J Korean Neurosurg Soc.  2016 Jan;59(1):78-81. 10.3340/jkns.2016.59.1.78.

A Case Report of the Angiosarcoma Involving Epicranial Muscle and Fascia : Is the Occipitofrontalis Muscle Composed of Two Different Muscles?

• Kim HK
• Lee HJ

• KMID: 2152924
• DOI: http://doi.org/10.3340/jkns.2016.59.1.78

Abstract

The occipitofrontalis muscle is generally regarded as one muscle composed of two muscle bellies joined through the galea aponeurotica. However, two muscle bellies have different embryological origin, anatomical function and innervations. We report a case of angiosarcoma of the scalp in a 63-year-old man whose MR showed that the superficial fascia overlying the occipital belly becomes the temporoparietal fascia and ends at the superior end of the frontal belly. Beneath the superficial fascia, the occipital belly of the occipitofrontalis muscle becomes the galea aponeurotica and inserts into the underside of the frontal belly. The presented case report supported the concept of which the occipitofrontalis muscle appears to be composed of two anatomically different muscles.

Keyword

Angiosarcoma; Occipitofrontalis; Galea aponeurotica; MRI

MeSH Terms

Fascia*
Hemangiosarcoma*
Humans
Magnetic Resonance Imaging
Middle Aged
Muscles*
Scalp
Subcutaneous Tissue

Figure

• 

  Fig. 1 63-year-old man with angiosarcoma of the scalp. Low power (A, ×100) and high power (B, ×400). Hematoxylin-eosin stain shows pleomorphic endothelial cells, and immunohistochemical staining (C, ×400) shows positive for CD31 antibody staining.

• 

  Fig. 2 Coronal view of T2 (A) and contrast enhanced T1 (B) weighted MR image shows a diffuse thickening of the scalp, invading subcutaneous fat with reticular patterns of high signal intensity (asterisk) due to angiosarcoma. Superficial fascia (arrows) shows diffuse thickening and enhancement, covering normal signal intensity of temporalis muscles (small arrow). Sagittal view of T2 (C) and contrast enhanced T1 (D) weighted image show tumor involvement of superficial fascia (arrows), overlying the occipital belly and galea aponeurotica (arrowheads). Color coding image according to signal intensity of coronal (E) and sagittal (F) views of T2 weighted MR image demonstrate the occipital belly of the occipitofrontalis muscle becomes the red colored galea aponeurotica (arrow head) and inserts into the underside of the green colored superficial musculoaponeurotic system (arrows), composed of the frontal belly of occipitofrontalis and temporoparietal fascia. Ga : galea aponeurotica, fb : frontal belly, ob : occipital belly, tpf : temporoparietal fascia.

• 

  Fig. 3 PET-CT show diffuse uptake in the scalp (arrowheads) but invisible increased uptake on epicranial muscle (A). Faint uptake is visible in lymph nodes (arrows) at the level VA (B). On the 6 months follow-up PET-CT, hot uptake were visible in the level VA lymph nodes (arrow) which showed faint uptake initial study (C), and multiple lymph node metastases of both neck (arrows) are seen (D).

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