두피에 발생한 혈관 육종 증례 보고 2례 (ase Report of Angiosarcoma on Scalp (2 Cases))

서지정보

· 발행기관 : 고신대학교(의대) 고신대학교 의과대학 학술지
· 수록지 정보 : 고신대학교 의과대학 학술지 / 25권 / 2호 / 187 ~ 191페이지
· 저자명 : 한예식

초록

Background: Angiosarcoma of the scalp is rare vascular tumor originating from endothelial cell. The prognosis is very poor with high propensity of local recurrence and distant metastasis. The author reports experiences with the latissimus dorsi free flap in the reconstruction of soft tissue defect of scalp caused by excision of angiosarcoma.
Methods: Two patients visited the hospital with 9x10cm, 8x11cm sized lesion on scalp. Distinguishing features were frequent occurrence of a peripheral erythematous ring, satellite nodules, intratumoral hemorrhage, and the tendency to bleed spontaneously. Both lesions in each patient had developed and increased in size for 5 months and for 3 months, respectively.
Results: Two patients were diagnosed as an angiosarcoma. Prior to the operations, the patients had evaluations preoperatively including brain CT, brain MRI and whole-body PET-CT. There were no evidence of metastasis. We performed wide excision and reconstruction by latissimus dorsi musculocutaneous free flap with split thickness skin graft on both cases. In case 2, radiation therapy was done within 1 month of tumor excision. Multiple distant metastasis occurred in case 1.
Conclusion: Angiosarcoma is a highly malignant tumor with poor prognosis. Treatment and reconstruction method was not yet established. Reconstruction methods include free flap, split thickness skin graft, local flap. We performed latissimus dorsi musculocutaneous free flap as reconstruction method. This method has advantages that have sufficient blood supply and bulk that offer durability to radiation therapy. However, it has a disadvantage in detection of local recurrences. And it has high potency than other reconstruction method for distant metastasis due to sufficient blood supply. Further discussion between doctor and patient is needed for the best possible selection of treatment.

영어초록

Background: Angiosarcoma of the scalp is rare vascular tumor originating from endothelial cell. The prognosis is very poor with high propensity of local recurrence and distant metastasis. The author reports experiences with the latissimus dorsi free flap in the reconstruction of soft tissue defect of scalp caused by excision of angiosarcoma.
Methods: Two patients visited the hospital with 9x10cm, 8x11cm sized lesion on scalp. Distinguishing features were frequent occurrence of a peripheral erythematous ring, satellite nodules, intratumoral hemorrhage, and the tendency to bleed spontaneously. Both lesions in each patient had developed and increased in size for 5 months and for 3 months, respectively.
Results: Two patients were diagnosed as an angiosarcoma. Prior to the operations, the patients had evaluations preoperatively including brain CT, brain MRI and whole-body PET-CT. There were no evidence of metastasis. We performed wide excision and reconstruction by latissimus dorsi musculocutaneous free flap with split thickness skin graft on both cases. In case 2, radiation therapy was done within 1 month of tumor excision. Multiple distant metastasis occurred in case 1.
Conclusion: Angiosarcoma is a highly malignant tumor with poor prognosis. Treatment and reconstruction method was not yet established. Reconstruction methods include free flap, split thickness skin graft, local flap. We performed latissimus dorsi musculocutaneous free flap as reconstruction method. This method has advantages that have sufficient blood supply and bulk that offer durability to radiation therapy. However, it has a disadvantage in detection of local recurrences. And it has high potency than other reconstruction method for distant metastasis due to sufficient blood supply. Further discussion between doctor and patient is needed for the best possible selection of treatment.

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