Abstract
We report a rare case of a cutaneous scalp angiosarcoma that was diagnosed based on detection of parotid gland metastases. A 79-year-old woman visited Aso Iizuka Hospital for evaluation of a left infra-auricular mass. Magnetic resonance imaging revealed a poorly circumscribed mass within the left parotid gland （52×41×40mm） and enlargement of the right-sided cervical lymph nodes. Fine-needle aspiration cytology of the mass and lymph nodes revealed atypical cells in both specimens. Initially, we diagnosed the patient with left parotid carcinoma （cT3N2cM0） and planned heavy ion radiotherapy for the primary lesion. We performed an incision biopsy of the left parotid gland and right neck dissection. Interestingly, postoperative histopathological and immunohistochemical evaluation showed angiosarcoma. The patient developed purpura （approximately 6cm in diameter） in the midline at the border between the scalp and the forehead, and skin biopsy evaluation revealed angiosarcoma, similar to the histopathological findings of the parotid mass. Follow-up computed tomography revealed multiple new lung and liver metastases. Sentinel lymph nodes in cases of frontal and facial malignancies include the upper jugular and parotid nodes; therefore, it is reasonable to conclude that the left infra-auricular mass, which was initially considered a primary lesion, was a metastatic angiosarcoma involving the parotid node. Based on these findings, we eventually diagnosed the patient with cutaneous scalp angiosarcoma accompanied by multiple metastases （T2N1M1）. The patient opted for best supportive care; unfortunately, she died 4 months after her first visit. Scalp or facial malignancies should be considered in the differential diagnosis in cases with parotid gland malignancy.
