Primary Epithelioid Sarcoma Manifesting as a Fungating Scalp Mass - Imaging Features and Treatment Options. A Case Report and Literature Review

Abstract

Primary epithelioid sarcoma is an extremely rare malignancy of the scalp. To date, less than a dozen such cases have been reported in the literature. The diagnosis often is a challenge to both radiologists and clinicians. This is largely attributed to the lack of literature on the imaging features of scalp epithelioid sarcoma. In this report, we highlight the role of multimodality imaging in the diagnosis of primary scalp epithelioid sarcoma and review the epidemiology, imaging, treatment options, and prognosis of these malignant scalp tumors. Displaying a multilobulated morphology, heterogeneous enhancement, and restricted diffusion on MRI, these tumors typically show central degeneration with hemorrhage, necrosis, and calcification. Wide surgical resection and adjuvant radiotherapy are the mainstays of treatment for localized scalp tumors. Nevertheless, the prognosis of patients with distant metastases at diagnosis is extremely poor compared to those with local or regional diseases.

Epithelioid Sarcoma of the Skull: A Differential Diagnostic Approach

“…features while it employed to describe the lesions using multimodality imaging in addition to CT modality. Compared to the case presented by Zhang et al 1 ,, in which the calvarium had no erosion and the dura was intact, this report illustrates a case where both the tables of the vault showed erosion, with a wide zone of transition, periosteal reaction and thickening of the dura and the soft tissue component. While the case reported by Zhang et al 1 was a fast-growing tumour that grew within a month and became fungating and painful while this case reports a slowly growing tumour over a period of six months with no pain involved.…”

“…Compared to the case presented by Zhang et al 1 ,, in which the calvarium had no erosion and the dura was intact, this report illustrates a case where both the tables of the vault showed erosion, with a wide zone of transition, periosteal reaction and thickening of the dura and the soft tissue component. While the case reported by Zhang et al 1 was a fast-growing tumour that grew within a month and became fungating and painful while this case reports a slowly growing tumour over a period of six months with no pain involved. 1 Despite the rarity of the tumour, PES is considered as a possibility because on CT scan, it appeared as a well-circumscribed extracerebral hypodense area surrounded by a hyperdense rim with erosion of both tables of the vault.…”

“…However, among the cases reported for PES of the scalp, including the present study, the ratio was found to be 1.4:1. [1][2][3][4][5][6][7][8][9][10] The age range at the time of diagnosis is also wide and varies from 1 to 80 years. 1 Most of the reported cases of PES are focused on histopathological morphology of epithelioid tumour cells and in this report, the focus is towards the radiological features to reiterate the importance of considering PES as a probable diagnosis from a list of differentials that present with an unknown calvarial lesion.…”

“…Only 12 cases of primary epithelioid sarcoma (PES) originating from the scalp have been reported to date, including the present study. [1][2][3][4][5][6][7][8][9][10] In addition, there is no recommended treatment modality specific for PES of the scalp, the reason being that there have been very few cases and limited study is available on the role of chemotherapy. 11 Thus, even in the recent time, wide surgical resection and adjuvant radiotherapy remain the mainstay of treatment.…”

An Efficient Resource Management Optimization Scheme for Internet of Vehicles in Edge Computing Environment

“…Su et al [ 26 ] used the vehicles parked around the street and the vehicles driving along the road to communicate the vehicle social community through V2V and used the content cached in the parked vehicles to reduce the delay of content download. Zhao et al [ 27 ] proposed a caching strategy in V2V scenario with information as the center and designed a dynamic probabilistic caching scheme. Zhang et al [ 28 ] proposed a MEC scenario computing resource allocation scheme based on DRL network, which avoids falling into the disaster of dimensionality.…”