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Seretis K, Klaroudas A, Galani V, Papathanakos G, Varouktsi A, Mitselou A, Batistatou A, Lampri E. Pleomorphic dermal sarcoma: it might be rare but it exists. J Surg Case Rep 2023; 2023:rjad374. [PMID: 37545789 PMCID: PMC10401320 DOI: 10.1093/jscr/rjad374] [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: 05/29/2023] [Accepted: 06/11/2023] [Indexed: 08/08/2023] Open
Abstract
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal tissue tumor. Its differential diagnosis from similar tumors, such as low differentiated squamous cell carcinoma, fibrosarcoma, desmoplastic melanoma, atypical fibroxanthoma (AFX), may be difficult, as they have similar clinical and histological presentation. We present a case of an 83-year-old man exhibiting an exophytic scalp lesion. Excision of the lesion was performed, ensuring clear surgical margins and pathologic examination revealed an invasive pleomorphic dermal sarcoma. This case highlights a rare case of a large pleomorphic dermal sarcoma, and it discusses the histological, molecular features, its differential diagnosis and management of PDS.
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Affiliation(s)
| | - Antonios Klaroudas
- Department of Anatomy-Histology-Embryology, School of Medicine University of Ioannina, Greece
| | - Vasiliki Galani
- Correspondence address. Department of Anatomy-Histology-Embryology, School of Medicine University of Ioannina, Greece. E-mail:
| | | | - Anna Varouktsi
- Department of Internal Medicine, Ippokrateio Hospital, Thessalonνki, Greece
| | - Antigoni Mitselou
- Department of Forensic Pathology, Medical School University of Ioannina, Greece
| | - Anna Batistatou
- Department of Pathology, Medical School University of Ioannina, Greece
| | - Evangeli Lampri
- Department of Pathology, Medical School University of Ioannina, Greece
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2
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Moore KJ, Schmults CD, Ruiz ES. No difference in survival for primary cutaneous pleomorphic sarcoma after Mohs surgery and wide local excision. J Am Acad Dermatol 2023; 88:495-498. [PMID: 35764220 DOI: 10.1016/j.jaad.2022.06.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/06/2022] [Accepted: 06/20/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Kevin J Moore
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Dana-Farber Brigham Cancer Center/Brigham and Women's Cancer Center, Center for Cutaneous Oncology, Boston, Massachusetts
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Dana-Farber Brigham Cancer Center/Brigham and Women's Cancer Center, Center for Cutaneous Oncology, Boston, Massachusetts.
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3
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O'Neill D, Evans M, Nunns D, El-Ghobashy A. Vulval extra-mammary Paget's disease: the master of disguise revealed. Br J Hosp Med (Lond) 2022; 83:1-12. [DOI: 10.12968/hmed.2021.0536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Extra-mammary Paget's disease is a rare cancer affecting the anogenital region and can present with a myriad of symptoms. In women, the diagnosis of Paget's disease can be challenging as it mimics several other vulval conditions. It is important to promptly recognise this disease because of its potential association with synchronous tumours, such as colorectal adenocarcinoma. The mainstay of treatment is with immunomodulating therapies or surgery, but unfortunately the risk of recurrence is high and appears to be independent of treatment choice and tissue margin status. There is growing evidence to move away from traditional surgical excision to using topical therapy, such as imiquimod, as surgery can often be extensive and disfiguring with a prolonged recovery time. There is considerable psychosexual and physical morbidity associated with Paget's disease, largely owing to multiple surgical recurrences. As recurrences can occur several years after the initial presentation, long-term follow up of patients is recommended.
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Affiliation(s)
- Danielle O'Neill
- Department of Gynaecology Oncology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Matthew Evans
- Department of Pathology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - David Nunns
- Department of Gynaecology Oncology, Nottingham University Hospitals Trust, Nottingham, UK
| | - Alaa El-Ghobashy
- Department of Gynaecology Oncology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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4
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Zhao D, Wen BP, Xu SY. Extramammary Paget's Disease in the Genital Area of a Male: A Case Report and Review of the Literature. Front Oncol 2021; 11:713786. [PMID: 34804917 PMCID: PMC8599444 DOI: 10.3389/fonc.2021.713786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/13/2021] [Indexed: 12/07/2022] Open
Abstract
Extramammary Paget's disease (EMPD) is an uncommon intraepithelial malignancy that is rarely found in the male. Currently, there is very little knowledge pertaining to EMPD imaging, particularly in cases that involve the scrotum. Here, a 67-year-old man with lichenification on his left scrotum confirmed to be EMPD was reviewed. Bloodwork did not return a positive result, but syphilis-specific antibodies were found. Conventional high-frequency ultrasound (US) and contrast-enhanced ultrasound (CEUS) imaging were utilized to determine the lesion size and blood perfusion. In the present case, the lesion's size and involvement were vividly depicted by CEUS, while results obtained by conventional US were grossly underestimated. Consequently, multimodal imaging assessment is likely to provide more accurate diagnoses for uncommon diseases, such as EMPD, and to aid in clinical decision-making.
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Affiliation(s)
- Dan Zhao
- Department of Medical Ultrasound, Hangzhou Red Cross Hospital, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Bo-ping Wen
- Department of Medical Ultrasound, Hangzhou Red Cross Hospital, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Sen-yin Xu
- Deparment of Ultrasound, Zhejiang Hospital, Hangzhou, China
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5
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Jibbe A, Worley B, Miller CH, Alam M. Surgical excision margins for fibrohistiocytic tumors, including atypical fibroxanthoma and undifferentiated pleomorphic sarcoma: A probability model based on a systematic review. J Am Acad Dermatol 2021; 87:833-840. [PMID: 34587553 DOI: 10.1016/j.jaad.2021.09.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mohs micrographic surgery or wide local excision is the treatment of choice for fibrohistiocytic tumors with metastatic potential, including atypical fibroxanthoma (AFX) and cutaneous undifferentiated pleomorphic sarcoma (cUPS). Since margin clearance is the strongest predictor of clinical recurrence, improved recommendations for appropriate surgical margins help delineate uniform excision margins when intraoperative margin assessment is not available. OBJECTIVE To determine appropriate surgical wide local excision margins for AFX and cUPS. METHODS Literature search (Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to March 2020) to detect case-level data. Estimation of margins required using a mathematical model based on extracted cases without recurrences. RESULTS Probabilistic modeling based on 100 cases extracted from 37 studies showed peripheral clearance margin (ie, wide local excision margin) calculated to clear 95% of all tumors was 2 cm for AFX and 3 cm for cUPS. AFX tumors 1 cm or less required a margin of 1 cm. LIMITATIONS Data were extracted from published cases. CONCLUSIONS Atypical fibroxanthoma removed with at least a 2-cm peripheral excision margin is less likely to recur. Smaller tumors 1 cm or less can be treated with a more conservative margin. Margin-control surgical techniques are recommended to ensure complete removal while minimizing surgical morbidity.
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Affiliation(s)
- Atieh Jibbe
- Division of Dermatology, Department of Internal Medicine, University of Kansas, Kansas City, Kansas
| | - Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Florida Dermatology and Skin Cancer Centers, Lake Wales, Florida
| | - Corinne H Miller
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Otoloaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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6
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Ripa V, Singh N, Star AE, Smith F. Progression of the atypical fibroxanthoma to pleomorphic dermal sarcoma in a heart transplant patient. BMJ Case Rep 2021; 14:14/7/e242359. [PMID: 34215640 DOI: 10.1136/bcr-2021-242359] [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: 11/04/2022] Open
Abstract
An 82-year-old man presented with a right scalp lesion which had been increasing in size. The patient's medical history was significant for a heart transplant 25 years before, and he was on chronic immunosuppression. Biopsy of the lesion showed atypical fibroxanthoma. The patient underwent an excision of the lesion with split thickness skin graft. Pathology showed fibroxanthoma with negative margins. Over the next 9 months, the patient developed new lesions, which were also excised to negative margins. However, with each new lesion, the histology demonstrated increasing dysplasia and ultimately pleomorphic sarcoma. The patient had a metastatic workup with CT of the chest, which was negative, and he underwent a radical scalpectomy, split thickness skin graft placement and adjuvant radiation therapy. The patient has not developed any new scalp lesions and no evidence of metastasis.
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Affiliation(s)
- Valeria Ripa
- General Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Natasha Singh
- Pathology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Allen E Star
- General Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Franz Smith
- Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
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7
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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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8
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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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9
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Kosutic D, Haw W, Ghura V. Current Concepts in the Surgical Management of Non-melanoma Skin Cancers. Clin Oncol (R Coll Radiol) 2019; 31:738-748. [DOI: 10.1016/j.clon.2019.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/12/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022]
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10
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Kholaki O, Chang D, Kim RY. Nasal Sebaceous Carcinoma: A Case Report and Review of the Literature. J Oral Maxillofac Surg 2019; 78:82-86. [PMID: 31526773 DOI: 10.1016/j.joms.2019.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/28/2022]
Abstract
Sebaceous carcinoma arising from the nasal vestibule is exceedingly rare, with 3 cases previously reported. We have described the case of a 69-year-old man with an indolent exophytic growth on the medial aspect of his right nasal vestibule. Incisional biopsy demonstrated sebaceous carcinoma. The clinical and pathologic features, in addition to the surgical course and the postoperative outcome, are discussed. We also report our findings from a review of the reported data, focusing on the diagnosis and treatment of this rare skin malignancy.
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Affiliation(s)
- Omar Kholaki
- Resident Surgeon, Department of Oral and Maxillofacial Surgery, Parkland/University of Texas Southwestern Medical Center, Dallas, TX.
| | - Dongkun Chang
- Pathologist, John Peter Smith Health Network, Fort Worth, TX
| | - Roderick Y Kim
- Assistant Fellowship Director and Director of Research, Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, TX
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11
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Chen ST, Guo LH, Yan JN, Wang Q, Li XL, Li MX, Zhu RZ, Yang WP, Xu HX. Ultrasound Biomicroscopy and High-Frequency Ultrasound for Evaluating Extramammary Paget Disease With Pathologic Correlation. JOURNAL OF ULTRASOUND IN MEDICINE 2019; 38:3229-3237. [PMID: 31144340 DOI: 10.1002/jum.15033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the performance of ultrasound biomicroscopy (UBM) and high-frequency ultrasound (HFUS) in the assessment of extramammary Paget disease (EMPD) and to correlate the imaging features with pathologic findings. METHODS In this retrospective study, we described the imaging features from UBM and HFUS based on 17 pathologically proven EMPD cases. The performance for visualizing layer involvement by UBM and HFUS was compared. Additionally, we checked the consistency between layer involvement of the lesions on UBM images and the pathologic results. Additionally, blood flow and the status of lymph nodes were investigated with HFUS. RESULTS Ultrasound biomicroscopy revealed that all 17 lesions (100%) were hypoechoic and grew in a creeping form. The feature of layer involvement was shown in 10 lesions (58.8%) limited to the epidermis and 6 lesions (35.3%) involving the dermis, and the remaining lesion (5.9%) involved the full skin layers. Layer involvement was clearly displayed by UBM for all lesions (100%) but for only 5 lesions (29.4%) by HFUS (P < .001). Additionally, the layer involvement of 15 lesions (88.2%) on UBM was consistent with the pathologic results (κ = 0.746). High-frequency ultrasound revealed profuse blood flow in most lesions (64.7% [11 of 17]), and 1 case showed inguinal lymph node metastasis. CONCLUSIONS Combined use of UBM and HFUS can provide key information on EMPD based on ultrasound features. Comparatively, UBM provides clearer morphologic information, whereas HFUS provides information on lymph node metastasis and blood flow.
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Affiliation(s)
- Si-Tong Chen
- Department of Medical Ultrasound, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.,Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Jian-Na Yan
- Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China.,Departments of Skin Surgery, Shanghai Skin Disease Hospital, Shanghai, China
| | - Qiao Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Ming-Xu Li
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Rui-Zheng Zhu
- Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China.,Departments of Pathology, Shanghai Skin Disease Hospital, Shanghai, China
| | - Wei-Ping Yang
- Department of Medical Ultrasound, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
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12
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13
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Abstract
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal tissue tumor. Distinguishing PDS from similar conditions, such as atypical fibroxanthoma (AFX), its less aggressive tumor counterpart, is difficult, as they are clinically and histologically similar. We present a case of a 77-year-old man presenting with a large nodular scalp lesion of three weeks duration. Pathology revealed a 3.3 cm invasive pleomorphic dermal sarcoma. Surgical excision with 2 cm margins was performed with successful healing of the graft. This case highlights a rare case of a large pleomorphic dermal sarcoma and discusses the histological features and management of PDS.
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Affiliation(s)
| | - Mai P Hoang
- Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Bobby Y Reddy
- Dermatology, Massachusetts General Hospital, Boston, USA
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14
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Schmitt AR, Long BJ, Weaver AL, McGree ME, Bakkum-Gamez JN, Brewer JD, Cliby WA. Evidence-Based Screening Recommendations for Occult Cancers in the Setting of Newly Diagnosed Extramammary Paget Disease. Mayo Clin Proc 2018; 93:877-883. [PMID: 29804724 DOI: 10.1016/j.mayocp.2018.02.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To identify the rates of associated and occult cancers in patients with extramammary Paget disease (EMPD) discovered using cancer screening methods at a tertiary medical center; to propose evidence-based cancer screening guidelines at the time of diagnosis of EMPD; and to clarify terminology associating EMPD with underlying malignancies. PATIENTS AND METHODS A retrospective review of patients with histologically confirmed EMPD presenting for care at our institution between January 1, 1992, and December 31, 2015, was performed. Both male and female patients were included. Descriptive analysis was performed. RESULTS A total of 161 patients met the inclusion criteria. Most (59.6%) were female patients, and the mean age at the time of EMPD diagnosis was 70.8±10.1 years. Most (82%) of the 161 patients had at least 1 cancer screening test performed, though screening practices varied widely. Of those screened for an underlying malignancy, 17 distant, noncontiguous malignancies were identified in 15 patients (11.4%), with prostate (n=5), urinary tract (n=5), and breast (n=2) malignancies found most frequently. Most malignancies were identified by urine cytology, mammography, and prostate-specific antigen blood test. Of all patients, 37 (23.0%) had an underlying contiguous malignancy identified by pathology. CONCLUSION All patients diagnosed with EMPD should undergo cancer screening. At minimum, evaluation should include age-appropriate screening and the addition of urine cytology, mammography, and prostate-specific antigen blood test-if not already performed-may be of particular use. An algorithm for evaluation of patients with newly diagnosed EMPD is proposed.
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Affiliation(s)
| | - Beverly J Long
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Jamie N Bakkum-Gamez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, MN; Division of Dermatologic Surgery, Mayo Clinic, Rochester, MN
| | - William A Cliby
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
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15
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Incidence and Clinical Features of Rare Cutaneous Malignancies in Olmsted County, Minnesota, 2000 to 2010. Dermatol Surg 2017; 43:116-124. [PMID: 28027201 DOI: 10.1097/dss.0000000000000936] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of rare cutaneous malignancies is unknown. Current estimates of rare cutaneous malignancy incidences are based on broad epidemiologic data or single institution experiences, not population-based data. OBJECTIVE To determine the incidence of several rare nonmelanoma skin cancers. MATERIALS AND METHODS The authors conducted a retrospective chart review of a population-based cohort between the years 2000 and 2010. Residents of Olmsted County, Minnesota, who were diagnosed with a biopsy-proven nonmelanoma skin cancer-excluding basal cell carcinoma and squamous cell carcinoma-were included in this study. The primary outcome was tumor incidence. Additionally, the authors extracted patient demographics, tumor characteristics, treatment modalities, and outcomes. RESULTS The age-adjusted and sex-adjusted incidences per 100,000 persons of multiple rare cutaneous malignancies were: atypical fibroxanthoma (1.8), sebaceous carcinoma (0.8), dermatofibrosarcoma protuberans (0.4), microcystic adnexal carcinoma (0.7), eccrine carcinoma (0.4), eccrine porocarcinoma (0.2), and leiomyosarcoma (0.2). CONCLUSION The authors report population-based incidences and clinical characteristics for these rare cutaneous malignancies. The immune status and smoking status of patients and the treatment and outcomes of these tumors are reported. Additional studies in a broader population are needed to further define the epidemiology and outcomes of these malignancies.
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16
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Underutilization of Mohs Micrographic Surgery for Less Common Cutaneous Malignancies in the United States. Dermatol Surg 2016; 42:653-62. [DOI: 10.1097/dss.0000000000000705] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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17
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Green B, Godden D, Brennan PA. Malignant cutaneous adnexal tumours of the head and neck: an update on management. Br J Oral Maxillofac Surg 2015; 53:485-90. [PMID: 25911053 DOI: 10.1016/j.bjoms.2015.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
Abstract
Adnexal tumours form a heterogeneous group of relatively rare neoplasms. Many of them have a poor prognosis and treatment can sometimes be difficult and controversial. We summarise the latest publications relating to malignant cutaneous adnexal tumours of the head and neck, and give an update on their management. We discuss Merkel cell carcinoma and other rare malignant adnexal tumours including dermatofibrosarcoma protuberans and atypical fibroxanthoma.
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Affiliation(s)
- B Green
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK.
| | - D Godden
- Department of Oral & Maxillofacial Surgery, Gloucestershire Royal Hospital, UK.
| | - P A Brennan
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK.
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18
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Atypical fibrous histiocytoma arising in the perianal area: a case report and review of the literature. Am J Dermatopathol 2013; 36:171-3. [PMID: 24061404 DOI: 10.1097/dad.0b013e31829bd682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Atypical fibrous histiocytoma (AFH) is an uncommon variant of cutaneous fibrous histiocytoma that can display histologic features associated with malignancy. Fewer than 150 cases have been reported in the literature. The majority of these lesions present on the trunk and extremities of middle-aged women. Genital lesions are rare, with one documented case of vulvar AFH and another case of scrotal AFH in the literature. We report an additional case of a 68-year-old woman who was diagnosed with an AFH in an unusual location, the perianal area. Histologically, the lesion was characterized by a nodular fairly well-circumscribed proliferation of large epithelioid macrophages with scattered lymphocytes and mast cells in the background. The atypical macrophages contained enlarged markedly pleomorphic nuclei with prominent nucleoli. Scattered multinucleated "monster cells" and atypical mitoses were observed throughout the lesion. Immunologically, the lesional cells were focally positive when stained with antibodies against CD163 and Factor XIIIa. They were negative for CD34, CD31, desmin, smooth muscle actin, CAM 5.2, keratin 5/6, S100, CD3, CD20, and CD30. The constellation of histologic and immunologic features was most consistent with an AFH. To our knowledge, this case is the first perianal presentation of AFH to date.
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19
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Thomas WW, Fritsch VA, Lentsch EJ. Population-based analysis of prognostic indicators in sebaceous carcinoma of the head and neck. Laryngoscope 2013; 123:2165-9. [PMID: 23670399 DOI: 10.1002/lary.24042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/09/2012] [Accepted: 01/15/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS Due to the rarity of sebaceous carcinoma of the head and neck, few large series have been reported and prognostic factors remain largely undetermined. This study presents prognostic factors in survival in sebaceous carcinoma of the head and neck. STUDY DESIGN Retrospective analysis was performed using the Surveillance Epidemiology and End Results (SEER) database for patients diagnosed with sebaceous carcinoma of the head and neck (SCHN). METHODS Clinicopathologic, treatment data, and 5-year disease specific survival were analyzed using univariable and multivariable regression analysis and Kaplan-Meier methodology. RESULTS Of the 1,433 patients identified to have SCHN, 16 were node-positive (1.14%). On multivariable analysis, independent prognostic indicators were: age at diagnosis (HR = 1.03, P = .021), tumor grade (HR = 4.97, P = .038), and distant metastasis (HR = 7.52, P = .006). Nodal metastasis occurred exclusively with poorly or undifferentiated tumors and was not a significant prognostic factor on multivariable analysis. CONCLUSION Elderly patients and patients with poorly differentiated tumors and/or distant disease at presentation have the highest risk of disease-specific mortality. Lymph node metastasis does not appear to be an independent prognostic factor in sebaceous cell carcinoma.
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Affiliation(s)
- W Walsh Thomas
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Hollmig TS, Kirkland BE, Henderson MT, Tang JY, Gladstone HB. The Evolving Conception and Management Challenges of Malignant Fibrous Histiocytoma. Dermatol Surg 2012; 38:1922-9. [DOI: 10.1111/j.1524-4725.2012.02538.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Reinstadler DR, Sinha UK. Uncommon cutaneous neoplasms of the head and neck. Facial Plast Surg Clin North Am 2012; 20:483-91. [PMID: 23084300 DOI: 10.1016/j.fsc.2012.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This article concentrates on the less-common cutaneous malignancies such as merkel cell, atypical fibroxanthoma, malignant fibrous histiocytoma, dermatofibrosarcoma protuberans, microcystic adnexal carcinoma, and sebaceous carcinoma. The clinical and histopathologic descriptions of each, most current and emerging etiologies, diagnosis, staging, treatment, and prognosis are discussed.
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Affiliation(s)
- David R Reinstadler
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA 90033, USA
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Taylor KA, Clarke LE, Clarke JT. JAAD Grand Rounds quiz. A rapidly growing tumor on the scalp. J Am Acad Dermatol 2012; 67:1091-2. [PMID: 23062902 DOI: 10.1016/j.jaad.2012.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 01/27/2012] [Indexed: 11/16/2022]
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Delport ES. Extramammary Paget's disease of the vulva: An annotated review of the current literature. Australas J Dermatol 2012; 54:9-21. [PMID: 22671146 DOI: 10.1111/j.1440-0960.2012.00898.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Extramammary Paget's disease is a rare and unusual neoplastic entity that presents mainly on apocrine gland-bearing skin. The vulva is the most common site of involvement but any area of the anogenital skin can be affected. Due to its rarity, variable clinical course and deceptive histological appearance it has a high misdiagnosis rate and both gynaecologists and dermatologists have limited experience in its management. The significance of the disease lies in its association with underlying malignancy as well as its inherent ability to invade the dermis and metastasise. The management is notoriously complicated and recurrence rates are high despite aggressive surgeries. Several alternative modalities are being explored, with results that are often variable and unpredictable. This review summarises the histopathological, clinical and therapeutic features of extramammary Paget's disease of the vulva reported in recent years.
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Hollmig TS, Sachdev R, Cockerell CJ, Posten W, Chiang M, Kim J. Spindle Cell Neoplasms Encountered in Dermatologic Surgery: A Review. Dermatol Surg 2012; 38:825-50. [DOI: 10.1111/j.1524-4725.2012.02296.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Mohs micrographic surgery (MMS) is a unique technique that can offer the highest cure rates and maximum tissue conservation in the management of specific primary and recurrent skin cancers. However, there are many areas of controversy that surround MMS, including appropriate indications for its use, technical quandaries, and outcomes. Recent efforts in these areas need to be assessed to identify research gaps in MMS to help fuel further work. The usefulness of MMS and its methods for delivery need more stringent, evidence-based, rigorous study.
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Affiliation(s)
- Maryam M Asgari
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA.
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McCoppin HH, Christiansen D, Stasko T, Washington C, Martinez JC, Brown MD, Zwald FO. Clinical spectrum of atypical fibroxanthoma and undifferentiated pleomorphic sarcoma in solid organ transplant recipients: a collective experience. Dermatol Surg 2011; 38:230-9. [PMID: 22129349 DOI: 10.1111/j.1524-4725.2011.02180.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atypical fibroxanthoma (AFX) and undifferentiated pleomorphic sarcoma (UPS) are uncommon, spindle cell cutaneous malignancies. Solid organ transplant recipients (SOTRs) are immunosuppressed and therefore have a higher incidence of cutaneous malignancies. OBJECTIVE We describe the clinical spectrum of AFX and a more-aggressive, deeper variant, UPS, in SOTRs. MATERIALS AND METHODS A retrospective chart review of AFX and UPS in SOTRs was implemented. Cases from Vanderbilt University, Emory University, Mayo Clinic-Jacksonville, and University of Rochester were included. A literature search included previously published cases. RESULTS The average age of SOTRs at time of tumor presentation was younger than typically seen in immunocompetent patients for AFX. Rates of local recurrences and metastases were higher in the SOTRs than is noted in the immunocompetent literature. Rates of recurrence were higher in those treated with excision than in those treated with Mohs micrographic surgery (MMS). CONCLUSION AFX and UPS may have a greater risk for recurrence, metastases, and mortality in SOTRs, in whom early treatment with MMS may demonstrate certain advantages in terms of minimizing risk of recurrence and metastasis. UPS and recurrent tumors should be staged appropriately and may respond to adjuvant radiation therapy and reduction of immunosuppression. Immunohistochemical evaluation is recommended to exclude other spindle cell tumors.
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Affiliation(s)
- Holly H McCoppin
- Department of Dermatology, Emory University, Atlanta, Georgia 30322, USA
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