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Kazmi I, Afzal M, Almalki WH, S RJ, Alzarea SI, Kumar A, Sinha A, Kukreti N, Ali H, Abida. From oncogenes to tumor suppressors: The dual role of ncRNAs in fibrosarcoma. Pathol Res Pract 2024; 258:155329. [PMID: 38692083 DOI: 10.1016/j.prp.2024.155329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/07/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
Fibrosarcoma is a challenging cancer originating from fibrous tissues, marked by aggressive growth and limited treatment options. The discovery of non-coding RNAs (ncRNAs), including long non-coding RNAs (lncRNAs), microRNAs (miRNAs), and small interfering RNAs (siRNAs), has opened new pathways for understanding and treating this malignancy. These ncRNAs play crucial roles in gene regulation, cellular processes, and the tumor microenvironment. This review aims to explore the impact of ncRNAs on fibrosarcoma's pathogenesis, progression, and resistance to treatment, focusing on their mechanistic roles and therapeutic potential. A comprehensive review of literature from databases like PubMed and Google Scholar was conducted, focusing on the dysregulation of ncRNAs in fibrosarcoma, their contribution to tumor growth, metastasis, drug resistance, and their cellular pathway interactions. NcRNAs significantly influence fibrosarcoma, affecting cell proliferation, apoptosis, invasion, and angiogenesis. Their function as oncogenes or tumor suppressors makes them promising biomarkers and therapeutic targets. Understanding their interaction with the tumor microenvironment is essential for developing more effective treatments for fibrosarcoma. Targeting ncRNAs emerges as a promising strategy for fibrosarcoma therapy, offering hope to overcome the shortcomings of existing treatments. Further investigation is needed to clarify specific ncRNAs' roles in fibrosarcoma and to develop ncRNA-based therapies, highlighting the significance of ncRNAs in improving patient outcomes in this challenging cancer.
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Affiliation(s)
- Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, 21589, Jeddah, Saudi Arabia
| | - Muhammad Afzal
- Department of Pharmaceutical Sciences, Pharmacy Program, Batterjee Medical College, P.O. Box 6231, Jeddah 21442, Saudi Arabia.
| | - Waleed Hassan Almalki
- Department of Pharmacology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Renuka Jyothi S
- Department of Biotechnology and Genetics, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, 72341, Sakaka, Al-Jouf, Saudi Arabia
| | - Ashwani Kumar
- Department of Pharmacy, Vivekananda Global University, Jaipur, Rajasthan 303012, India
| | - Aashna Sinha
- School of Applied and Life Sciences, Division of Research and Innovation Uttaranchal University, Dehradun, Uttarakhand, India
| | - Neelima Kukreti
- School of Pharmacy, Graphic Era Hill University, Dehradun 248007, India
| | - Haider Ali
- Centre for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, India; Department of Pharmacology, Kyrgyz State Medical College, Bishkek, Kyrgyzstan
| | - Abida
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia
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Acharya B, Yadav DK, Chetry A, Chhetri P, Chhetri P, Shah D. Bednar's tumor at right shoulder in an adult male: a case report of a rare entity. Ann Med Surg (Lond) 2024; 86:1196-1199. [PMID: 38333248 PMCID: PMC10849307 DOI: 10.1097/ms9.0000000000001672] [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: 08/26/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Bednar tumor, a rare variant of dermatofibrosarcoma protuberans is a tumor with low malignant potential. Owing to limited studies, the pathogenesis and risk factor of this tumor are not clearly understood. The tumor extends from the epidermis to the dermal layers and even affects the surrounding bone. Here, the authors present a case of a 48-year-old male with a Bednar tumor, which was successfully managed by wide local excision and flap repair. Case presentation Our patient presented to the hospital after the reappearance of mass, 6 years after the excision of the previously misdiagnosed lipoma. Vitals and systematic examination were normal. Local examination revealed an oval-shaped mass with a glistening surface on the right shoulder. The patient underwent wide excision and skin flap surgery for the treatment, and the diagnosis was confirmed through histopathological examination and immunohistochemistry for the CD34 marker. Clinical discussion Bednar tumor is an infrequent skin tumor linked to genetic anomalies and is one of the rare variants [(<0.1%) of skin tumors]. Diagnosis can be done by histopathological examination and CD34 marker positivity via immunohistochemistry. This tumor is mistaken for lipoma, leading to recurrent growth postexcision. The tumor demands a broader resection due to the high chances of reoccurrence. Although Mohs micrographic surgery is the ideal approach, its limited availability in resource-constrained settings prompts alternative strategies. Conclusion This case highlights the challenges of diagnosis, the rarity of the condition, and the need for vigilant follow-up due to the tumor's propensity for recurrence.
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Affiliation(s)
| | - Dev K. Yadav
- KIST Medical College and Teaching Hospital, Lalitpur
| | - Ankita Chetry
- KIST Medical College and Teaching Hospital, Lalitpur
| | | | | | - Divyani Shah
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Malek D, Alam H, Luo L, Hong A, Edison M. Dermatofibrosarcoma Protuberans Presenting as a Primary Breast Mass. Cureus 2023; 15:e46052. [PMID: 37900364 PMCID: PMC10604421 DOI: 10.7759/cureus.46052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an atypical soft tissue malignancy that affects the dermis and subcutaneous tissue. The cause of DFSP is not clearly understood. This report highlights a rare case of DFSP of the left breast. We report a case of an 18-year-old female with past medical history of type 1 diabetes mellitus, who presented to the breast imaging clinic with a six-month history of left breast lump and associated skin discoloration. The patient had a dedicated left breast ultrasound which showed an indistinct, oval, hyperechoic mass in the superficial breast, measuring 1.4 x 1.0 x 2.5 cm with mild internal vascularity. An ultrasound-guided biopsy of this left breast mass was recommended and performed approximately three weeks later, demonstrating DFSP. The patient was then advised for consultation with Oncology, Surgical Oncology, and Radiation Oncology, to which surgical excision was the final recommendation. The patient had a wide local surgical excision procedure for her left breast mass with surgical pathology confirming negative margins shortly thereafter. This case highlights a great index of suspicion that should be taken when evaluating palpable breast masses with associated skin discoloration in young patients.
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Affiliation(s)
| | - Harris Alam
- Radiology, AdventHealth Orlando, Orlando, USA
| | - Lin Luo
- Radiology, AdventHealth Orlando, Orlando, USA
| | - Andrea Hong
- Radiology, AdventHealth Orlando, Orlando, USA
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Lerttiendamrong B, Annoppornchai P, Promniyom P. Fibrosarcomatous dermatofibrosarcoma protuberans: a rapidly growing 30 cm mass on the posterior scalp. ASIAN BIOMED 2023; 17:200-205. [PMID: 37860677 PMCID: PMC10584390 DOI: 10.2478/abm-2023-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing sarcoma of the skin and subcutaneous tissue, accounting for around 5 cases per million per year. Fibrosarcomatous transformation of DFSP occurs in 10%-15% of DFSP cases, with a higher risk of local recurrence, metastasis, and death. We present a case of a male in his 30s with a complaint of rapidly progressive mass in the occipital region of the head. Within 1 year, the mass enlarged by >30 cm. Physical examination revealed a skin-colored 40×30 cm mass with an overlying skin necrosis at the posterior scalp. Brain, neck, and chest computed tomography (CT) scans were performed. The mass was surgically excised by wide excision with a 2 cm margin. Pathological report confirmed fibrosarcomatous DFSP Grade 3 with decreased CD34 expression. Delayed reconstruction of free flap and split-thickness skin graft were subsequently performed. No recurrence was detected 3 months postoperatively.
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Affiliation(s)
- Bhoowit Lerttiendamrong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Pavinee Annoppornchai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Pasu Promniyom
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
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Lagacé F, D’Aguanno K, Prosty C, Laverde-Saad A, Cattelan L, Ouchene L, Oliel S, Genest G, Doiron P, Richer V, Jfri A, O’Brien E, Lefrançois P, Powell M, Moreau L, Litvinov IV, Muntyanu A, Netchiporouk E. The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications. J Cutan Med Surg 2023; 27:NP1-NP36. [PMID: 37401812 PMCID: PMC10486181 DOI: 10.1177/12034754231177582] [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: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. OBJECTIVES AND PROJECT DESCRIPTION The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. FUTURE IMPACT With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Connor Prosty
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Alexandra Laverde-Saad
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Lydia Ouchene
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sarah Oliel
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Genevieve Genest
- Division of Allergy and Immunology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philip Doiron
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Abdulhadi Jfri
- Department of Dermatology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth O’Brien
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Powell
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Moreau
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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6
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Kuhlmann C, Ehrl D, Taha S, Wachtel N, Schmid A, Bronsert P, Zeller J, Giunta RE, Eisenhardt SU, Braig D. Dermatofibrosarcoma protuberans of the scalp: Surgical management in a multicentric series of 11 cases and systematic review of the literature. Surgery 2023; 173:1463-1475. [PMID: 37012145 DOI: 10.1016/j.surg.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/08/2023] [Accepted: 02/23/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans is a rare, slow-growing soft-tissue malignancy originating in the dermis that is characterized by an infiltrating growth pattern with a marked tendency of local recurrence. Complete surgical resection with pathological margin clearance must be achieved to reduce the risk of tumor recurrence. Resulting defects often require extensive reconstructive procedures. Dermatofibrosarcoma protuberans of the scalp poses particular challenges owing to the proximity to the face and brain. This study aims to evaluate treatment options and proposes an algorithm for management of scalp dermatofibrosarcoma protuberans based on a multicentric case series and systematic review of the literature. METHODS A retrospective multicentric chart analysis of 11 patients with scalp dermatofibrosarcoma protuberans who presented within the last 20 years was performed regarding demographic data, pathological tumor characteristics, and surgical management (resection and reconstruction). Additionally, a further 42 patients (44 cases) were identified through a systematic Preferred Reporting Systems for Systematic Reviews and Meta-Analysis-based review of the literature searching the Medline and Embase databases. RESULTS In total, 30 cases were classified as primary and 20 cases as recurring scalp dermatofibrosarcoma protuberans (data from 5 cases were missing). The median tumor size was 24 cm2 (interquartile range 7.8-64), and the median defect size was 55.8 cm2 (interquartile range 48-112). Recurring scalp dermatofibrosarcoma protuberans was more often associated with invasion of deeper layers and required more extensive tumor resection to achieve negative margins. Within the subgroup that was managed with peripheral and deep en face margin assessment, no recurrence was observed. Most patients required local (41. 8%) or free flap (27.8%) reconstruction after dermatofibrosarcoma protuberans resection. CONCLUSION Whenever possible, peripheral and deep en face margin assessment-based techniques should be preferred for resection of scalp dermatofibrosarcoma protuberans because they provide superior oncological safety while preserving uninvolved tissue. Patients with locally advanced and recurring scalp dermatofibrosarcoma protuberans often require multidisciplinary treatment including neurosurgery, radiotherapy, and microvascular reconstructive surgery and should be referred to a specialized center.
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Affiliation(s)
- Constanze Kuhlmann
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany.
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Sara Taha
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Nikolaus Wachtel
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Adrian Schmid
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Tumorbank Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Johannes Zeller
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Riccardo E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - David Braig
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany; Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Singh GK, Das P, Dhillon A, Aggrawal M. An Asymptomatic Plaque on the Shoulder. Indian Dermatol Online J 2023; 14:445-447. [PMID: 37266093 PMCID: PMC10231697 DOI: 10.4103/idoj.idoj_549_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 07/23/2022] [Accepted: 07/24/2022] [Indexed: 06/03/2023] Open
Affiliation(s)
- Gautam K. Singh
- Department of Dermatology, Base Hospital Delhi Canttand Army College of Medical Sciences, New Delhi, India
| | - Pankaj Das
- Department of Dermatology, Base Hospital Delhi Canttand Army College of Medical Sciences, New Delhi, India
| | - Amen Dhillon
- Department of Dermatology, Base Hospital Delhi Canttand Army College of Medical Sciences, New Delhi, India
| | - Monika Aggrawal
- Department of Pathology, Base Hospital Delhi Canttand Army College of Medical Sciences, New Delhi, India
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Espinoza AF, Onwuka E, Hicks MJ, Masand P, Monson L, Okcu MF, Pinglay N, Vidimos A, Vasudevan SA. Dermatofibrosarcoma protuberans case report: Aggressive tumor in a preadolescent child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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9
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Tolat A, Kalwaniya DS, Sharma A, Kumar D, Rana S, Ahluwalia C. A Detailed Review of Surgical Management of Uncommon Cutaneous Disorders. Cureus 2023; 15:e36763. [PMID: 37123679 PMCID: PMC10132855 DOI: 10.7759/cureus.36763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
A variety of cutaneous disorders can present to the general surgeon either directly or by referral for surgical intervention. Some conditions are commonly seen and operated on by general surgeons which include lipoma, epidermoid cyst, etc. On the other hand, some are uncommon conditions like dermatofibrosarcoma protuberans and chondroid syringoma which require a high index of suspicion to diagnose. Most general surgeons are not familiar with the latest guidelines to treat such uncommon conditions. In this article, we provide a review of uncommon cutaneous disorders requiring surgical intervention that were encountered at our high-volume tertiary care center and a discussion about their etiology, presentation, diagnosis, management and follow-up with one case report of each condition. The objective of this article is to familiarize the general surgeon with these cutaneous disorders which though uncommon, will present in their practice at some point.
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10
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Li Y, Chen Z, Nie S, Wu Z. Atrophic dermatofibrosarcoma protuberans: Two case reports and literature review. Front Oncol 2023; 13:1100398. [PMID: 36845717 PMCID: PMC9948607 DOI: 10.3389/fonc.2023.1100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
Dermatofibrosarcoma protuberans is a rare, locally aggressive, slowly growing cutaneous fibroblastic sarcoma with a high recurrence rate and low metastatic potential. Atrophic dermatofibrosarcoma protuberans is a rare variant usually presents as atrophic plaques, easily neglected and misdiagnosed as benign lesions by patients and dermatologists. Here we report two cases of atrophic dermatofibrosarcoma protuberans, one of which was accompanied by pigment, and review other cases have been reported in the literature. Understanding the most up-to-date literature and early identification of these dermatofibrosarcoma protuberans variants can help clinicians avoid delayed diagnosis and improve prognosis.
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Affiliation(s)
| | | | - Shu Nie
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Henry OS, Platoff R, Cerniglia KS, Batchu S, Goodwin BJ, Sandilos G, Adams A, Hong YK. Tyrosine kinase inhibitors versus radiation therapy in unresectable dermatofibrosarcoma protuberans (DFSP): A narrative systematic review. Am J Surg 2023; 225:268-274. [PMID: 36184329 DOI: 10.1016/j.amjsurg.2022.09.040] [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: 07/29/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND In unresectable dermatofibrosarcoma protuberans (DFSP), no clear guideline exists regarding the use of tyrosine kinase inhibitors (TKI) versus radiotherapy. This study reviews current literature regarding TKI and radiotherapy in unresectable DFSP. METHODS Following PROSPERO registration (CRD42021232508), a systematic literature search was performed including all studies reporting clinical results of TKI and/or radiotherapy in the treatment of unresectable DFSP. A narrative synthesis was used to compare patient characteristics, outcomes, and adverse effects. RESULTS Of 1345 screened studies, 14 were included for review. Patient age ranged 18-77 years and 55% were male. Radiotherapy patients exhibited lower grade disease than TKI patients. Overall clinical benefit following TKI ranged from 70% to 96%. Radiotherapy patients exhibited control or resolution on last follow-up in 90% of cases. Radiotherapy adverse effects were mild, while TKI adverse effects were more severe and managed with dose reduction. CONCLUSION TKI may be employed in unresectable DFSP of all histology types whereas radiation alone may be limited to low-grade and classic-type DFSP. TKI may cause more severe adverse effects compared to radiation alone.
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Affiliation(s)
- Owen S Henry
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Rebecca Platoff
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | | | - Sai Batchu
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | - Amanda Adams
- Medical Library, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Young K Hong
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA.
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IKEDA A, HISAOKA M, GOTO H, YOSHIDA Y, YAMAMOTO O. First Case of Allochronic Onset of Two Primary Dermatofibrosarcoma Protuberans Lesions Proved by COL1A1-PDGFB Fusion Gene Analysis. Acta Derm Venereol 2022; 102:adv00822. [PMID: 36444562 PMCID: PMC9811292 DOI: 10.2340/actadv.v102.2421] [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] [Indexed: 11/30/2022] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Ayano IKEDA
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504
| | - Masanori HISAOKA
- Department of Pathology and Oncology, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Hiroyuki GOTO
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504
| | - Yuichi YOSHIDA
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504
| | - Osamu YAMAMOTO
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504
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Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive dermal-based sarcoma. Metastatic potential is extremely low, primarily in the setting of fibrosarcomatous transformation. DFSP is characterized by a t(17;22) (q22;q13) translocation that results in active PDGFB signaling. Surgical resection with negative margins (typically including the underlying fascia) is the potentially curative treatment. Delayed wound closure should be considered for cases requiring extensive resection or tissue rearrangement. Tyrosine kinase inhibitors, such as imatinib, have shown response rates of 50% to 60% in patients with locally advanced or metastatic disease. Radiation can be useful for residual or recurrent diseases.
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Al Laham O, Atia F, Shaheen J, Alkhoury L, Ibrahim D, Alchikh Omar M. A unique case of Dermatofibrosarcoma Protuberans arising from an inguinal hernial repair scar in a Middle Eastern male - A Case Report. Int J Surg Case Rep 2022; 96:107334. [PMID: 35777334 PMCID: PMC9284050 DOI: 10.1016/j.ijscr.2022.107334] [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: 05/20/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Dermatofibrosarcoma Protuberans (DFSP) is a rare and fatal variant of Spindle Cell Sarcoma. It has an annual incidence rate of 0.8 to 4.5 cases per one million individuals. It's locally aggressive and has vague and masquerading clinical presentations. Misdiagnosis is devastating as it can lead to time wasting, expenditure of unnecessary resources, and possibly raise morbidity and mortality for patients. It is warranted to raise preoperative clinical awareness to achieve prompt surgical therapeutic interventions to reach an up-to-par prognosis. CASE PRESENTATION We demonstrate the case of a 50-year-old previously healthy Middle Eastern male patient, who was referred to our General Surgery clinic with the chief complaint of an expansive bulge in his left iliac fossa. Preoperative imaging could not exclude a neoplastic cause behind the presentation. Based on the clinical picture, a surgical intervention was decided. CLINICAL DISCUSSION Our patient's treatment was consummated by means of classical surgical resection of the lesion with adequate negative margins and referring him to an oncologist specialized in DFSP to undergo the necessary adjuvant treatment. Definitive diagnosis was firmly entrenched postoperatively after finalization of the histopathological and immunohistochemical analyses of the resected protuberance. CONCLUSION DFSP is an eminently rare entity, especially DFSPs which originate from a surgical scar -as was our patient's- and fluctuates in its clinical presentation, thus, it is our responsibility to depict, study this malignant tumor, and document its incidence, so that we can make ironclad clinical decrees to plummet the morbidity and mortality of this relentless neoplasia.
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Affiliation(s)
- Omar Al Laham
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria,Corresponding author at: Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria.
| | - Fareed Atia
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria
| | - Jack Shaheen
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria
| | - Lama Alkhoury
- Department of Laboratory Diagnosis, Damascus University, Damascus, Syria
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15
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Yu Q, Zhu Y, Huang R, Li Y, Song L, Zhang X, Tang M, Gu Q, Li P, Zhou N, Li Y. Diagnosis and differential diagnosis of dermatofibrosarcoma protuberans: Utility of high-resolution dynamic contrast-enhanced (DCE) MRI. Skin Res Technol 2022; 28:651-663. [PMID: 35639715 PMCID: PMC9907642 DOI: 10.1111/srt.13164] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a kind of low-grade malignant spindle cell neoplasm, the diagnosis, and treatment, which have markedly attracted clinicians' attention for its repeated recurrence. High-resolution magnetic resonance imaging (HR-MRI) has shown unique capabilities in diagnosis of various cutaneous tumors. MATERIALS AND METHODS Data of 29 patients with clinically suspected DFSPs and undergoing dynamic contrast-enhanced (DCE) HR-MRI preoperatively were prospectively collected. The HR-MRI qualitative features were evaluated and compared. The DCE-associated quantitative parameters and the time-signal intensity curve (TIC) types were provided using DCE sequences. RESULTS A total of 7 DFSPs, nine dermatofibromas (DF, including four cases of cellular variant [CDF]), 12 keloids, and one nodular fasciitis were enrolled. DFSP showed the largest major diameter and the deepest depth. Five DFSPs (71.4%) showed ill-defined margins as well as infiltration of peripheral adipose. All DFSPs showed irregular shape. Most DFSPs presented hyperintensity on T2 WI (71.4%) and iso-intensity on T1 WI (85.7%). Six cases (85.7%) had significant enhancement, and six cases (85.7%) had homogeneous enhancement. There were significant differences of Ktrans , Kep , Ve and iAUC values among DFSPs, DFs, and keloids, and DFSP had the highest values for these parameters. Six DFSPs (85.7%) and four CDFs (100%) showed type-III TICs, while the other lesions showed type-Ⅰor type-Ⅱ TICs. CONCLUSIONS DCE-HR-MRI could show the growth characteristics of DFSPs, which was of great value for the diagnosis and differential diagnosis of DFSPs and was helpful for the determination of treatment options, thereby to improve the prognosis of patients.
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Affiliation(s)
- Qiuyu Yu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yueqian Zhu
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Renjun Huang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Li
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Linyi Song
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoping Zhang
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mengxiao Tang
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qinghua Gu
- Department of Radiology, Suzhou Yongding Hospital, Suzhou, China
| | - Ping Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Naihui Zhou
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yonggang Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Yuan J, Li X, Yu S. Molecular targeted therapy for advanced or metastatic soft tissue sarcoma. Cancer Control 2021; 28:10732748211038424. [PMID: 34844463 PMCID: PMC8727831 DOI: 10.1177/10732748211038424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Soft tissue sarcomas are a form of rare and heterogeneous neoplasms with high recurrence rate and mortality. Over the past decades, less progress has been achieved. Surgical management with or without adjuvant/neoadjuvant radiotherapy is still the first-line treatment for localized soft tissue sarcomas, and chemotherapy is the additional option for those with high-risk. However, not all patients with advanced or metastatic soft tissue sarcomas benefit from conventional chemotherapy, targeted therapy takes the most relevant role in the management of those resistant to or failed to conventional chemotherapy. Heterogeneous soft tissue sarcomas vary from biological behavior, genetic mutations, and clinical presentation with a low incidence, indicating the future direction of histotype-based even molecule-based personalized therapy. Furthermore, increasing preclinical studies were carried out to investigate the pathogenesis and potential therapeutic targets of soft tissue sarcomas and increasing new drugs have been developed in recent years, which had started opening new doors for clinical treatment for patients with advanced/metastatic soft tissue sarcomas. Here we sought to summarize the concise characteristics and advance in the targeted therapy for the most common subtypes of soft tissue sarcomas.
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Affiliation(s)
- Jin Yuan
- Departments of Orthopedics, 71041National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyang Li
- Departments of Orthopedics, 71041National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengji Yu
- Departments of Orthopedics, 71041National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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17
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Cantu NA, Ullah A, Stumpo-Decoons L, Belakhlef S, Kruse EJ. Low-Grade Fibromyxoid Sarcoma of the Back. Cureus 2021; 13:e17308. [PMID: 34567863 PMCID: PMC8451521 DOI: 10.7759/cureus.17308] [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] [Accepted: 08/19/2021] [Indexed: 11/06/2022] Open
Abstract
A 29-year-old male presented with a seven-year history of a slow-growing, painless, firm, mobile mass in the right upper back that was bothersome when supine or with direct pressure. On initial presentation, a clinical diagnosis of lipoma was given. The mass progressively increased in size over several years but remained painless. The mass measured 15 x 10 cm on examination. Excision of the lesion was performed, which revealed a white cut surface with cystic degenerative changes. Histologically, the lesion revealed spindle cell morphology with occasional mitosis. Diffuse immunohistochemical staining with MUC4 supports a diagnosis of low-grade fibromyxoid sarcoma (LGFMS). Tumor was present with focal extension into the deep margin. However, serial magnetic resonance imaging studies performed suggest no residual disease and negative regional lymph node involvement. This case demonstrates the growth pattern of LGFMS, but also denotes the importance of correlating radiological and pathological features to accurately diagnose and treat these tumors in a timely fashion.
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Affiliation(s)
- Nicholas A Cantu
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Asad Ullah
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
| | | | - Sami Belakhlef
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Edward J Kruse
- Surgery, Medical College of Georgia - Augusta University, Augusta, USA
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18
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Lin P, Yang Z, Tu P, Li H. Atrophic pigmented dermatofibrosarcoma protuberans misdiagnosed as hyperpigmentation. Indian J Dermatol Venereol Leprol 2021; 87:693-695. [PMID: 34379942 DOI: 10.25259/ijdvl_713_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Pingping Lin
- Department of Dermatology and Venereology, Peking University First Hospital, Xicheng, Beijing, China
| | - Zhihui Yang
- Department of Dermatology and Venereology, Peking University First Hospital, Xicheng, Beijing, China
| | - Ping Tu
- Department of Dermatology and Venereology, Peking University First Hospital, Xicheng, Beijing, China
| | - Hang Li
- Department of Dermatology and Venereology, Peking University First Hospital, Xicheng, Beijing, China
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19
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Xiong JX, Cai T, Hu L, Chen XL, Huang K, Chen AJ, Wang P. Risk factors related to postoperative recurrence of dermatofibrosarcoma protuberans: A retrospective study and literature review. World J Clin Cases 2021; 9:5442-5452. [PMID: 34307598 PMCID: PMC8281415 DOI: 10.12998/wjcc.v9.i20.5442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade malignant soft tissue tumor characterized by rosette-like infiltrative growth. Postoperative recurrence of this tumor is very common.
AIM To evaluate the risk factors related to recurrence after wide local excision (WLE) of DFSP and to guide clinical diagnosis and treatment.
METHODS The medical records of 44 DFSP patients confirmed by pathology at our hospital from 2012 to 2019 were retrospectively reviewed. The relationship between clinical features, tumor characteristics, treatment, and recurrence risk were analyzed, and the possible risk factors for postoperative tumor recurrence were evaluated.
RESULTS There were 44 patients in total, including 21 males and 23 females. The median progression free survival was 36 mo (range, 1-240 mo). Twenty patients were treated for the first time, while 24 had previous treatment experience. Forty-two cases were followed for 25.76 ± 22.0 mo, among whom four (9.52%) experienced recurrence after WLE (rate was 9.52%). The recurrence rate in the recurrent group was higher than that in the patients with primary tumor (19.05% vs 0%, P = 0.028). Eighteen cases had a history of misdiagnosis (rate was 40.91%). The recurrence rate among patients with previous experience of misdiagnosis was significantly higher than in patients without (68% vs 36.84%, P = 0.04). The tumor diameter in patients with a history of treatment was larger than in patients treated for the first time (4.75 ± 0.70 cm vs 2.25 ± 0.36 cm, P = 0.004).
CONCLUSION To sum up, the clinical manifestations of DFSP are not specific and are easily misdiagnosed, thus commonly causing the recurrence of DFSP. After incomplete resection, the tumor may rapidly grow. Previous recurrence history may be a risk factor for postoperative recurrence, and tumor location may have an indirect effect on postoperative recurrence; however, we found no significant correlation between sex, age, course of the disease, or tumor size and postoperative recurrence.
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Affiliation(s)
- Jian-Xia Xiong
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Tao Cai
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Li Hu
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Xiao-Li Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Kun Huang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Ai-Jun Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Ping Wang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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20
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Bramati C, Melegatti MN, Lalla F, Giordano L. Management of two rare cases of dermatofibrosarcoma protuberans arising in the parotid region. BMJ Case Rep 2021; 14:14/6/e243837. [PMID: 34140333 DOI: 10.1136/bcr-2021-243837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous tumour, accounting for less than 1% of malignant tumours of the head and neck region. This tumour rarely presents metastatic disease, but has a high recurrence rate. Therefore, wide surgical excision with microscopically free margins is the therapeutic gold standard. Only five cases are described in literature of this tumour arising in the parotid region, a site that presents challenges both in achieving a wide demolition and in reconstructing the resulting defect. Here we describe two cases of DFSP arising in the parotid region that were treated surgically, achieving microscopically free margins. Reconstruction of the vast skin defect was achieved by means of a supraclavicular artery island flap, with good functional and aesthetic results.
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Affiliation(s)
- Chiara Bramati
- Otorhinolaryngology - Head & Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy .,School of Medicine, Universita Vita Salute San Raffaele, Milano, Lombardia, Italy
| | - Michela Nicole Melegatti
- Otorhinolaryngology - Head & Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy.,School of Medicine, Universita Vita Salute San Raffaele, Milano, Lombardia, Italy
| | - Francesca Lalla
- Otorhinolaryngology - Head & Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy.,School of Medicine, Universita Vita Salute San Raffaele, Milano, Lombardia, Italy
| | - Leone Giordano
- Otorhinolaryngology - Head & Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
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21
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Dermatofibrosarcoma Protuberans: A Clinicopathologic and Therapeutic Analysis of 254 Cases at a Single Institution. Dermatol Surg 2021; 47:e26-e30. [PMID: 32769521 DOI: 10.1097/dss.0000000000002578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade tumor that typically does not metastasize but often recurs. Fibrosarcomatous DFSP (FS-DFSP) is associated with a substantially higher rate of metastasis and a poorer prognosis. OBJECTIVE This study sought to investigate the epidemiological, histopathological, and clinical characteristics of DFSP, especially with a particular focus on FS-DFSP. MATERIALS AND METHODS Clinical data from 254 patients treated between January 1999 and July 2018 were retrospectively reviewed. Endpoints of the study were the incidence of significant disease-related clinical events. RESULTS Follow-up data from 211 patients were available for analysis, with a median follow-up time of 38 months (range: 1-196 months). The 5-year recurrence-free survival rate of patients underwent wide-local excision (WLE) was 97.1%. Patients underwent WLE exhibited a significantly decreased recurrence rate relative to patients treated through local excision (2.9% vs 37.7%; p < .001). Fibrosarcomatous DFSP had significantly higher rates of distant metastasis (66.7% [n = 4] vs 2.0% [n = 4]; p < .001) and long-term mortality (50.0% [n = 3] vs 1.5% [n = 3]; p < .001), compared with classical DFSP (C-DFSP). CONCLUSION Wide-local excision is an effective means of reducing DFSP recurrence. Rates of metastasis are higher for FS-DFSP than for C-DFSP, with the former having significantly poorer outcomes.
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22
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Adem D, Yazici S, Ozsen M, Cetintas SK, Yalcinkaya U, Şahin AB, Tanrıverdi O, Orhan SO, Ocak B, Cubukcu E, Kahveci R, Evrensel T. The Ki-67 proliferation index predicts recurrence-free survival in patients with dermatofibrosarcoma protuberans. Bosn J Basic Med Sci 2021; 21:174-178. [PMID: 33091330 PMCID: PMC7982062 DOI: 10.17305/bjbms.2020.5088] [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: 08/25/2020] [Accepted: 10/17/2020] [Indexed: 11/16/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue sarcoma that originates from the dermis or subcutaneous tissue in the skin. While its prognosis is generally favorable, disease recurrence is relatively frequent. Since morbidity after repeated surgery may be significant, an optimized prediction of recurrence-free survival (RFS) has the potential to improve current management strategies. The purpose of this study was to investigate the prognostic value of the Ki-67 proliferation index with respect to RFS in patients with DFSP. We retrospectively analyzed data from 45 patients with DFSP. We calculated the Ki-67 proliferation index as the percentage of immunostained nuclei among the total number of tumor cell nuclei regardless of the intensity of immunostaining. We constructed univariate and multivariate Cox proportional hazards regression models to identify predictors of RFS. Among the 45 patients included in the study, 8 developed local recurrences and 2 had lung metastases (median follow-up: 95.0 months; range: 5.2-412.4 months). The RFS rates at 60, 120, and 240 months of follow-up were 83.8%, 76.2%, and 65.3%, respectively. The median Ki-67 proliferation index was 14%. Notably, we identified the Ki-67 proliferation index as the only independent predictor for RFS in multivariate Cox proportional hazards regression analysis (hazard ratio = 1.106, 95% confidence interval = 1.019-1.200, p = 0.016). In summary, our results highlight the potential usefulness of the Ki-67 proliferation index for facilitating the identification of patients with DFSP at a higher risk of developing disease recurrences.
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Affiliation(s)
- Deligonul Adem
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Serkan Yazici
- Department of Dermatology and Venereology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Mine Ozsen
- Department of Surgical Pathology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | | | - Ulviye Yalcinkaya
- Department of Surgical Pathology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ahmet Bilgehan Şahin
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ozgur Tanrıverdi
- Department of Medical Oncology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Sibel Oyucu Orhan
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Birol Ocak
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Erdem Cubukcu
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ramazan Kahveci
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Turkkan Evrensel
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
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23
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Bonaventura B, Kraus D, Stark GB, Fuellgraf H, Kiefer J. Dermatofibrosarcoma protuberans in a young patient with epidermolysis bullosa: a case report. BMC Surg 2021; 21:100. [PMID: 33622311 PMCID: PMC7903690 DOI: 10.1186/s12893-021-01105-6] [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: 10/22/2020] [Accepted: 02/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Epidermolysis bullosa is a group of rare inherited skin diseases characterized by blister formation following mechanical skin trauma. Epidermolysis bullosa is associated with increased skin cancer rates, predominantly squamous cell carcinomas, yet to our best knowledge, there is no reported case of dermatofibrosarcoma protuberans in a patient with Epidermolysis bullosa. Case presentation Here, we present a 26-year-old man with junctional epidermolysis bullosa, who developed a DFSP on the neck. Initial, the skin alteration was mistakenly not considered malignant, which resulted in inadequate safety margins. The complete resection required a local flap to close the defect, which is not unproblematic because of the chronic inflammation and impaired healing potential of the skin due to Epidermolysis bullosa. Conclusions To our best knowledge, this is the first reported case of a skin-associated sarcoma in a patient with EB; however, further investigation is required to verify a correlation.
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Affiliation(s)
- B Bonaventura
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Comprehensive Cancer Center Freiburg, University of Freiburg, Freiburg, Germany.
| | - D Kraus
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Comprehensive Cancer Center Freiburg, University of Freiburg, Freiburg, Germany
| | - G B Stark
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Comprehensive Cancer Center Freiburg, University of Freiburg, Freiburg, Germany
| | - H Fuellgraf
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Freiburg, Germany
| | - J Kiefer
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Comprehensive Cancer Center Freiburg, University of Freiburg, Freiburg, Germany
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24
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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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25
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Li Y, Liang J, Xu X, Jiang X, Wang C, Chen S, Xiang B, Ji Y. Clinicopathological features of fibrosarcomatous dermatofibrosarcoma protuberans and the construction of a back-propagation neural network recognition model. Orphanet J Rare Dis 2021; 16:48. [PMID: 33499900 PMCID: PMC7836157 DOI: 10.1186/s13023-021-01698-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/19/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Fibrosarcomatous dermatofibrosarcoma protuberans (FS-DFSP) is a form of tumor progression of dermatofibrosarcoma protuberans (DFSP) with an increased risk of metastasis and recurrence. Few studies have compared the clinicopathological features of FS-DFSP and conventional DFSP (C-DFSP). OBJECTIVES To better understand the epidemiological and clinicopathological characteristics of FS-DFSP. METHODS We conducted a cohort study of 221 patients diagnosed with DFSP and built a recognition model with a back-propagation (BP) neural network for FS-DFSP. RESULTS Twenty-six patients with FS-DFSP and 195 patients with C-DFSP were included. There were no differences between FS-DFSP and C-DFSP regarding age at presentation, age at diagnosis, sex, size at diagnosis, size at presentation, and tumor growth. The negative ratio of CD34 in FS-DFSP (11.5%) was significantly lower than that in C-DFSP (5.1%) (P = 0.005). The average Ki-67 index of FS-DFSP (18.1%) cases was significantly higher than that of C-DFSP (8.1%) cases (P < 0.001). The classification accuracy of the BP neural network model training samples was 100%. The correct rates of classification and misdiagnosis were 84.1% and 15.9%. CONCLUSIONS The clinical manifestations of FS-DFSP and C-DFSP are similar but have large differences in immunohistochemistry. The classification accuracy and feasibility of the BP neural network model are high in FS-DFSP.
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Affiliation(s)
- Yanan Li
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37 Guo-Xue-Xiang, Chengdu, 610041, China
| | - Jiaqi Liang
- Shaanxi Zhongtian Rocket Technology Co, Ltd, Xi'an, 710025, China
| | - Xuewen Xu
- Department of Burns and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chuan Wang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37 Guo-Xue-Xiang, Chengdu, 610041, China
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Bo Xiang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37 Guo-Xue-Xiang, Chengdu, 610041, China.
| | - Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37 Guo-Xue-Xiang, Chengdu, 610041, China.
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ACAR A, YAMAN B, YANMAZ A, YOLDAŞ AH, KARAARSLAN I, AKALIN T, ÖZDEMİR F, GERÇEKER TÜRK B, CANER A, KANDİLOĞLU G, HAYDAROĞLU A, CEYLAN C. Ege Üniversitesi Hastanesinde görülen melanom dışı deri kanserlerinin epidemiyolojik ve demografik özellikleri. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.815373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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27
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Yamada T, Ohwada S. A Bednar tumor in a healthy woman. Clin Case Rep 2020; 8:2076-2077. [PMID: 33088558 PMCID: PMC7562886 DOI: 10.1002/ccr3.3029] [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: 04/25/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
A Bednar tumor (BT) is a soft tissue sarcoma that mimics neurofibroma and rarely occurs in the deeper layers of the skin. Local recurrence of BT is possible with incomplete resection, but the occurrence of distant metastasis is rare.
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Affiliation(s)
| | - Susumu Ohwada
- ASKOHWADA Consultation Clinic of Gastroenterology and Oncology Gunma Japan
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28
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Martinez C, McDougal E, Gilstrap J, Friedman HI, Rivera M. An oral presentation of dermatofibromasarcoma protuberans with literature review: A case report. Int J Surg Case Rep 2020; 76:98-102. [PMID: 33011661 PMCID: PMC7533289 DOI: 10.1016/j.ijscr.2020.09.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/22/2022] Open
Abstract
Dermatofibrosarcoma rarely presents as an intra-oral lesion. Surgical excision in the head and neck region has inherent challenges. Dermatofibrosarcoma is an insidious tumor that requires careful pathologic margin assessments.
Introduction Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally invasive soft tissue tumor with a high rate of recurrence after surgical intervention. DFSP primarily occurs on the trunk and proximal extremities, with reported 10–15% occurring in the head and neck region. DFSP presenting within the oral cavity is a rare entity with few descriptions in the literature. Standard of care involves resection, either by Mohs micrographic surgery or wide local excision with careful evaluation of the surgical margins. Due to the invasive nature of this tumor, complete excision in sensitive areas such as the head and neck pose unique challenges. Case presentation We present a case of DFSP presenting from within the oral cavity, along with its management, in a 50-year-old male. In addition, we review the published literature. The patient neglected a 3-month history of a rapidly enlarging mass of the left cheek. A buccal mucosal biopsy revealed the diagnosis of DFSP. The patient underwent wide local excision of the tumor resulting in a full thickness defect which required reconstruction utilizing a radial forearm free flap. The final pathology report demonstrated positive margins that necessitated additional excision. Discussion There are few reported cases of an intraoral presentation of dermatofibrosarcoma. Due to the sensitive location of the tumor, there are challenges associated with obtaining clear margins after resection and ultimately reconstruction. Conclusion This case and literature review highlight the rarity of an oral cavity presentation DFSP, and the associated surgical challenges.
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Affiliation(s)
- Carlos Martinez
- Prisma Health/University of South Carolina School of Medicine, Department of Surgery, Division of Plastic & Reconstructive Surgery, 2 Medical Park Rd. Suite 302, Columbia, SC 29203, United States.
| | - Elizabeth McDougal
- Prisma Health/University of South Carolina School of Medicine, Department of Surgery, Division of Plastic & Reconstructive Surgery, 2 Medical Park Rd. Suite 302, Columbia, SC 29203, United States
| | - Jarom Gilstrap
- Prisma Health/University of South Carolina School of Medicine, Department of Surgery, Division of Plastic & Reconstructive Surgery, 2 Medical Park Rd. Suite 302, Columbia, SC 29203, United States
| | - Harold I Friedman
- Prisma Health/University of South Carolina School of Medicine, Department of Surgery, Division of Plastic & Reconstructive Surgery, 2 Medical Park Rd. Suite 302, Columbia, SC 29203, United States
| | - Mariangela Rivera
- South Carolina ENT, Allergy and Sleep Medicine, 3 Medical Park Rd. Suite 100, Columbia, SC 20203, United States
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Zhou Arlene Y, Chin J, Strutin MD, Lomiguen CM. Unmasking dermatofibrosarcoma protuberans: Case report of an atypical presentation complicated by post-surgical excision. Int J Surg Case Rep 2020; 69:101-104. [PMID: 32305027 PMCID: PMC7163292 DOI: 10.1016/j.ijscr.2020.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/08/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Dermatofibrosarcoma Protuberans (DFSP) is a rare type of malignant tumor of the cutaneous soft tissue that typically involves the dermis and surrounding structures. The typical clinical presentation involves an asymptomatic, slowly enlarging, indurated plaque, usually found on the trunk. PRESENTATION OF CASE Here we present an atypical presentation of DFSP in a patient with a recurrent mass that was initially diagnosed as a lipoma, with supporting literature and clinical considerations for post-surgical management DISCUSSION: In its earlier stages, DFSP can mimic other benign or malignant dermatological pathologies, which can complicate diagnosis purely via history and physical exam. Atypical features such as prior surgical management, morphology, and location can complicate the clinical diagnosis of DFSP. Immunohistochemistry is often required for definitive diagnosis as DFSP is CD34+ and is histologically described as spindle-cells in whorled or storiform pattern, with uniform, small elongated cells. CONCLUSION DFSP is a rare tumor of the skin and subcutaneous tissue. Though it commonly presents with induration, skin discoloration, and telangiectasias, it is important to keep DFSP as a differential in new masses found on previous surgical sites, especially if the previous mass had a possibility of recurrence.
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Affiliation(s)
- YaQun Zhou Arlene
- Department of Primary Care, Touro College of Osteopathic Medicine, New York, NY, United States; Department of Surgery, Saint Clare's Denville Hospital, Denville, NJ, United States.
| | - Justin Chin
- Department of Primary Care, Touro College of Osteopathic Medicine, New York, NY, United States; Department of Family Medicine, Lifelong Medical Care, Richmond, CA, United States.
| | - Millard D Strutin
- Department of Surgery, Saint Clare's Denville Hospital, Denville, NJ, United States
| | - Christine M Lomiguen
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, United States.
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Navarrete-Dechent C, Mori S, Barker CA, Dickson MA, Nehal KS. Imatinib Treatment for Locally Advanced or Metastatic Dermatofibrosarcoma Protuberans: A Systematic Review. JAMA Dermatol 2020; 155:361-369. [PMID: 30601909 DOI: 10.1001/jamadermatol.2018.4940] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Dermatofibrosarcoma protuberans (DFSP) has the potential for local destruction and recurrence, although it carries a low risk of metastasis. Complete surgical resection with negative margins is considered the gold standard for treatment; however, there are cases that are unresectable owing to tumor extension or size or owing to risk of cosmetic and/or functional impairment. Imatinib treatment has been used for locally advanced or metastatic DFSP. Objective To evaluate the usefulness of imatinib for treating DFSP. Evidence Review We conducted a systematic review on the PubMed and Embase databases for articles published from September 2002 through October 2017 using the key words "dermatofibrosarcoma" or "dermatofibrosarcoma protuberans" AND "therapy" AND "imatinib." References within retrieved articles were also reviewed to identify additional studies. Studies of adults with histologically proven DFSP treated with imatinib as monotherapy or as an adjuvant or neoadjuvant therapy to surgery were included. Extracted data were analyzed using descriptive statistics. PRISMA guidelines were followed. All analysis took place October through December 2017. Findings Nine studies met inclusion criteria; 152 patients were included. The calculated mean patient age was 49.3 years (range, 20-73 years). Calculated mean tumor diameter was 9.9 cm (range, 1.2-49.0 cm). When COL1A1-PDGFβ protein translocation (collagen, type 1, alpha 1-platelet-derived growth factor β) was reported, it was present in 90.9% of patients (111 of 122). Complete response was seen in 5.2% of patients (8 of 152), partial response in 55.2% (84 of 152), stable disease in 27.6% (42 of 152), and progression in 9.2% (14 of 152). Four of the 152 patients (2.6%) were excluded from the analysis owing to unknown or unevaluable response. There were no differences in response rate using 400-mg or 800-mg daily doses (67.5% or 27 of 40 patients for 400-mg dose vs 67.1% or 49 of 73 patients for 800-mg dose complete or partial response; P > .99). Adverse events were present in at least 73.5% of cases (78 of 106); severe adverse events were present in 15.1% of cases (20 of 132). Conclusions and Relevance Imatinib is a useful directed therapy in patients with DFSP who are not surgical candidates owing to disease extension or significant cosmetic or functional impairment. There seems to be no difference between 400- or 800-mg daily doses.
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Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shoko Mori
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark A Dickson
- Sarcoma Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon dermal neoplasm that exhibits a high rate of local recurrence and infiltrative behavior, but has a low risk of metastasis. It arises as a slowly progressive, painless pink or violet plaque. Histologically, DFSP is characterized by a monomorphous spindle cell proliferation in a storiform pattern. The gold standard of treatment is surgical resection with negative margins. In cases where obtaining clear margins is not possible, radiation and systemic therapy with tyrosine kinase inhibitors, such as imatinib mesylate, has been shown to be effective.
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Affiliation(s)
- Aubrey Allen
- Brody School of Medicine, East Carolina University, 517 Moye Boulevard, Greenville, NC 27834, USA.
| | - Christine Ahn
- Departments of Dermatology and Pathology, Wake Forest School of Medicine, 4618 Country Club Road, Winston Salem, NC 27104, USA
| | - Omar P Sangüeza
- Departments of Dermatology and Pathology, Wake Forest School of Medicine, 4618 Country Club Road, Winston Salem, NC 27104, USA
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Malan M, Xuejingzi W, Quan SJ. The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans. Pan Afr Med J 2019; 33:297. [PMID: 31692830 PMCID: PMC6815477 DOI: 10.11604/pamj.2019.33.297.17692] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Usually most patients with dermatofibrosarcoma protuberans (DFSP) may present rather late when the tumor is in protuberant phase due to its rarity and indolent onset. It has a high propensity for local recurrence and destructive nature. Management of DFSP requires a biopsychosocial and Multidisplinary approach regardless of the clinical or immunohistochemical variant. Surgery is the Gold standard management of localized disease. DFSP rarely exhibits any lymphatic or hematogenous dissemination. It is because of its high recurrence rate associated with Wide Local Excision (WLE), the introduction of Mohs micrographic surgery (MMS) has really helped in reducing the rates of recurrence of DFSP. Thus, the aim of this meta-analysis and systemic review is to advocate for MMS over WLE for DFSP and other cutaneous malignancies using DFSP as a prototype. The objective of this study were to conduct a meta-analysis on comparative surgical methods used in the cure of DFSP with regards to WLE verses MMS, to evaluate the cure rates with relation to recurrence rates, offer a recommendation on the various treatment modalities based on the location of lesion, and use of adjuvant therapy in different clinical-medical setups. A comprehensive retrospective analysis search in EMBASE, Google Scholar and Medline (PubMed) for studies published from 2008 to 2018 containing the surgical management of DFSP with WLE verses MMS were reviewed. Five studies of moderate-quality evidence (level B) with a pooled patient load of 684 was analyzed and found for recurrence of DFSP after WLE and MMS to be 9.10% and 2.72% respectively after an average follow-up time for both groups of 5.32 years with a female predominance of 1.58. The trunk is the commonest site for the DFSP lesion which was at 52.80% then the upper and lower extremities zones and the head and neck zones at 31.75% and 15.45% respectively. The pooled adjusted odds ratio (OR) analysis indicated that there was a direct relationship with regards the reduced recurrence rate of DFSP in the MMS group compared to the WLE group (OR:0.31;95%; CI :0.17-0.56). Furthermore, there was significant association between the reduced recurrence rate with the MMS in DFSP patients with a statistical P-value of 0.0001 at 95% CI. The expected increased recurrence rate by zones was in WLE head and neck zone at 38.19% then trunk and extremities zone at 13.34%. In the MMS group it was at of 23.4% as compared to 16.0% in the head and neck zone. Mohs Micrographic Surgery (MMS) is more efficacious in the cure rate and recurrence reduction of DFSP and should be advocated for as first line therapy especially in high recurrence prone zones.
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Affiliation(s)
- Malumani Malan
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, Peoples Republic of China
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, Peoples Republic of China
| | - Wu Xuejingzi
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, Peoples Republic of China
| | - Song Ji Quan
- Head of Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, People's Republic of China
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Duffy R, Liaqat M, Lawrence N, Manders S. Dermatofibrosarcoma protuberans in a pediatric patient with ataxia telangiectasia syndrome. Pediatr Dermatol 2019; 36:400-401. [PMID: 30854690 DOI: 10.1111/pde.13779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ataxia telangiectasia (AT) is a rare autosomal recessive neurodegenerative disorder caused by a mutation in the ATM gene. An impaired immune response due to the gene mutation leads to an increased risk of infection and malignancy. We present a rare case of dermatofibrosarcoma protuberans arising in a patient with AT.
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Affiliation(s)
- Robert Duffy
- Cooper Medical School of Rowan University, Camden, NJ
| | - Maryam Liaqat
- Division of Dermatology, Cooper University Hospital, Camden, NJ
| | - Naomi Lawrence
- Division of Dermatology, Cooper University Hospital, Camden, NJ
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Escobar GF, Ribeiro CK, Leite LL, Barone CR, Cartell A. Dermoscopy of Dermatofibrosarcoma Protuberans: What Do We Know? Dermatol Pract Concept 2019; 9:139-145. [PMID: 31106017 DOI: 10.5826/dpc.0902a10] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2019] [Indexed: 12/14/2022] Open
Abstract
Background Dermatofibrosarcoma protuberans (DFSP) is an uncommon mesenchymal tumor of intermediate malignancy. Its rarity and slow progression often imply a delayed diagnosis. There are few previous reports of dermoscopic features of DFSP and most are single case descriptions. Objectives To report 2 cases of DFSP and their dermoscopic features, as well as conduct a review of all previous cases published addressing the use of dermoscopy in this tumor. Methods We conducted a literature search for all dermoscopic cases of DFSP. In addition, we presented 2 additional cases and compared them to the earlier findings. Results We summarized the main dermoscopic findings of DFSP based on analysis from 32 patients. The most common features of this tumor are the presence of vessels (81%), followed by a pigmented network (78%) and a pinkish background (66%). Conclusions DFSP can mimic benign lesions and the diagnosis may be challenging. Dermoscopy is an important tool that may enhance clinical suspicion toward the diagnosis of DFSP.
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Affiliation(s)
- Gabriela F Escobar
- Department of Dermatology, Hospital de Clínicas de Porto Alegre (HCPA), Brazil
| | | | - Leandro L Leite
- Department of Dermatology, Hospital de Clínicas de Porto Alegre (HCPA), Brazil
| | - Carolina R Barone
- Department of Dermatology, Hospital de Clínicas de Porto Alegre (HCPA), Brazil
| | - André Cartell
- Medical School, University of Rio Grande do Sul (UFRGS), Brazil
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42/m mit derben erythematösen Knoten im Bereich der Leiste. Hautarzt 2019; 70:75-77. [DOI: 10.1007/s00105-019-4368-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Current Update on the Molecular Biology of Cutaneous Sarcoma: Dermatofibrosarcoma Protuberans. Curr Treat Options Oncol 2019; 20:29. [PMID: 30874910 DOI: 10.1007/s11864-019-0628-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT Cutaneous sarcoma is a group of malignant mesenchymal tumors primarily involving the dermis, and it is characterized by extreme clinicopathological heterogeneity. Although its occurrence rate is rare, dermatofibrosarcoma protuberans (DFSP) is one of the most common types of dermal sarcoma. DFSP grows slowly and tends to relapse locally after inadequate resection. There are various histological variants of DFSP tumors and it often mimics benign lesions such as dermatofibroma and scar, which make accurate diagnosis difficult and delayed, and some cases progress to the stage where the tumor is unresectable. Recent advancements in cancer genetics and molecular biology methods have elucidated the COL1A1-PDGFB fusion gene, some novel fusion gene variants and pathways related to DFSP pathogenesis that have resulted in the evolution of cutaneous sarcoma diagnosis and treatment. For example, some clinical studies have confirmed the efficacy of imatinib methylate, an αPDGFR-targeted therapy for unresectable or metastatic DFSP. The present review summarizes recent updates in DFSP research, diagnostics, and treatment.
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38
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Wu S, Huang Y, Li Z, Wu H, Li H. Collagen Features of Dermatofibrosarcoma Protuberans Skin Base on Multiphoton Microscopy. Technol Cancer Res Treat 2019; 17:1533033818796775. [PMID: 30213241 PMCID: PMC6137550 DOI: 10.1177/1533033818796775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Dermatofibrosarcoma protuberans is a rare, low-grade skin fibroblastic tumor which tends to recur locally due to its high misdiagnosis. Dermatofibrosarcoma protuberans usually spreads through the intracutaneous and subcutaneous layers into the deep dermis layer in which the main component is collagen. Therefore, alterations in collagen shape and content are important for accurate diagnosis of dermatofibrosarcoma protuberans. In this study, multiphoton microscopy was employed to observe normal human skin and dermatofibrosarcoma protuberans skin. Then, a centerline based on an algorithm that skeletonizes a binary image of fibers was applied to analyze collagen shapes in 2 types of skin. Then, collagen content, including intensity and density, was quantitatively obtained to demonstrate differences between the 2 skin types. Results indicate that collagen shape and density can be considered as auxiliary diagnostic parameters to improve the accuracy of dermatofibrosarcoma protuberans diagnosis.
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Affiliation(s)
- Shulian Wu
- 1 College of Photonic and Electronic Engineering, Fujian Normal University, Fujian Provincial Key Laboratory of Photonic Technology, Key Laboratory of Optoelectronic Science and Technology for Medicine, Ministry of Education, Fuzhou, China
| | - Yudian Huang
- 2 Department of Pathology, Fuzhou First Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Zhifang Li
- 1 College of Photonic and Electronic Engineering, Fujian Normal University, Fujian Provincial Key Laboratory of Photonic Technology, Key Laboratory of Optoelectronic Science and Technology for Medicine, Ministry of Education, Fuzhou, China
| | - Huaqing Wu
- 1 College of Photonic and Electronic Engineering, Fujian Normal University, Fujian Provincial Key Laboratory of Photonic Technology, Key Laboratory of Optoelectronic Science and Technology for Medicine, Ministry of Education, Fuzhou, China
| | - Hui Li
- 1 College of Photonic and Electronic Engineering, Fujian Normal University, Fujian Provincial Key Laboratory of Photonic Technology, Key Laboratory of Optoelectronic Science and Technology for Medicine, Ministry of Education, Fuzhou, China
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Glade DC, Gillooly ZD, Browning JC. Enlarging lesion on the back of a 17-year-old boy. Pediatr Dermatol 2019; 36:163-165. [PMID: 30675952 DOI: 10.1111/pde.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel C Glade
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Zachary D Gillooly
- Division of Dermatology, University of Texas Health San Antonio, San Antonio, Texas
| | - John C Browning
- Division of Dermatology, University of Texas Health San Antonio, San Antonio, Texas
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Dermatofibrosarcoma protuberans – the impact of radiation therapy: a single institution series. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396918000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundDermatofibrosarcoma protuberans (DFSP) is a locally aggressive intermediate malignancy.ObjectiveThe purpose of this retrospective analysis is to determine the efficacy of radiation therapy (RT) in local control of DFSP.Patients and methodsThe recurrence-free survival (RFS) for 45 patients treated for DFSP at our institution was estimated and compared between surgery alone and postoperative RT groups.ResultsAge range of the patients were in the third and fourth decades; males:females=2:1; most common site: anterior abdominal wall; tumours >5 cm in size in 75%; low grade in 77·8%; margins positive in 31·8% and <5 mm margins in 45·5%. Two-thirds of patients had at least one recurrence before presentation to our institution. RT dose was >50 Gy in 88% of patients. The patients treated with postoperative RT had poorer prognostic factors compared with surgery alone: they were males (17 versus 13 patients), and presented with high-grade tumours (5 versus 1 patients), multiple recurrences prior to presentation (25 versus 20 patients) and positive or <5 mm margins (22 versus 12 patients). Median follow-up for surgery alone group was 17 (1–152) months and for postoperative RT group, this was 54 (5–121) months. RFS at 5 years was 77·1% for surgery alone and 87·9% for postoperative RT group but was not statistically significant. The median time to recurrence was 4 years.ConclusionRT delays the time to recurrence in DFSP. RT improves the outcome of DFSP for recurrent tumours and with positive margins.
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Dermatofibrosarcoma Protuberans of the Neck: A Brief Review of the Literature. Indian J Otolaryngol Head Neck Surg 2018; 71:369-372. [PMID: 31741988 DOI: 10.1007/s12070-018-1314-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022] Open
Abstract
Dermatofibrosarcome protuberance (DFSP) is a rare, slow growing soft tissue sarcoma with fibroblastic origin, which has a great, potential of local invasion and recurrence. Because of its unspecific appearance and slow growth features it is commonly misdiagnosed as other benign lesions that leads to a late accurate diagnosis or an inadequate initial treatment. A young female patient with DFSP on the neck who was initially misdiagnosed as lipoma and then underwent inadequate initial resection is presented in this case.
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Abstract
Superficial solid masses are common conditions in clinical practice, however, some of which can be easily diagnosed and others would be difficult. Although imaging of superficial masses is not always characteristic, it would be helpful to give a definitive diagnosis or narrow a differential diagnosis. Crossing-section imaging can depicture the masses directly, find some pathognomonic signs and demonstrate their relationship with adjacent structures, which can provide decision support for clinician's reference. Computed tomography (CT) can be used to detect calcifications and bone erosion which could not be seen on radiographs. Magnetic resonance imaging (MRI) is the preferred way for evaluating soft tissue lesions and provides information on hemorrhage, necrosis, edema, cystic and myxoid degeneration, and fibrosis. Other advantages of MRI are its superior soft tissue resolution and any profile imaging, which can aid the assessment of extension and adjacent infiltration. Positron emission tomography (PET)/CT and PET/MRI have been increasingly used in bone and soft tissue sarcomas and provides advantages in the initial tumor staging, tumor grading, therapy assessment, and recurrence detection. Therefore, imaging examination can play an important role in treatment decision making for superficial solid tumors. Here we review the important conditions presenting as superficial mass and show the imaging of typical cases diagnosed in our hospital.
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Affiliation(s)
- Jingfeng Zhang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yanyuan Li
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yilei Zhao
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jianjun Qiao
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
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