781 Radiology of Infiltrating Ang ioli poma Felix S. Chew1 Terry M. Hudson Irvin F. Hawkins, Jr. Received September 11 , 1 979; accepted after revision June 1 6, 1980 Presented at the annual meeting of the Amen- can Roentgen Ray Society, Las Vegas, Nev. , April 1980. ‘All authors: Department of Radiology, Box J- 374, J. Hillis Miller Health Center, University of Florida, Gainesville, FL 3261 0. Address reprint requests to T. M. Hudson. AJR 135:781-787, October 1980 0361 -803x/80/ 1354-0781 $00.00 © American Roentgen Ray Society Infiltrating angiolipomas are rare benign soft-tissue neoplasms that are locally aggressive and require wide surgical excision. Of 10 patients studied, five showed serpiginous densities intermixed with fat on plain films. Six radionuclide bone scans showed uptake by the soft-tissue lesion. Eight angiograms demonstrated poorly mar- ginated, very hypervascular lesions. Computed tomography (CT) in five patients yielded excellent visualization of predominantly low density lesions that invaded and replaced skeletal muscle. The combination of angiography and CT indicated the specific diag- nosis and demonstrated the size, extent, and vascularity of the tumors. Infiltrating angiolipomas are rare, benign neoplasms found most frequently in the soft tissues of the thigh. Since the clinicopathologic characterization by Gonzalez-Crussi, Enneking, and Arean [1 ] in 1 966, 20 cases have been reported in the English language [2-6]; we add 10 more. Histologically, these unencap- sulated tumors are composed predominantly of mature lipocytes with foci of angiomatous proliferation (fig. 1 ). Mitoses and cellular atypia are absent [1 -3] and the lesion does not metastasize [1 -4]. In contrast to noninfiltrating angioli- pomas, which are well defined, encapsulted, and subcutaneous [7], infiltrating angiolipomas are locally aggressive. They infiltrate through muscle, fascia, and subcutaneous tissues with apparent disregard for anatomic barriers, and can progress to neurologic involvement or bone destruction. Management of infiltrating angiolipomas can be difficult because of their distressing symptoms and their propensity to recur locally after surgical resection [2, 3, 8]. The likelihood of local recurrence depends on the completeness of the resection; thus, reduced rates of recurrence should follow wider margins of excision. Since angiolipomas present no threat to life, mutilating surgery with excessive loss of function hardly seems justified; local resections are the pro- cedures of choice. Ideally, the lesion should be resected en bloc with wide margins [8]. Delineation of the exact limits of the lesion is critical for rational surgical planning. Since angiolipomas blend into normal tissue without a distinct margin, this cannot be done by direct visual inspection at the time of operation. Preoperative imaging is therefore directed not only toward establishing the diagnosis but also toward defining the total anatomic extent of the lesion. We studied the relative merits and limitations of several modes of diagnostic imaging in infiltrating angiolipomas and report our findings. Downloaded from www.ajronline.org by 171.243.65.178 on 05/15/23 from IP address 171.243.65.178. Copyright ARRS. For personal use only; all rights reserved
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