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Dhaliwal D, Sayyadioskoie S, Siatecka H, Hunt C, Diwan AH. A Tale of Two Tumors: A Collision Tumor of Atypical Fibroxanthoma and Basal Cell Carcinoma. Am J Dermatopathol 2024; 46:309-311. [PMID: 38574065 DOI: 10.1097/dad.0000000000002694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT A collision tumor is an infrequent phenomenon characterized by the presence of 2 histologically distinct tumor types (either benign or malignant) occurring within the same specific anatomical site. We describe a rare case of co-occurrence of basal cell carcinoma and atypical fibroxanthoma presenting as a single lesion on the scalp in a 76-year-old man. The lesion was clinically suspicious for basal cell carcinoma and biopsied. Histologic examination showed 2 distinct tumors, one with basaloid cells and the other one with pleomorphic spindle cells colliding and growing together. Immunohistochemical stains were crucial in establishing the diagnosis. This presentation is exceedingly rare and requires additional evaluation for diagnosis.
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Affiliation(s)
- Dilshad Dhaliwal
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX
| | | | - Hanna Siatecka
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX
| | | | - A Hafeez Diwan
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX
- Department of Dermatology, Baylor College of Medicine, Houston, TX; and
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Kuntz T, Grimm A, Hofmann SC, Michalowitz AL, Schaller J, Hellmich M, Assaf C, Oellig F, Kreuter A. Hydrochlorothiazide and increased risk of atypical fibroxanthoma and pleomorphic dermal sarcoma. J Dtsch Dermatol Ges 2024; 22:513-519. [PMID: 38483049 DOI: 10.1111/ddg.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/11/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND AND OBJECTIVES Previous work has demonstrated that hydrochlorothiazide (HCTZ) is a risk factor for squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) due to pro-photocarcinogenic effects. Atypical fibroxanthoma (AFX) and pleomorphic sarcoma (PDS), both ultraviolet-induced cancers, display a rare but rising cutaneous tumor entity. This study aimed to evaluate if the use of HCTZ is higher in patients with AFX/PDS than in patients with SCC/BCC and subsequently may be a risk factor for AFX/PDS-development. PATIENTS AND METHODS In a retrospective study of four German skin cancer centers, AFX/PDS cases and SCC/BCC controls were sex and age matched (1:3) over a time-period of 7 years (2013-2019) to evaluate the use of HCTZ, immunosuppressive medication, second malignancies, and presence of diabetes mellitus. RESULTS Overall, 146 AFX/PDS and 438 controls (SCC/BCC) were included in the study. The use of HCTZ was significantly higher in patients with AFX/PDS (44.5%) compared to patients with SCC/BCC (25.3%). Additionally, the presence of diabetes mellitus was significantly higher in AFX/PDS patients. CONCLUSIONS This study demonstrates a significantly higher use of HCTZ in patients with AFX/PDS compared to SCC/BCC. This result suggests that HCTZ may be a risk factor for AFX/PDS. Additionally, diabetes mellitus or its comorbidities may be associated with an increased risk for AFX/PDS.
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Affiliation(s)
- Thomas Kuntz
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
- Department of Dermatology, Venereology, and Allergology, Helios St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
| | - Alexander Grimm
- Department of Dermatology, Venereology, and Allergology, Helios St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
| | - Silke C Hofmann
- Department of Dermatology, Allergology, und Dermatosurgery, Helios University Hospital Wuppertal, University of Witten-Herdecke, Wuppertal, Germany
| | - Alena-Lioba Michalowitz
- Department of Dermatology, Venereology, and Allergology, Helios St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
| | - Jörg Schaller
- Department of Dermatology, Venereology, and Allergology, Helios St. Johannes Hospital Duisburg, Duisburg, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Chalid Assaf
- Department of Dermatology and Venereology, Helios Klinikum Krefeld, Krefeld, Germany
| | - Frank Oellig
- Institute of Pathology, Mülheim an der Ruhr, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, Helios St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
- Department of Dermatology, Venereology, and Allergology, Helios St. Johannes Hospital Duisburg, Duisburg, Germany
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Lue M, Harrah P, Shrestha S, Wang HT. Reconstruction after Resection of Undifferentiated Pleomorphic Sarcoma and Invasive Ductal Carcinoma in a Patient with Li-Fraumeni Syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5737. [PMID: 38623446 PMCID: PMC11018177 DOI: 10.1097/gox.0000000000005737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/28/2024] [Indexed: 04/17/2024]
Abstract
This case exhibits a presentation of multiple primary malignancies in a patient with Li-Fraumeni syndrome, necessitating surgical excision and multistaged reconstruction. Due to Li-Fraumeni syndrome patients' predisposition to developing malignancies, management includes lifelong surveillance and aggressive treatment of cancers. Plastic surgeons can minimize damage to patient's quality of life by carrying out reconstruction in a thoughtful manner that maximizes function and considers a potential lifetime of future reconstructive needs.
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Affiliation(s)
- Melinda Lue
- From the Joe R and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Tex
- Division of Plastic and Reconstructive Surgery, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
| | - Payden Harrah
- From the Joe R and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Tex
- Division of Plastic and Reconstructive Surgery, Long School of Medicine, University of Texas Medical Center San Antonio, San Antonio, Tex
| | - Sabi Shrestha
- From the Joe R and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Tex
| | - Howard T Wang
- Department of Surgery, Division of Plastic Surgery, University of Texas Health San Antonio, San Antonio, Tex
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Kuntz T, Grimm A, Hofmann SC, Michalowitz AL, Schaller J, Hellmich M, Assaf C, Oellig F, Kreuter A. Hydrochlorothiazid: Erhöhtes Risiko für atypisches Fibroxanthom und pleomorphes dermales Sarkom. J Dtsch Dermatol Ges 2024; 22:513-520. [PMID: 38574023 DOI: 10.1111/ddg.15379_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/11/2024] [Indexed: 04/06/2024]
Abstract
ZusammenfassungHintergrund und ZieleBisherige Arbeiten haben gezeigt, dass Hydrochlorothiazid (HCT) aufgrund seiner photokarzinogenen Wirkung einen Risikofaktor für Plattenepithelkarzinome (SCC) und Basalzellkarzinome (BCC) darstellt. Atypische Fibroxanthome (AFX) und pleomorphe dermale Sarkome (PDS), beides UV‐induzierte Tumoren, stellen eine seltene, aber zunehmende Tumorentität der Haut dar. In dieser Studie soll untersucht werden, ob die Einnahme von HCT bei Patienten mit AFX/PDS höher ist als bei Patienten mit SCC/BCC und ob dies ein Risikofaktor für die Entwicklung von AFX/PDS sein könnte.Patienten und MethodikIn einer retrospektiven Studie an vier deutschen Hautkrebszentren wurden AFX/PDS‐Fälle und SCC/BCC‐Kontrollen über einen Zeitraum von sieben Jahren (2013‐2019) geschlechts‐ und alters‐gematcht (1:3) auf die Einnahme von HCT und immunsuppressiven Medikamenten sowie auf Zweitmalignome und Diabetes mellitus untersucht.ErgebnisseInsgesamt wurden 146 AFX/PDS und 438 Kontrollen (SCC/BCC) in die Studie eingeschlossen. Die Einnahme von HCT war bei Patienten mit AFX/PDS (44,5%) im Vergleich zu Patienten mit SCC/BCC (25,3%) signifikant häufiger. Außerdem war Diabetes mellitus bei AFX/PDS‐Patienten signifikant häufiger.SchlussfolgerungenDiese Studie zeigt eine signifikant höhere Einnahme von HCT bei Patienten mit AFX/PDS im Vergleich zu SCC/BCC. Dies legt nahe, dass HCT ein Risikofaktor für AFX/PDS sein könnte. Darüber hinaus könnten ein Diabetes mellitus oder dessen Begleiterkrankungen mit einem erhöhten Risiko für AFX/PDS assoziiert sein.
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Affiliation(s)
- Thomas Kuntz
- Klinik für Dermatologie und Venerologie, Universität Köln
- Klinik für Dermatologie und Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Universität Witten-Herdecke, Oberhausen
| | - Alexander Grimm
- Klinik für Dermatologie und Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Universität Witten-Herdecke, Oberhausen
| | - Silke C Hofmann
- Klinik für Dermatologie, Venerologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal
| | - Alena-Lioba Michalowitz
- Klinik für Dermatologie und Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Universität Witten-Herdecke, Oberhausen
| | - Jörg Schaller
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Johannes Klinik Duisburg
| | - Martin Hellmich
- Institut für Medizinische Statistik und Bioinformatik, Medizinische Fakultät der Universität Köln
| | - Chalid Assaf
- Klinik für Dermatologie und Venerologie, Helios Klinikum Krefeld
| | | | - Alexander Kreuter
- Klinik für Dermatologie und Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Universität Witten-Herdecke, Oberhausen
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Johannes Klinik Duisburg
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Nahm WJ, Badiavas EV, Kirsner RS, Boyd CJ, Arthur AA, Bae S, Shen J. Atypical Fibroxanthoma Treated with a Topical Combination of Imiquimod, Tazarotene, and 5-Fluorouracil. Dermatol Ther (Heidelb) 2024; 14:1049-1056. [PMID: 38467988 PMCID: PMC11052744 DOI: 10.1007/s13555-024-01127-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Abstract
This case report describes an 80-year-old man who presented with a growing erythematous nodule with erosion, measuring 0.6 cm × 0.6 cm, on his right temple. This lesion was later diagnosed as atypical fibroxanthoma (AFX). Instead of undergoing Mohs surgery, the gold standard treatment, the patient opted to pursue a topical treatment regimen because of financial costs associated with surgical removal and repair. This topical regimen consisted of tazarotene cream, imiquimod cream, and 5-fluorouracil solution, applied for 30 days. The patient was directed to use this combination 5 days per week for 6 weeks. The specified dosage for each medication was a fifth of a packet of imiquimod 5% cream, an equivalent amount of tazarotene 0.1% cream, and a single drop of 5-fluorouracil 2% solution. These were combined on a bandage and placed on the lesion overnight. Following the treatment, a 3-week post-application examination revealed an erosion, 1.0 cm × 0.9 cm, amidst erythema. A subsequent incisional biopsy with histopathology and stains for CD10 and CD99, 3 weeks after treatment, and three punch biopsies with histopathology and stains for CD10 and CD99, 1-year post-treatment, confirmed the absence of AFX. AFX is a superficial variant of pleomorphic dermal sarcoma (PDS), which shares histologic similarities, yet the exact relationship between AFX/PDS and undifferentiated pleomorphic sarcoma is still not well understood. Previous studies have indicated a genomic similarity between AFX/PDS and cutaneous squamous cell carcinoma (cSCC), which suggests the potential efficacy of cSCC-targeted treatments for AFX/PDS. This case marks the first recorded instance of successful topical medical treatment of AFX, offering an alternative for patients who may opt out of surgical intervention. Continued research to assess the broader efficacy of this approach is encouraged.
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Affiliation(s)
- William J Nahm
- New York University Grossman School of Medicine, New York, NY, USA.
| | - Evangelos V Badiavas
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert S Kirsner
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Carter J Boyd
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Anita A Arthur
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Sean Bae
- Institute for Cancer Genetics, Columbia University, New York, NY, USA
| | - John Shen
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University Miami Miller School of Medicine, Miami, FL, USA
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Saleh JS, Whittington CP, Bresler SC, Patel RM. Pleomorphic Dermal Sarcoma. Surg Pathol Clin 2024; 17:153-158. [PMID: 38278604 DOI: 10.1016/j.path.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Pleomorphic dermal sarcoma (PDS) is a rare cutaneous/subcutaneous neoplasm of purported mesenchymal differentiation that exists along a clinicopathologic spectrum with atypical fibroxanthoma (AFX). While PDS and AFX share histopathologic and immunohistochemical features, PDS exhibits deeper tissue invasion and has a higher rate of metastasis and local recurrence than AFX. Given its aggressive clinical course, early recognition and clinical management of PDS are essential for optimizing patient outcomes. This review aims to provide a brief overview of the clinicopathologic and molecular features, prognosis, and treatment of PDS.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA; Department of Dermatology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Carli P Whittington
- Department of Pathology, University of Michigan, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA; Department of Dermatology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Scott C Bresler
- Department of Pathology, University of Michigan, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA; Department of Dermatology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Rajiv M Patel
- Department of Pathology, University of Michigan, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA; Department of Dermatology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA; Cutaneous Pathology, WCP Laboratories, Inc., Maryland Heights, MO, USA.
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7
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Moody R, Darji K, Missall TA, Chow P, Behshad R. A Case of Pleomorphic Dermal Sarcoma: Giant Exophytic Tumor of the Medial Canthus. Dermatopathology (Basel) 2023; 11:13-18. [PMID: 38247725 PMCID: PMC10801471 DOI: 10.3390/dermatopathology11010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
We present the case of a 99-year-old Caucasian female who was referred for treatment of a painless, 8.0 cm × 7.8 cm exophytic, pedunculated, ulcerated tumor of the left medial canthus. Pathology showed spindled, oval, and polygonal cells with pleomorphic nuclei. Many multinuclear giant cells and mitotic figures were also noted. The tumor was highlighted with CD10, showed focal positivity with actin, desmin, and CD68, and had increased Ki67 immunohistochemical staining. The tumor was negative for pancytokeratin, CK5/6, p63, MART-1/MelanA, S100, Sox10, p40, CD34, and CD23. Based on clinicopathologic correlation, the diagnosis of pleomorphic dermal sarcoma (PDS) was made. Pleomorphic dermal sarcoma (PDS) refers to a deep, histologically high-grade tumor that often resembles other tumors clinically and histologically. As PDS is frequently aggressive and related to adverse outcomes, it is important to recognize its distinguishing features in comparison to other similar entities, including atypical fibroxanthoma (AFX) and pleomorphic leiomyosarcoma (PLMS). To our knowledge, there is only one other reported case in the literature of PDS occurring on the eye. By reviewing and understanding characteristic etiologies, locations of presentation, histopathological features, and management techniques, pathologists can make a more accurate diagnosis and dermatologists can provide more effective patient care in a timely manner.
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Affiliation(s)
- Rylee Moody
- School of Medicine, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
| | - Kavita Darji
- Department of Dermatology, SSMHealth SLUCare, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
| | - Tricia A. Missall
- Department of Dermatology, University of Florida, Gainesville, FL 32606, USA
| | - Peter Chow
- Department of Dermatology, SSMHealth SLUCare, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
| | - Ramona Behshad
- Department of Dermatology, SSMHealth SLUCare, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
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Ørholt M, Abebe K, Rasmussen LE, Aaberg FL, Lindskov LJ, Schmidt G, Wagenblast AL, Petersen MM, Loya AC, Daugaard S, Herly M, Jensen DH, Vester-Glowinski P. Atypical fibroxanthoma and pleomorphic dermal sarcoma: Local recurrence and metastasis in a nationwide population-based cohort of 1118 patients. J Am Acad Dermatol 2023; 89:1177-1184. [PMID: 37634740 DOI: 10.1016/j.jaad.2023.08.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The prognosis of patients with atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) remains uncertain and no standardized follow-up programs have been established. OBJECTIVE To recommend a standardized follow-up program of patients with AFX and PDS based on nationwide long-term estimates of local recurrence and metastasis. METHODS All patients with AFX and PDS in Denmark between 2002 and 2022 were included. Danish National Registries were used to estimate the risks of local recurrence and metastasis for AFX and PDS. RESULTS The 5-year risk of local recurrence was 10% for AFX and 17% for PDS. The 5-year risk of metastasis was 0.8% for AFX and 16% for PDS. PDS metastasized within 3 years in >90% of the patients with the lungs as the primary metastasis site (50%). Invasion beyond the subcutis, perineural/intravascular infiltration, and increasing age significantly increased the risk of PDS relapse. LIMITATIONS Risk of misclassification and lack of detailed surgical information. CONCLUSION The follow-up of patients with AFX can be limited to clinical visits for 4 years. Patients with PDS should be followed with clinical visits and PET/CT twice a year for the first 3 years and once a year for a minimum of 1 year.
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Affiliation(s)
- Mathias Ørholt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Kiya Abebe
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Louise E Rasmussen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik L Aaberg
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lærke J Lindskov
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Grethe Schmidt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne Lene Wagenblast
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael M Petersen
- Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anand C Loya
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Daugaard
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - David Hebbelstrup Jensen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Vester-Glowinski
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Challa BS, Plaza JA, Wakely PE. Fine needle aspiration cytopathology of pleomorphic dermal sarcoma. Cytopathology 2023; 34:472-478. [PMID: 37204069 DOI: 10.1111/cyt.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Pleomorphic dermal sarcoma (PDS) is an uncommon cutaneous mesenchymal neoplasm. It is cytomorphologically identical to atypical fibroxanthoma (AFX), but differs due to its invasion beyond the dermis. We undertook an examination of our experience with fine needle aspiration (FNA) biopsy cytology of PDS. MATERIALS AND METHODS Our cytopathology files were searched for examples of PDS with concomitant histopathological verification. FNA biopsy smears and cell collection were performed using standard techniques. RESULTS Seven cases of PDS were retrieved from four different patients (M:F, 1:1; age range: 63-88 years; mean age = 78 years). All patients (57%) presented with a primary tumour with one having an FNA biopsy of two local recurrences and a single distant metastasis. Five aspirates were from the extremities and two from the head/neck. Tumours ranged from 1.0 to 3.5 cm (mean, 2.2 cm). Specific cytological diagnoses were pleomorphic spindle/epithelioid sarcoma (3 cases), PDS (2), AFX (1), and atypical myofibroblastic lesion, query nodular fasciitis (1). Immunohistochemical (IHC) staining from FNA-generated cell blocks in two cases showed non-specific staining with vimentin in both cases; positive CD10, CD68, and INI-1 staining in one case; and smooth muscle actin expression in the other. Multiple negative stains were performed in both of these cases to exclude malignant melanoma, carcinoma, and specific forms of sarcoma. Cytopathology consisted of a mixture of spindle, epithelioid, and bizarre pleomorphic cells. CONCLUSION Coupled with ancillary IHC stains, FNA biopsy can help recognise PDS as a sarcomatous cutaneous neoplasm, but is unable to distinguish PDS from AFX.
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Affiliation(s)
- Bindu S Challa
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Jose A Plaza
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
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10
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Kasago IS, Chatila WK, Lezcano CM, Febres-Aldana CA, Schultz N, Vanderbilt C, Dogan S, Bartlett EK, D'Angelo SP, Tap WD, Singer S, Ladanyi M, Shoushtari AN, Busam KJ, Hameed M. Undifferentiated and Dedifferentiated Metastatic Melanomas Masquerading as Soft Tissue Sarcomas: Mutational Signature Analysis and Immunotherapy Response. Mod Pathol 2023; 36:100165. [PMID: 36990277 PMCID: PMC10698871 DOI: 10.1016/j.modpat.2023.100165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
The distinction between undifferentiated melanoma (UM) or dedifferentiated melanoma (DM) from undifferentiated or unclassifiable sarcoma can be difficult and requires the careful correlation of clinical, pathologic, and genomic findings. In this study, we examined the utility of mutational signatures to identify patients with UM/DM with particular attention as to whether this distinction matters for treatment because the survival of patients with metastatic melanoma has dramatically improved with immunologic therapy, whereas durable responses are less frequent in sarcomas. We identified 19 cases of UM/DM that were initially reported as unclassified or undifferentiated malignant neoplasm or sarcoma and submitted for targeted next-generation sequencing analysis. These cases were confirmed as UM/DM by harboring melanoma driver mutations, UV signature, and high tumor mutation burden. One case of DM showed melanoma in situ. Meanwhile, 18 cases represented metastatic UM/DM. Eleven patients had a prior history of melanoma. Thirteen of 19 (68%) of the tumors were immunohistochemically completely negative for 4 melanocytic markers (S100, SOX10, HMB45, and MELAN-A). All cases harbored a dominant UV signature. Frequent driver mutations involved BRAF (26%), NRAS (32%), and NF1 (42%). In contrast, the control cohort of undifferentiated pleomorphic sarcomas (UPS) of deep soft tissue exhibited a dominant aging signature in 46.6% (7/15) without evidence of UV signature. The median tumor mutation burden for DM/UM vs UPS was 31.5 vs 7.0 mutations/Mb (P < .001). A favorable response to immune checkpoint inhibitor therapy was observed in 66.6% (12/18) of patients with UM/DM. Eight patients exhibited a complete response and were alive with no evidence of disease at the last follow-up (median 45.5 months). Our findings support the usefulness of the UV signature in discriminating DM/UM vs UPS. Furthermore, we present evidence suggesting that patients with DM/UM and UV signatures can benefit from immune checkpoint inhibitor therapy.
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Affiliation(s)
- Israel S Kasago
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Walid K Chatila
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cecilia M Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Nikolaus Schultz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chad Vanderbilt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sandra P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
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11
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McClure E, Carr MJ, Patel A, Hussnain Naqvi SM, Kim Y, Harrington M, Cruse W, Gonzalez RJ, Sondak VK, Sarnaik AA, Messina JL, Zager JS. Atypical Fibroxanthoma: Outcomes from a Large Single Institution Series. Cancer Control 2023; 30:10732748231155699. [PMID: 36764930 PMCID: PMC9926370 DOI: 10.1177/10732748231155699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Atypical fibroxanthomas (AFX) are rare malignant cutaneous neoplasms. Unfortunately, limited clinicopathologic and outcomes data on this cancer exists. OBJECTIVE We report the clinical, pathologic, and treatment characteristics, as well as oncologic outcomes in this single-institution retrospective analysis. METHODS This retrospective cohort study compiled clinical, pathologic, treatment, and outcome data for all patients with AFX on definitive excision diagnosed, evaluated, and treated primarily by surgical resection at a single institution between 2000-2020. Descriptive statistics evaluated clinical and pathologic characteristics. Kaplan-Meier method and Cox proportional-hazards models were used to evaluate overall survival and recurrence-free survival. RESULTS 78 patients with AFX were identified. The majority were elderly, immunocompetent, Caucasian men. 85% of tumors were located on the head and neck. 63% of patients were correctly diagnosed only after complete resection of the index lesion. The median surgical margin was 1.0 cm. Overall, only 1.3% (1/78) of patients developed a local recurrence (RFS). No patients died of disease. CONCLUSION This study suggests that resection margins of 1 cm achieve excellent local control with close to 99% RFS and 100% disease-specific survival.
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Affiliation(s)
- Erin McClure
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael J Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of General Surgery, University of Louisville, Louisville, KY, USA
| | - Ayushi Patel
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Syed Mahrukh Hussnain Naqvi
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Youngchul Kim
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael Harrington
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Plastic Surgery, University of South Florida, Tampa, FL, USA
| | - Wayne Cruse
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Plastic Surgery, University of South Florida, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Ricardo J Gonzalez
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA,Department of Sarcoma, University of South Florida, Tampa, FL, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Amod A Sarnaik
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Jane L Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA,Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA,Jonathan S Zager, Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 N. McKinley Drive, Tampa, FL 33612-9416, USA.
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12
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Vasilyev NV, Vtorushin SV, Maltseva AA, Sannikova AV. [Atypical fibroxanthoma]. Arkh Patol 2023; 85:65-72. [PMID: 37814853 DOI: 10.17116/patol20238505165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Atypical fibroxanthoma (AFX) is a rare skin tumor characterized by a combination of a «malignant» morphological features and non-aggressive clinical course. Diagnosing AFX is challenging due to histological «diversity» and heterogeneous immunophenotype. The presented review describes the history and evolution of AFX as a nosological form of cancer, its histogenetic origin, pathogenesis and biological potential. The clinical, morphological, immunohistochemical, molecular cytogenetic characteristics and histological subtypes of the tumor as well as differential diagnosis have been presented in detail.
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Affiliation(s)
- N V Vasilyev
- Cancer Research Institute of Tomsk National Research Medical Center, Tomsk, Russia
| | - S V Vtorushin
- Cancer Research Institute of Tomsk National Research Medical Center, Tomsk, Russia
- Siberian State Medical University, Tomsk, Russia
| | - A A Maltseva
- Cancer Research Institute of Tomsk National Research Medical Center, Tomsk, Russia
| | - A V Sannikova
- City Clinical Hospital No 3 named after B.I. Alperovich, Tomsk, Russia
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13
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Kuntz T, Siebdrath J, Hofmann SC, Baltaci M, Schaller J, Hellmich M, von Goltzheim LS, Assaf C, Oellig F, Michalowitz AL, Helbig D, Kreuter A. Increase of atypical fibroxanthoma and pleomorphic dermal sarcoma: a retrospective analysis of four German skin cancer centers. J Dtsch Dermatol Ges 2022; 20:1581-1588. [PMID: 36442137 DOI: 10.1111/ddg.14911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES In recent years, considerable insight has been gained into the pathogenesis, diagnosis and treatment of cutaneous sarcomas, including atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). Both entities have shown increasing incidence rates in the last decade. This study was initiated to evaluate how these new insights impact the number of diagnoses of AFX/PDS compared to other cutaneous sarcoma entities. PATIENTS AND METHODS In a retrospective study of four German skin cancer centers, all histopathological reports of cutaneous sarcomas (AFX, PDS, dermatofibrosarcoma protuberans, cutaneous leiomyosarcoma, angiosarcoma, and Kaposi sarcoma) confirmed by board-certified dermatopathologists were analyzed during a time-period of seven years (2013-2019). Additionally, utilization of immunohistochemical markers (including pan-cytokeratin, S100, desmin, CD34, CD10, procollagen-1, CD99, CD14, and CD68) as an adjunct to diagnose AFX/PDS was recorded. RESULTS Overall, 255 cutaneous sarcomas were included in the present study. The diagnosis of a cutaneous sarcoma has consequently risen from 2013 to 2019 (from 16 to 52 annual cases). The results of AFX/PDS revealed 4.6 times more diagnoses in 2019 than in 2013. Atypical fibroxanthoma represented the most common subtype, displaying 49.3 % of all diagnosed cutaneous sarcomas. Additionally, the increase of AFX/PDS was linked to the use of immunohistochemistry, with specific immunohistochemical markers used in 57.1 % of cases in 2013 compared to 100 % in 2019. CONCLUSIONS This retrospective study of four German skin cancer centers demonstrates a substantial rise of AFX/PDS, possibly due to recently established diagnostic and terminology standards. This rise is probably linked to increased utilization of specific immunohistochemical markers. Atypical fibroxanthoma/PDS may be more common than previously thought and seems to represent the most frequent cutaneous sarcoma subtype.
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Affiliation(s)
- Thomas Kuntz
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany.,Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
| | - Julian Siebdrath
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
| | - Silke C Hofmann
- Department of Dermatology, Allergology, und Dermatosurgery, HELIOS University Hospital Wuppertal, University of Witten-Herdecke, Wuppertal, Germany
| | - Mehmet Baltaci
- Department of Dermatology and Venereology, HELIOS Klinikum Duisburg, Duisburg, Germany
| | - Jörg Schaller
- Department of Dermatology and Venereology, HELIOS Klinikum Duisburg, Duisburg, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Luise Stach von Goltzheim
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Chalid Assaf
- Department of Dermatology and Venereology, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Frank Oellig
- Institute of Pathology, Mülheim an der Ruhr, Germany
| | - Alena-Lioba Michalowitz
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
| | - Doris Helbig
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany.,Department of Dermatology and Venereology, HELIOS Klinikum Duisburg, Duisburg, Germany
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14
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Kuntz T, Siebdrath J, Hofmann SC, Baltaci M, Schaller J, Hellmich M, von Goltzheim LS, Assaf C, Oellig F, Michalowitz AL, Helbig D, Kreuter A. Zunahme des atypischen Fibroxanthoms und pleomorphen dermalen Sarkoms: eine retrospektive Analyse vier deutscher Hauttumorzentren. J Dtsch Dermatol Ges 2022; 20:1581-1588. [PMID: 36508370 DOI: 10.1111/ddg.14911_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/14/2022] [Indexed: 12/14/2022]
Abstract
HINTERGRUND UND ZIELE In den letzten Jahren konnten umfassende Erkenntnisse über die Pathogenese, Diagnostik und Behandlung von kutanen Sarkomen, insbesondere des atypischen Fibroxanthoms (AFX) und pleomorphen dermalen Sarkoms (PDS) gesammelt werden. Beide Entitäten zeigten innerhalb der letzten Dekade steigende Inzidenzraten. Die vorliegende Studie diente der Untersuchung, welchen Einfluss die neuen Erkenntnisse auf die Fallzahlen von AFX/PDS im Vergleich zu anderen Sarkom-Entitäten haben. PATIENTEN UND METHODIK Diese retrospektive Studie wurde an vier deutschen Hauttumorzentren durchgeführt und alle von zertifizierten Dermatopathologen bestätigten histopathologischen Befunde von kutanen Sarkomen (AFX, PDS, Dermatofibrosarcoma protuberans, kutanes Leiomyosarkom, Angiosarkom und Kaposi-Sarkom) in einem Zeitraum von sieben Jahren (2013-2019) evaluiert. Zusätzlich wurde der Einsatz von immunhistochemischen Markern als diagnostische Hilfe (Panzytokeratin, S100, Desmin, CD34, CD10, Prokollagen-1, CD99, CD14 und CD68) erfasst. ERGEBNISSE Insgesamt konnten 255 kutane Sarkome in die vorliegende Studie eingeschlossen werden. Die Zahl der kutanen Sarkome nahm kontinuierlich von 2013 bis 2019 zu (von 16 auf 52 Fälle im Jahr). Die Diagnose eines AFX/PDS konnte in 2019 4,6-mal häufiger als in 2013 gestellt werden. Das AFX stellte mit 49,3 % aller kutanen Sarkome den häufigsten Sarkom-Subtypen dar. Zusätzlich war der Anstieg von AFX/PDS mit dem Einsatz von Immunhistochemie assoziiert. Der Einsatz von spezifischen Immunhistochemischen Markern stieg von 57,1 % im Jahr 2013 auf 100 % in 2019. SCHLUSSFOLGERUNGEN Diese retrospektive Studie von vier deutschen Hauttumorzentren demonstriert eine substanzielle Zunahme von AFX/PDS, wahrscheinlich infolge kürzlich etablierter beziehungsweise verbesserter diagnostischer und terminologischer Standards. Dieser Anstieg ist vermutlich mit dem vermehrten Einsatz von bestimmten immunhistochemischen Markern assoziiert. AFX/PDS treten wahrscheinlich häufiger auf als bisher vermutet und repräsentieren möglicherweise den häufigsten kutanen Sarkom-Subtyp.
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Affiliation(s)
- Thomas Kuntz
- Klinik für Dermatologie, Venerologie und Allergologie, Universität zu Köln.,Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Krankenhaus Oberhausen, Universität Witten-Herdecke, Oberhausen
| | - Julian Siebdrath
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Krankenhaus Oberhausen, Universität Witten-Herdecke, Oberhausen
| | - Silke C Hofmann
- Klinik für Dermatologie, Allergologie und Dermatochirurgie, HELIOS Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Wuppertal
| | - Mehmet Baltaci
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Duisburg
| | - Jörg Schaller
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Duisburg
| | - Martin Hellmich
- Institut für Medizinische Statistik und Bioinformatik, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln
| | - Luise Stach von Goltzheim
- Institut für Medizinische Statistik und Bioinformatik, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln
| | - Chalid Assaf
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Krefeld
| | | | - Alena-Lioba Michalowitz
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Krankenhaus Oberhausen, Universität Witten-Herdecke, Oberhausen
| | - Doris Helbig
- Klinik für Dermatologie, Venerologie und Allergologie, Universität zu Köln
| | - Alexander Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Krankenhaus Oberhausen, Universität Witten-Herdecke, Oberhausen.,Klinik für Dermatologie und Venerologie, HELIOS Klinikum Duisburg
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15
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Immunohistochemical Characteristics of Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: A Systematic Review and Meta-Analysis. Am J Dermatopathol 2022; 44:913-920. [DOI: 10.1097/dad.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Helbig D, Klein S. Immune checkpoint inhibitors for unresectable or metastatic pleomorphic dermal sarcomas. Front Oncol 2022; 12:975342. [PMID: 36465341 PMCID: PMC9712951 DOI: 10.3389/fonc.2022.975342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/03/2022] [Indexed: 04/04/2024] Open
Abstract
Pleomorphic dermal sarcomas (PDS) are rare neoplasms of the skin that occur in UV-exposed sites in the elderly, but represent the most common cutaneous sarcomas. Although the majority of PDS can be surgically removed, local recurrences occur in up to 28%, usually occurring within the first two years after primary excision. Metastases are diagnosed in up to 20% of cases, mainly observed in the skin, lymph nodes and lungs, preferentially affecting patients with underlying hemato-oncologic diseases. Similar to other UV-induced tumors, PDS are inflammatory and immunogenic tumors (with a high number of CD4+/CD8+ tumor-infiltrating lymphocytes (TILs) and checkpoint molecule expression such as PD-L1, LAG-3, TIGIT) with a very high mutational burden. The most common genetic alterations include UV-induced TP53 loss of function mutations, followed by alterations in the CDKN2A/B gene. Rarely, targetable genetic alterations can be detected. Compelling experimental data and clinical reports about PD-1/PD-L1-blocking antibodies in patients with PDS suggest its use as first line treatment in unresectable or metastatic tumor stages. However, individual ("off-line") patient management should be discussed in an interdisciplinary tumor board based on molecular genetic testing, mutational burden, PD-L1 expression, and evidence of tumor-infiltrating lymphocytes in addition to comorbities of the individual patient.
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Affiliation(s)
- Doris Helbig
- Department of Dermatology, University Hospital Cologne, Cologne, Germany
| | - Sebastian Klein
- Department of Hematology and Stem Cell Transplantation, University Duisburg-Essen, University Hospital Essen, Essen, Germany
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17
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Perez AN, Dashti NK, Cates JMM. Prognostic factors for pleomorphic dermal sarcoma: analysis of 1911 cases from the SEER database. J Clin Pathol 2022; 76:424-428. [DOI: 10.1136/jcp-2022-208570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022]
Abstract
Prognostic factors for pleomorphic dermal sarcoma, a rare undifferentiated neoplasm of the skin, are poorly defined, and typical staging systems do not appear to be appropriate for these neoplasms. We; therefore, sought to identify prognostic factors for disease-specific survival and predictors of metastasis.Pleomorphic dermal sarcomas were identified in the Surveillance, Epidemiology and End Results database (N=1911). Multiple imputation was used to overcome inherent limitations in this dataset to assess prognostic factors using multivariable Cox proportional hazard stratified by (neo)adjuvant radiotherapy and logistic regression for presentation with metastasis.Age, tumour size and metastasis were independent prognostic factors for cutaneous sarcoma-specific survival. Only tumour size was associated with increased odds of presentation with metastasis, with tumours >4 cm at highest risk. Metastasis is the most important factor in determining outcomes, with age and size as lesser factors. Only tumour size is predictive of metastasis, with larger tumours at highest risk.
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18
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BRUSASCO M, MACCHI S, DE GIORGI F, MORA E, ZUCCHI A, FELICIANI C, SATOLLI F. AEIOU not only Merkel cell carcinoma. Ital J Dermatol Venerol 2022; 157:453-454. [DOI: 10.23736/s2784-8671.22.07200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Coelho-Lima J, Bruty J, Watkins J, Liu H, Price R, Stefanos N. Clear cell variant of atypical fibroxanthoma and pleomorphic dermal sarcoma: molecular characterization and review of the literature. J Cutan Pathol 2022; 49:1031-1034. [PMID: 35922373 DOI: 10.1111/cup.14307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are unusual cutaneous tumors that typically arise in sun-damaged skin of elderly individuals. Several histopathologic variants have been described, but the clear cell variant is particularly rare with only 18 cases of AFX and 1 case of PDS reported. Here, we present two cases of clear cell AFX and PDS highlighting key histopathologic findings and molecular alterations assessed by next generation sequencing (NGS).
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Affiliation(s)
- Jose Coelho-Lima
- Histopathology Registrar, Addenbrooke's Hospital, Cambridge, UK.,NIHR Academic Clinical Fellow, University of Cambridge, Cambridge, UK
| | - Jonathan Bruty
- Clinical Scientist, East of England Genomic Laboratory Hub, Cambridge, UK
| | - James Watkins
- Consultant Histopathologist, Addenbrooke's Hospital, Cambridge, UK
| | - Hongxiang Liu
- Consultant Clinical Scientist, East of England Genomic Laboratory Hub, Cambridge, UK
| | - Richard Price
- Consultant Plastic Surgeon, Addenbrooke's Hospital, Cambridge, UK
| | - Niki Stefanos
- Consultant Histopathologist, Addenbrooke's Hospital, Cambridge, UK
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20
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Azin M, Ameri AH, Foreman RK, Neel VA, Lorenzo ME, Demehri S. Lethal Dermal Sarcoma in Immunosuppressed Patients. Oncologist 2022; 27:e759-e761. [PMID: 35867136 PMCID: PMC9438906 DOI: 10.1093/oncolo/oyac141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/24/2022] [Indexed: 11/14/2022] Open
Abstract
Skin cancer is the leading malignancy in immunosuppressed patients, including organ transplant recipients (OTRs), which is increasing in incidence as OTRs live longer. We performed a single-center case series of 4 patients with scalp pleomorphic dermal sarcoma and a history of multiple keratinocyte carcinomas. Outcomes included incidence of dermal sarcoma, dermal sarcoma-related mortality, and histopathologic findings. Out of more than 200 patients followed over a 3-year period in Massachusetts General Hospital High Risk Skin Cancer Clinics, all skin cancer-related deaths (2/2) were due to metastatic dermal sarcoma. Three of 4 patients diagnosed with scalp dermal sarcoma were OTRs and had been on at least one immunosuppressive medication for a median of 9 years. For patients who died from dermal sarcoma, the median time between diagnosis and death was 6 months. Our findings suggest pleomorphic dermal sarcoma contributes to skin cancer-related morbidity and mortality in OTRs.
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Affiliation(s)
- Marjan Azin
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Amir H Ameri
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ruth K Foreman
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Victor A Neel
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mayra E Lorenzo
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shadmehr Demehri
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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21
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Messina V, Cope B, Keung EZ, Fiore M. Management of Skin Sarcomas. Surg Oncol Clin N Am 2022; 31:511-525. [DOI: 10.1016/j.soc.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Ørholt M, Aaberg FL, Abebe K, Walsh S, Roenigk RK, Venzo A, Schmidt G, Klyver H, Jensen DH, Herly M, Vester-Glowinski PV. Risk factors for local atypical fibroxanthoma recurrence and progression to pleomorphic dermal sarcoma: A meta-analysis of individualized participant data. J Surg Oncol 2022; 126:555-562. [PMID: 35441377 PMCID: PMC9544245 DOI: 10.1002/jso.26898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/14/2022] [Accepted: 04/07/2022] [Indexed: 11/09/2022]
Abstract
Background Risk factors for local atypical fibroxanthoma (AFX) recurrence and progression to pleomorphic dermal sarcoma (PDS) have not previously been identified. Objective To identify risk factors and provide follow‐up suggestions for local AFX recurrence and progression to PDS. Methods and Materials A literature search was performed in the PubMed, EMBASE, and Cochrane databases. The PRISMA and MOOSE guidelines were followed. The risks of local AFX recurrence and progression to PDS were presented as Kaplan–Meier plots and risk factors were presented as hazard ratios (HRs) calculated with univariate and multivariate Cox regression. Results Five hundred and ninety‐eight patients with AFX from 14 studies were included. Age >74 years and male sex significantly increased the risk of local recurrence (HR: 7.31 [95% confidence interval [CI]: 1.78–30.0], p < 0.01 and HR: 2.89 [95% CI: 1.04–8.01], p < 0.05, respectively). There was no difference when comparing wide local excision and Mohs' micrographic surgery (p = 0.89). The risks of local AFX recurrence and progression to PDS after 2 years were <1%. Conclusion A more intensive follow‐up regimen could be considered in patients >74 years old and males due to the higher risk of local AFX recurrence.
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Affiliation(s)
- Mathias Ørholt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik L Aaberg
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kiya Abebe
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - S Walsh
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex: St Richard's Hospital, Chichester, West Sussex, UK
| | - Randall K Roenigk
- Department of Dermatology and Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alessandro Venzo
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Grethe Schmidt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Helle Klyver
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - David H Jensen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter V Vester-Glowinski
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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23
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Sim JY, Lee DH, Jang B, Suh MJ. Atypical Fibroxanthoma Resected without Auricular Deformity in an Elderly Patient: A Case Study. EAR, NOSE & THROAT JOURNAL 2022:1455613221084072. [PMID: 35387526 DOI: 10.1177/01455613221084072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Atypical fibroxanthoma (AFX) is a dermal spindle-cell cutaneous malignancy, which is a relatively benign type of skin cancer that occurs in the elderly with sun-damaged skin. This is a case study of a rapidly enlarged left auricular mass lesion in an elderly patient who was diagnosed with AFX based on histopathological and immunohistochemical findings, and then treated by complete excision to prevent recurrence or metastasis. There was no recurrence during the 1-year follow-up. For otolaryngologists or plastic surgeons, recognizing the clinical and pathologic characteristics of AFX is important for accurate diagnosis and treatment.
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Affiliation(s)
- Jae-Yeop Sim
- Department of Otorhinolaryngology, 91577Jeju National University College of Medicine, Jeju-do, Korea
| | - Dong Hui Lee
- Department of Pathology, 37984Jeju National University College of Medicine, Jeju-do, Korea
| | - Bogun Jang
- Department of Pathology, 37984Jeju National University College of Medicine, Jeju-do, Korea
| | - Michelle J Suh
- Department of Otorhinolaryngology, 91577Jeju National University College of Medicine, Jeju-do, Korea
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Helbig D, Ziemer M, Dippel E, Erdmann M, Hillen U, Leiter U, Mentzel T, Osterhoff G, Ugurel S, Utikal J, von Bubnoff D, Weishaupt C, Grabbe S. S1‐Leitlinie Atypisches Fibroxanthom (AFX) und pleomorphes dermales Sarkom (PDS). J Dtsch Dermatol Ges 2022; 20:235-245. [PMID: 35146874 DOI: 10.1111/ddg.14700_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Doris Helbig
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Köln
| | - Mirjana Ziemer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig
| | - Edgar Dippel
- Klinik für Dermatologie und Venerologie, Klinikum der Stadt Ludwigshafen
| | - Michael Erdmann
- Hautklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Berlin Neukölln
| | - Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinikum, Eberhard-Karls-Universität Tübingen
| | | | - Georg Osterhoff
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR
| | - Selma Ugurel
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Jochen Utikal
- Klinische Kooperationseinheit Dermatoonkologie des Deutschen Krebsforschungszentrum Heidelberg (DKFZ) und der Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg
| | - Dagmar von Bubnoff
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | | | - Stephan Grabbe
- Hautklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz
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Atypical fibroxanthoma and pleomorphic dermal sarcoma: Is superficial infiltration in subcutaneous tissue acceptable in AFX? Ann Diagn Pathol 2022; 58:151915. [DOI: 10.1016/j.anndiagpath.2022.151915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 11/23/2022]
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26
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Helbig D, Ziemer M, Dippel E, Erdmann M, Hillen U, Leiter U, Mentzel T, Osterhoff G, Ugurel S, Utikal J, von Bubnoff D, Weishaupt C, Grabbe S. S1-guideline atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). J Dtsch Dermatol Ges 2022; 20:235-243. [PMID: 35099104 DOI: 10.1111/ddg.14700] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are rare cutaneous neoplasms representing histomorphological, genetic as well as epigenetic variants of a disease spectrum. Both tumors typically manifest as nonspecific, often ulcerated, skin- to flesh-colored nodules in chronically sun-damaged skin of elderly male patients. AFX is a rather well demarcated, often rapidly growing tumor. PDS tumors are poorly circumscribed and are characterized by aggressive infiltrative growth. Fast as well as slow growth behavior has been reported for both tumors. Histologically, both are composed of spindle-shaped and epithelioid tumor cells with pleomorphic nuclei as well as atypical multinucleated giant cells. Atypical mitoses are common. In contrast to AFX, PDS involves relevant parts of the subcutis and shows areas of tumor necrosis and/or perineural infiltration. Due to the poorly differentiated nature of AFX/PDS (Grade 3), histopathologically similar cutaneous sarcomas, undifferentiated carcinomas, melanomas and other diseases have to be excluded by immunohistochemical analysis. The treatment of choice is micrographically controlled surgery. In cases of AFX, a cure can be assumed after complete excision. Local recurrence rates are low as long as PDS tumors are surgically removed with a safety margin of 2 cm. Metastasis is rare and mostly associated with very thick or incompletely excised tumors; it mainly affects the skin and lymph nodes. Distant metastasis is even more rare. No approved and effective systemic therapy has been established.
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Affiliation(s)
- Doris Helbig
- Department of Dermatology and Venereology, University Hospital Cologne, Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venereology, and Allergology, University Hospital Leipzig, Germany
| | - Edgar Dippel
- Department of Dermatology and Venereology, University Hospital Ludwigshafen, Germany
| | - Michael Erdmann
- Department of Dermatology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen - European Metropolis Region Nürnberg, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Klinikum Berlin Neukölln, Berlin, Germany
| | - Ulrike Leiter
- Center for Dermato-Oncology, University Hospital Dermatology, Eberhard-Karls-Universität Tübingen, Germany
| | | | - Georg Osterhoff
- Department and Clinic for Orthopedics, Trauma Surgery, and Plastic Surgery, University Hospital Leipzig AöR, Germany
| | - Selma Ugurel
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, Germany
| | - Jochen Utikal
- Clinical Cooperation Unit Dermatology of the German Cancer Research Institute Heidelberg (DKFZ) and the Department of Dermatology, Venereology, and Allergology, Medical Faculty Mannheim, Ruprecht-Karls-Universität Heidelberg, Germany
| | - Dagmar von Bubnoff
- Department of Dermatology, Venereology, and Allergology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | | | - Stephan Grabbe
- Department of Dermatology, University Hospital, Johannes Gutenberg University Mainz, Germany
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Logan IT, Vroobel KM, le Grange F, Perrett CM. Pleomorphic dermal sarcoma: Clinicopathological features and outcomes from a 5-year tertiary referral centre experience. Cancer Rep (Hoboken) 2021; 5:e1583. [PMID: 34766474 PMCID: PMC9675369 DOI: 10.1002/cnr2.1583] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/27/2021] [Accepted: 10/12/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Pleomorphic dermal sarcoma (PDS) describes rare dermal-based malignant tumours that are morphologically similar to atypical fibroxanthoma (AFX). PDS may be differentiated from AFX by the presence of one or more of the following histologic features: subcutaneous invasion, tumour necrosis, lymphovascular invasion (LVI), and/or perineural infiltration (PNI). AIMS To further define the clinicopathological features, surgical management, and outcomes of PDS primary tumours. METHODS AND RESULTS This study was a retrospective observational case series using a database search from 2012 to 2017. Inclusion criteria required all cases to meet the histopathologic criteria for PDS as confirmed by a specialist soft-tissue histopathologist. A total of n = 17 cases were included with a median age of 78 years (range 66-85). All tumours were located on the head and neck, with 13/17 located on the scalp. Primary treatment was with wide local excision (WLE) in all cases. Median follow-up was 48 months. Local recurrence occurred in 4/17 cases (24%) and distant metastasis in 2/17 cases (12%). CONCLUSION PDS behaves more aggressively than atypical fibroxanthoma with which it shares a biologic continuum. The optimal surgical management approach is yet to be determined.
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Affiliation(s)
- Ian T. Logan
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Katherine M. Vroobel
- Department of HistopathologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Franel le Grange
- Department of OncologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Conal M. Perrett
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
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Ak M, Kahraman A, Arnold FM, Turko P, Levesque MP, Zoche M, Ramelyte E, Dummer R. Clinicopathological and Genomic Profiles of Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma Identify Overlapping Signatures with a High Mutational Burden. Genes (Basel) 2021; 12:genes12070974. [PMID: 34202213 PMCID: PMC8303615 DOI: 10.3390/genes12070974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/27/2022] Open
Abstract
Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are rare tumors developing in chronically sun-exposed skin. Clinicopathological features are similar, but they differ in prognosis, while PDS has a more aggressive course with a higher risk for local recurrence and metastases. In current clinical practice, they are diagnosed by exclusion using immunohistochemistry. Thus, stringent diagnostic criteria and correct differentiation are critical in management and treatment for optimal outcomes. This retrospective single-center study collected clinicopathological data and tumor samples of 10 AFX and 18 PDS. Extracted genomic DNA from tumor specimens was analyzed by a next-generation sequencing (NGS) platform (FoundationOne-CDx™). Among 65 identified mutations, TP53 inactivating mutations were observed in all tumor specimens. In both AFX and PDS, the known pathogenic gene alterations in CDKN2A, TERT promoter, and NOTCH1 were frequently present, along with high mutational burden and stable Micro-Satellite Instability status. The mutational profiles differed only in ASXL1, which was only present in AFX. Further differences were identified in likely pathogenic and unknown gene alterations. Similarities in their genomic signatures could help to distinguish them from other malignancies, but they are not distinguishable between each other using the FoundationOne-CDx™ NGS panel. Therefore, histological criteria to determine diagnosis remain valid. For further insight, performing deep tumor profiling may be necessary.
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Affiliation(s)
- Melike Ak
- Dermatology Department, University Hospital Zurich, 8091 Zurich, Switzerland; (M.A.); (P.T.); (M.P.L.); (E.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
| | - Abdullah Kahraman
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
- Pathology Department, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Fabian M. Arnold
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
- Pathology Department, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Patrick Turko
- Dermatology Department, University Hospital Zurich, 8091 Zurich, Switzerland; (M.A.); (P.T.); (M.P.L.); (E.R.)
| | - Mitchell P. Levesque
- Dermatology Department, University Hospital Zurich, 8091 Zurich, Switzerland; (M.A.); (P.T.); (M.P.L.); (E.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
| | - Martin Zoche
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
- Pathology Department, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Egle Ramelyte
- Dermatology Department, University Hospital Zurich, 8091 Zurich, Switzerland; (M.A.); (P.T.); (M.P.L.); (E.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
| | - Reinhard Dummer
- Dermatology Department, University Hospital Zurich, 8091 Zurich, Switzerland; (M.A.); (P.T.); (M.P.L.); (E.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
- Correspondence: ; Tel.: +41-44-255-11-11
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Jang N, Shin HW, Yoon KC. Locally Advanced Pleomorphic Dermal Sarcoma of the Forearm. J Hand Surg Am 2021; 46:521.e1-521.e5. [PMID: 33082036 DOI: 10.1016/j.jhsa.2020.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023]
Abstract
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal tissue tumor that shares pathological features with atypical fibroxanthoma, but also exhibits tumor necrosis, invasion beyond the superficial subcutis, and vascular or perineural infiltration. In addition, PDS also has relatively high rates of local recurrence and metastasis and is usually encountered in elderly men, especially in the head and neck area. In this article, we report a rare case of PDS that infiltrated the fascial tissues in the forearm of a female patient. After wide local excision, the defect was covered with an anterolateral thigh free flap and adjuvant radiotherapy was instituted.
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Affiliation(s)
- Nam Jang
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Woo Shin
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Kun Chul Yoon
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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30
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Hasler H, Beissert S, Laske J. Atypisches Fibroxanthom oder pleomorphes dermales Sarkom – eine Frage der Infiltrationstiefe. AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1423-3383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDas atypische Fibroxanthom (AFX) ist eine seltene, niedrig-maligne mesenchymale Neoplasie der Haut. Die Abgrenzung zum malignen fibrösen Histiozytom bzw. pleomorphen dermalen Sarkom (PDS) wurde seit der Erstbeschreibung Anfang der 1960er-Jahre immer wieder kontrovers diskutiert. Mittlerweile wird der Begriff des pleomorphen dermalen Sarkoms für Tumore verwendet, die eine Infiltration der Subkutis, nekrotische Anteile oder eine perineurale oder lymphovaskuläre Infiltration aufweisen. Die Unterscheidung der beiden Entitäten erfolgt folglich vorwiegend histologisch, eine immunhistochemische Abgrenzung ist bisher nicht möglich.Wir berichten über 2 Patienten mit atypischem Fibroxanthom und pleomorphem dermalem Sarkom. Beide Tumorentitäten sollten mittels weiter Exzision oder mikrografisch kontrollierter Chirurgie vollständig exzidiert werden. Insbesondere beim pleomorphen dermalen Sarkom kommt es häufiger zu Rezidiven und Metastasierung, deshalb sollte der Sicherheitsabstand größer als beim AFX gewählt werden und v. a. in den ersten 3 Jahren nach der Behandlung eine engmaschige Nachsorge erfolgen.Eine einheitliche Klassifikation der beiden Tumorentitäten, die das aggressivere Verhalten des tiefer infiltrierenden pleomorphen dermalen Sarkoms berücksichtigt, wäre erstrebenswert.Zudem sollten beide Tumore der Meldepflicht unterliegen, um weitere epidemiologische Daten sammeln zu können.
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Affiliation(s)
- H. Hasler
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
| | - S. Beissert
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
| | - J. Laske
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
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31
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Iglesias-Pena N, Martínez-Campayo N, López-Solache L. Relation Between Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: Histopathologic Features and Review of the Literature. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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32
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Mantzouranis K, Georgakopoulou VE, Chlapoutakis S, Melemeni D, Damaskos C, Garmpis N, Sklapani P, Trakas N, Tsiafaki X. Atypical Fibroxanthoma: An unexpected cause of hemoptysis. Acta Med Litu 2021; 28:165-169. [PMID: 34393640 PMCID: PMC8311850 DOI: 10.15388/amed.2021.28.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/22/2022] Open
Abstract
Atypical fibroxanthoma is an infrequent, low-grade superficial cutaneous neoplasm, usually presenting as a nodule or plaque of red color. It is considered as a superficial variant of pleomorphic dermal sarcoma. Although atypical fibroxanthoma has similar histologic features to pleomorphic dermal sarcoma, it has less aggressive behavior. Atypical fibroxanthoma usually occurs on sun-exposed regions of the head and neck of elderly patients. Ultraviolet light, specific genetic mutations and administration of immunosuppressive agents to transplant recipients have been associated with the pathogenesis of the tumor. The prognosis is typically excellent when treated with complete excision of the primary lesion. This report describes the rare case of a 84-year-old man with hemoptysis due to metastatic cutaneous atypical fibroxanthoma.
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Affiliation(s)
| | | | | | | | - Christos Damaskos
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GreeceN.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GreeceN.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, Athens, Greece
| | - Xanthi Tsiafaki
- 1 Pulmonology Department Sismanogleio Hospital, Athens, Greece
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Ding L, Xu WJ, Tao XY, Zhang L, Cai ZG. Clinicopathological features of superficial CD34-positive fibroblastic tumor. World J Clin Cases 2021; 9:2739-2750. [PMID: 33969057 PMCID: PMC8058686 DOI: 10.12998/wjcc.v9.i12.2739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/13/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Superficial CD34-positive fibroblastoma (SCPFT) is a newly discovered mesenchymal tumor characterized by high polymorphism, low mitotic rate, and diffuse CD34-positive reactions.
AIM To further determine the clinicopathological features of SCPFT.
METHODS We retrospectively analyzed the clinicopathological data, immunohistochemistry results, and differential diagnoses of four patients with SCPFT and performed a literature review. Relevant fusion genes were also detected.
RESULTS The tumors were all located in the lower extremities and presented as slow-growing painless masses located in the dermis and subcutaneous tissue. Microscopically, the tumors were composed of spindle-shaped to epithelioid cells with scattered abnormal and pleomorphic nuclei on a fibrous or fibromyxoid background. Necrosis was not found in the tumor tissues, and mitotic figures were rare. Immunohistochemically, the tumor cells were strongly positive for vimentin and CD34, and CKpan showed focal positivity in two tumors. All four patients were followed (13-57 mo, mean 35 mo), and one patient experienced local recurrence.
CONCLUSION SCPFT is a newly discovered borderline mesenchymal tumor that can locally recur or even metastasize. Familiarity with its clinicopathological features will help avoid confusion with skin mesenchymal tumors with similar features.
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Affiliation(s)
- Li Ding
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Wen-Jing Xu
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Xiao-Ying Tao
- Department of Pathology, Hangzhou People's Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Liang Zhang
- Department of Pathology, Huaiyuan County People's Hospital, Bengbu 233000, Anhui Province, China
| | - Zhao-Gen Cai
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
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Rosenfeld DJ, Cappel MA, Tolkachjov SN. Cutaneous mesenchymal tumors treated with Mohs micrographic surgery: a comprehensive review. Int J Dermatol 2021; 60:1334-1342. [PMID: 33715156 DOI: 10.1111/ijd.15500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 12/20/2022]
Abstract
Cutaneous mesenchymal tumors (CMT) are rare tumors with wide clinicopathologic heterogeneity. Treatment of malignant cutaneous mesenchymal tumors traditionally includes wide local excision (WLE), though Mohs micrographic surgery (MMS) has been increasingly used. A PubMed literature review of articles from inception until September 2019 related to malignant CMT and surgical treatment with MMS or WLE was completed. Dermatofibrosarcoma protuberans treated with MMS recurred in 1.2% of patients with no reported metastasis. Atypical fibroxanthoma treated with MMS recurred and metastasized in 2.7 and 2.5%, respectively. Undifferentiated pleomorphic sarcoma treated with MMS recurred in 32% with an unknown metastatic rate. Superficial leiomyosarcoma treated with MMS recurred in 3.8% with no reported metastasis. Cutaneous angiosarcoma and myofibrosarcoma treated with MMS have shown no recurrence or metastatic disease, but literature is sparse. The rarity of malignant CMT and the lack of comparative data on treatment make conclusive treatment recommendations difficult. However, recent literature suggests MMS is a useful option and potentially a superior treatment for primary cutaneous mesenchymal tumors.
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Affiliation(s)
- David J Rosenfeld
- Department of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Mark A Cappel
- Dermatopathology, Gulf Coast Dermatopathology Laboratory Dermatology, Dermatology Associates of Tampa Bay, Tampa, FL, USA
| | - Stanislav N Tolkachjov
- Dermatology and Mohs Micrographic and Reconstructive Surgery, Epiphany Dermatology, Dallas, TX, USA
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Abstract
Cutaneous sarcomas represent a rare group of tumors presenting in the head and neck. In this article, we discuss specific sarcoma tumor types and their presentation, pathogenesis, histologic findings, and management recommendations. Tumors to be reviewed include dermatofibrosarcoma protuberans, atypical fibroxanthoma, pleomorphic dermal sarcoma, cutaneous leiomyosarcoma, and angiosarcoma.
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Affiliation(s)
- Brittny N Tillman
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical School, 2001 Inwood Road, Dallas, TX 75390-8868, USA.
| | - Jeffrey C Liu
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Fox Chase Cancer Center, 3440 North Broad Street, Philadelphia, PA 19140, USA
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36
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Undifferentiated pleomorphic sarcoma of skin in unusual locations: Report of two cases. Jt Dis Relat Surg 2021; 32:253-257. [PMID: 33463447 PMCID: PMC8073439 DOI: 10.5606/ehc.2021.78856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/02/2020] [Indexed: 11/21/2022] Open
Abstract
Undifferentiated pleomorphic sarcoma (UPS) of the skin is a rare soft tissue sarcoma subtype with a high risk of metastasis and local recurrence. Ultraviolet exposure plays a prominent role in its etiology. Herein, we present two rare cases of UPS of the skin with an occurrence in non-ultraviolet exposed locations and discuss the need of wide resection and the identification of the depth of the tumor. Due to the resection of the skin, resulting defect was undertaken with skin grafting. One case was extending to the fascia and, after the resection, vacuum-assisted closure therapy was used for the formation of granulation tissue. No recurrence was seen after three and four years for either cases. In conclusion, UPS is a rare, aggressive malignant tumor with a high local recurrence and metastasis rate. Suspicion of malignancy in a plaque-like or nodular lesion in the skin is crucial, and local recurrence and metastasis risk is significantly correlated to the success of wide excision.
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38
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Iglesias-Pena N, Martínez-Campayo N, López-Solache L. Relation Between Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: Histopathologic Features and Review of the Literature. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:392-405. [PMID: 33301761 DOI: 10.1016/j.ad.2020.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 12/20/2022] Open
Abstract
The relation between atypical fibroxanthoma and pleomorphic dermal sarcoma has led to confusion and debate in the literature. Both tumors present on sun-exposed skin, typically on the head and neck, in patients of advanced age. Both are comprised of a variable mix of histiocytoid, spindle, epithelioid, and/or giant multinucleated cells with pleomorphic nuclei. No immunohistochemical diagnostic techniques have emerged to distinguish these tumors. Diagnosis is by exclusion. Histologically, atypical fibroxanthoma is seen as a well-circumscribed dermal nodule but there will be no evidence of extensive subcutaneous invasion, tumor necrosis, or lymphovascular or perineural invasion. Therefore, if any of the aforementioned features is present, the diagnosis would be pleomorphic dermal sarcoma. This narrative review of the literature aims to identify the distinguishing and overlapping histopathologic features of these 2 tumors as they have been described in case series.
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Affiliation(s)
- N Iglesias-Pena
- Servicio de Dermatología, Hospital Universitario Lucus Augusti, Lugo, España.
| | - N Martínez-Campayo
- Servicio de Dermatología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - L López-Solache
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario A Coruña, A Coruña, España
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Bowe CM, Godhania B, Whittaker M, Walsh S. Pleomorphic dermal sarcoma: a clinical and histological review of 49 cases. Br J Oral Maxillofac Surg 2020; 59:460-465. [PMID: 33441282 DOI: 10.1016/j.bjoms.2020.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal neoplasm that shares histopathological features with atypical fibroxanthoma (AFX), but has additional features of deep invasion of the superficial subcutis, tumour necrosis, and vascular and perineural invasion, which confers a risk of local recurrence and metastases. To study the clinical and pathological spectrum more comprehensively, we retrieved 49 cases of pleomorphic dermal sarcoma from our departmental files. There was a strong male predominance (n=45). The mean (range) age at presentation was 80 (47-97) years. The tumours had a median (range) maximum dimension of 23.5 (5-75) mm. There was a strong predilection for the head and face (n=47), with the scalp (n=32) being the most common site. Ulceration was observed in 21 patients, tumour necrosis in seven, perineural infiltration in six, and lymphovascular invasion in two. CD10 was expressed in all cases. Smooth muscle actin was expressed in 15 and CD68 in 14. Follow up was available in 41 cases (mean (range) 22.4 (2-90) months). Six patients had local recurrences, despite all having originally undergone primary surgical resections and having reports of clear margins. Progressive metastatic disease was observed in one patient who died from their disease. Based on the Kaplan Meier method, median overall survival was 70.8 (8.4-133.1) months. Although AFX and PDS may be part of a spectrum, distinction is important to emphasise the potential for malignant behaviour in PDS.
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Affiliation(s)
- C M Bowe
- Oral & Maxillofacial Surgery Department, St. Richards Hospital, Chichester.
| | - B Godhania
- Oral & Maxillofacial Surgery Department, St. Richards Hospital, Chichester
| | - M Whittaker
- Department of Pathology, St. Richards Hospital, Chichester
| | - S Walsh
- Oral & Maxillofacial Surgery Department, St. Richards Hospital, Chichester
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Ibanez MA, Rismiller K, Knackstedt T. Prognostic factors, treatment, and survival in cutaneous pleomorphic sarcoma. J Am Acad Dermatol 2020; 83:388-396. [DOI: 10.1016/j.jaad.2018.08.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/21/2018] [Accepted: 08/29/2018] [Indexed: 01/30/2023]
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Hashimoto K, Nishimura S, Oka N, Akagi M. Surgical management of sarcoma in adolescent and young adult patients. BMC Res Notes 2020; 13:257. [PMID: 32456671 PMCID: PMC7249334 DOI: 10.1186/s13104-020-05107-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/21/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To examine the clinical features and outcomes of adolescent and young adult sarcoma patients who underwent surgical management and clarify important factors associated with prognosis. We reviewed 18 young adult sarcoma patients sarcoma patients treated surgically in our hospital. The tumor site, histology, grade, stage, and American Society of Anesthesiologists-Physical Status before surgery, operation time, intraoperative blood loss, complications, surgical margin, local recurrence, metastasis, and outcomes were investigated. The 3-year survival rate was also calculated. We compared survival based on age, grade, and surveyed features of poor outcome cases. Results The 3-year survival rate was 61.3%. There was no significant difference in survival based on age, grade, operation time, or intraoperative blood loss. Three of five patients who died of the disease had stage ≥ IV at diagnosis. All patients with R1 surgical margins developed recurrence and all those with an American Society of Anesthesiologists-Physical Status ≥ 2 died. Patients with late-stage sarcomas, R1 tumor margin, or high American Society of Anesthesiologists-Physical Status score had poor prognoses. To achieve a favorable outcome in adolescent and young adult sarcoma patients, early detection and obtaining R0 ≥ surgical margin are essential.
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Affiliation(s)
- Kazuhiko Hashimoto
- Department of Orthopaedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan.
| | - Shunji Nishimura
- Department of Orthopaedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan
| | - Naohiro Oka
- Department of Orthopaedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan
| | - Masao Akagi
- Department of Orthopaedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan
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Lonie S, Yau B, Henderson M, Gyorki D, Angel C, Webb A. Management of pleomorphic dermal sarcoma. ANZ J Surg 2020; 90:2322-2324. [PMID: 32338819 DOI: 10.1111/ans.15909] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pleomorphic dermal sarcoma (PDS) is a rare, poorly defined skin neoplasm with features similar to atypical fibroxanthoma, but with adverse histopathological characteristics indicating metastatic potential such as tumour necrosis, invasion beyond superficial subcutis or vascular and/or perineural infiltration. Optimal treatment for PDS is uncertain and reported outcomes vary due to the rarity of this diagnosis and uncertainty over histopathological categorization. The aim of this study was to review the clinical and histopathological features of PDS in a single Australian centre. METHODS A retrospective review of all patients managed at the Peter MacCallum Cancer Centre with PDS between 2003 and 2017 was performed by a search of electronic records and histories reviewed. RESULTS A total of 27 patients were identified, mostly elderly males (85.2%, mean age 79.8 years). Lesions were seen most commonly on the head and neck region (96.3%), predominantly on the scalp (63%). Mean tumour radial surgical excision margin was 12.8 mm. Eighteen patients (66.7%) underwent radiotherapy; 13 adjuvant, three neoadjuvant and two with palliative intent. After median follow-up of 46.4 months, two patients had recurrence (7.4%); both had inadequate deep margins at first excision. There were three all-cause deaths in the cohort. There was one disease-specific mortality with metastatic PDS disease at the time of initial presentation. CONCLUSION PDS is a rare cutaneous malignancy most commonly found in the head and neck region in elderly men, which is best managed with adequate surgical excision. The role of radiotherapy is undefined and an area for future investigation.
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Affiliation(s)
- Sarah Lonie
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benny Yau
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Henderson
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Angel
- Department of Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Angela Webb
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Craig PJ. An Overview of Uncommon Cutaneous Malignancies, Including Skin Appendageal (Adnexal) Tumours and Sarcomas. Clin Oncol (R Coll Radiol) 2019; 31:769-778. [PMID: 31466845 DOI: 10.1016/j.clon.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/07/2019] [Accepted: 07/23/2019] [Indexed: 01/25/2023]
Abstract
A standardised classification of malignant skin appendageal (adnexal) tumours and sarcomas is required for improved patient management and prognosis. This has been hindered by considerable morphological variation both within and between tumour types, the use of many synonyms for the same tumour types and variation in classification between pathologists. This update uses the improved classification in the 2018 WHO classification of skin tumours as the basis to discuss malignant skin appendageal tumours, sarcomas and cutaneous metastases that regularly present to skin cancer clinicians, multidisciplinary skin cancer teams and tumour boards, with current evidence for management, where appropriate.
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Affiliation(s)
- P J Craig
- Gloucestershire Cellular Pathology Laboratory, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK.
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Soleymani T, Aasi SZ, Novoa R, Hollmig ST. Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma. Dermatol Clin 2019; 37:253-259. [DOI: 10.1016/j.det.2019.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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45
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Wollina U, Schönlebe J, Bujok V, Lotti T, Tchernev G, Temelkova I, Vojvodic A. Dermal Pleomorphic Sarcoma of the Scalp - Report of Two Cases. Open Access Maced J Med Sci 2019; 7:2982-2984. [PMID: 31850104 PMCID: PMC6910786 DOI: 10.3889/oamjms.2019.274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/18/2019] [Accepted: 05/19/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: Neoplasias of the UV-exposed head-and-neck area of the elderly include non-melanoma skin cancers of various origin. CASE REPORT: We report two cases of rapid growing exophytic scalp tumors on chronic sun-damaged skin, in one case with a tendency of bleeding. The tumours were removed by wide surgical excision with 3D margin control, and the resulting defect was covered by a meshed split skin graft. Histopathologic examination disclosed a dermal pleomorphic sarcoma in both cases. The staging was unremarkable in both patients. CONCLUSIONS: Sarcomatous tumours of the scalp should be completely excised with a 3D margin control. Dermal pleomorphic sarcoma is a more aggressive variant compared to atypical fibroxanthoma despite some similarities.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Jacqueline Schönlebe
- Institute of Pathology "Georg Schmorl", Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Violetta Bujok
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Torello Lotti
- Department of Dermatology, University of Rome "G. Marconi", Rome, Italy
| | - Georgi Tchernev
- Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Ivanka Temelkova
- Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Aleksandra Vojvodic
- Military Medical Academy of Belgrade, Serbia, and University of Rome Guglielmo Marconi Rome, Italy
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Electrochemotherapy as Promising Treatment Option in Rare Recurrent Cutaneous Neoplasm of the Scalp: Case Report of an Elderly Patient. Case Rep Oncol Med 2019; 2019:2507642. [PMID: 31049235 PMCID: PMC6458881 DOI: 10.1155/2019/2507642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/07/2019] [Accepted: 02/19/2019] [Indexed: 11/17/2022] Open
Abstract
Background Atypical fibroxanthoma (AFX) is a tumor that commonly presents on the head or neck in older individuals. Making a definitive diagnosis of AFX is challenging, and frequently, it is hard to distinguish from pleomorphic dermal sarcoma (PDS). There are no clear recommendations regarding the treatment of AFX, but an extensive surgery is actually considered the best option. Electrochemotherapy (ECT) is a novel therapeutic modality of local treatment in which the application of electrical pulses, enhancing cell membrane permeability, allows greater intracellular accumulation of chemotherapy drugs in the skin or subcutaneous tumors. Case Report We report a case of a 78-year-old male affected by a red, ulcerative, dermal, scalp nodule, which was treated with ECT with a complete clinical response. We have also reported literature data on this topic. Results In this case, ECT showed to be an effective and safe treatment for recurrent neoplasms of the head and neck, considering the complete response obtained and the absence of disease relapse after two years. Conclusion To the best of our knowledge, this is the first case report that shows great clinical results using ECT after surgery in relapsed AFX/PDS. However, more studies are needed to confirm our results.
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Koelsche C, Stichel D, Griewank KG, Schrimpf D, Reuss DE, Bewerunge-Hudler M, Vokuhl C, Dinjens WNM, Petersen I, Mittelbronn M, Cuevas-Bourdier A, Buslei R, Pfister SM, Flucke U, Mechtersheimer G, Mentzel T, von Deimling A. Genome-wide methylation profiling and copy number analysis in atypical fibroxanthomas and pleomorphic dermal sarcomas indicate a similar molecular phenotype. Clin Sarcoma Res 2019; 9:2. [PMID: 30809375 PMCID: PMC6375211 DOI: 10.1186/s13569-019-0113-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/05/2019] [Indexed: 12/14/2022] Open
Abstract
Background Atypical fibroxanthomas (AFX) and pleomorphic dermal sarcomas (PDS) are lesions of the skin with overlapping histologic features and unspecific molecular traits. PDS behaves aggressive compared to AFX. Thus, a precise delineation, although challenging in some instances, is relevant. Methods We examined the value of DNA-methylation profiling and copy number analysis for separating these tumors. DNA-methylation data were generated from 17 AFX and 15 PDS using the Illumina EPIC array. These were compared with DNA-methylation data generated from 196 tumors encompassing potential histologic mimics like cutaneous squamous carcinomas (cSCC; n = 19), basal cell carcinomas (n = 10), melanoma metastases originating from the skin (n = 11), leiomyosarcomas (n = 11), angiosarcomas of the skin and soft tissue (n = 11), malignant peripheral nerve sheath tumors (n = 19), dermatofibrosarcomas protuberans (n = 13), extraskeletal myxoid chondrosarcomas (n = 9), myxoid liposarcomas (n = 14), schwannomas (n = 10), neurofibromas (n = 21), alveolar (n = 19) and embryonal (n = 17) rhabdomyosarcomas as well as undifferentiated pleomorphic sarcomas (n = 12). Results DNA-methylation profiling did not separate AFX from PDS. The DNA-methylation profiles of the other cases, however, were distinct from AFX/PDS. They reliably assigned to subtype-specific DNA-methylation clusters, although overlap occurred between some AFX/PDS and cSCC. Copy number profiling revealed alterations in a similar frequency and distribution between AFX and PDS. They involved losses of 9p (22/32) and 13q (25/32). Gains frequently involved 8q (8/32). Notably, a homozygous deletion of CDKN2A was more frequent in PDS (6/15) than in AFX (2/17), whereas amplifications were non-recurrent and overall rare (5/32). Conclusions Our findings support the concept that AFX and PDS belong to a common tumor spectrum. We could demonstrate the diagnostic value of DNA-methylation profiling to delineating AFX/PDS from potential mimics. However, the assessment of certain histologic features remains crucial for separating PDS from AFX.
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Affiliation(s)
- Christian Koelsche
- 1Department of General Pathology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120 Heidelberg, Baden-Württemberg Germany
| | - Damian Stichel
- 2Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120 Heidelberg, Baden-Württemberg Germany.,3Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg Germany.,4German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Baden-Württemberg Germany
| | - Klaus G Griewank
- 5Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, North Rhine-Westphalia Germany.,Dermatopathologie bei Mainz, Nieder-Olm, Rhineland-Palatinate Germany
| | - Daniel Schrimpf
- 2Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120 Heidelberg, Baden-Württemberg Germany.,3Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg Germany.,4German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Baden-Württemberg Germany
| | - David E Reuss
- 2Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120 Heidelberg, Baden-Württemberg Germany.,3Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg Germany.,4German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Baden-Württemberg Germany
| | - Melanie Bewerunge-Hudler
- 4German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Baden-Württemberg Germany.,7Genomics and Proteomics Core Facility, Microarray Unit, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg Germany
| | - Christian Vokuhl
- 8Department of Pediatric Pathology, University Hospital of Schleswig-Holstein, Kiel, Schleswig-Holstein Germany
| | - Winand N M Dinjens
- 9Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Iver Petersen
- Institute of Pathology, SRH Poliklinik Gera GmbH, Gera, Germany
| | - Michel Mittelbronn
- Luxembourg Centre of Neuropathology (LCNP), Luxembourg City, Luxembourg.,12Laboratoire National de Santé (LNS), Dudelange, Luxembourg.,13Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg City, Luxembourg.,14NORLUX Neuro-Oncology Laboratory, Luxembourg Institute of Health (LIH), Luxembourg City, Luxembourg
| | | | - Rolf Buslei
- 15Institute of Pathology, Sozialstiftung Bamberg, Bamberg, Germany
| | - Stefan M Pfister
- 4German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Baden-Württemberg Germany.,16Hopp Childrens Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany.,17Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg Germany.,18Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Heidelberg, Baden-Württemberg Germany
| | - Uta Flucke
- 19Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gunhild Mechtersheimer
- 1Department of General Pathology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120 Heidelberg, Baden-Württemberg Germany
| | - Thomas Mentzel
- Dermatopathology Bodensee, Friedrichshafen, Baden-Württemberg Germany
| | - Andreas von Deimling
- 2Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120 Heidelberg, Baden-Württemberg Germany.,3Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg Germany.,4German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Baden-Württemberg Germany
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Llombart B, Serra-Guillén C, Requena C, Alsina M, Morgado-Carrasco D, Machado I, Sanmartín O. Leiomyosarcoma and Pleomorphic Dermal Sarcoma: Guidelines for Diagnosis and Treatment. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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50
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Ting SW, Yang SJ, Lee YY. Atypical fibroxanthoma in a young female patient with systemic lupus erythematosus: A case report and literature review. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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