.
1. Widespread angiosarcoma of the right scalp right lateral face, with apparent infiltration of the right parotid gland, but no gross invasion of the underlying skull.2. RIght level 2B lymphadenopathy is consistent with metastatic disease, with probable metastatic involvement of smaller right lower level 2B, inferior parotid, and supraclavicular lymph nodes as well.3. No evidence of intracranial metastases. 4. Probable late subacute lacunar infarcts involving the right thalamocapsular region and left lateral thalamus superimposed upon a background of chronic lacunar infarcts involving the right external capsule, left caudate head, and left cerebellar hemisphere and chronic small vessel ischemic white matter disease.