Detection of Recurrent Cutaneous Angiosarcoma of Lower Extremity with 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography: Report of Three Cases
A 39 year old female with history of chronic lymphedema of left leg, developed a non healing ulcer. Biopsy from the ulcer revealed angiosarcoma (STS). She underwent 18F-FDG PET-CT for staging. It revealed multiple 18F-FDG avid (SUVmax-4.5) cutaneous nodules on anterior aspect of left leg [Figures and -] but no distant metastasis. She underwent radical surgery followed by four cycles of chemotherapy. 18F-FDG PET-CT was repeated to assess response one month after completion of chemotherapy. Complete resolution of cutaneous lesions was seen, suggesting complete response [Figures and -]. The patient then lost to follow up and presented 2 years later with multiple cutaneous nodules in left leg. 18F-FDG PET-CT study was repeated for any distant metastasis. Multiple large 18F-FDG avid (SUVmax-7.3) necrotic cutaneous nodules were seen in left leg suggesting extensive recurrent disease [Figures and -] but no distant metastasis was seen. The patient was advised for an amputation, which she refused. She is on palliative radio-chemotherapy.