Dermatofibrosarcoma- An uncommon entity, commonly mismanaged: a case report

Surgical Management of Pediatric Dermatofibrosarcoma Protuberans: About Two Challenging Case Reports

Dermatofibrosarcoma protuberans (DFSP) is an extremely rare cutaneous tumor in children, marked by local aggressiveness, slow growth, high recurrence rate, and low metastatic potential. Its prevalence is often underestimated in children due to its slow growth and frequent misdiagnosis. Diagnosing DFSP can be challenging due to nonspecific symptoms. While most cases present as nodular lesions on the trunk or proximal extremities, some lesions, such as atrophic plaques or sclerotic nodular plaques, can mimic vascular malformations and confuse clinicians. Histologic and immunohistochemical studies are essential for definitive diagnosis. The treatment of choice is complete surgical resection with wide margins to reduce the risk of recurrence. We report two pediatric DFSP cases on the trunk, including one mimicking vascular malformations. Both cases had successful 4 cm margin resections, with no recurrences observed after 6 months and 2 years of follow-up, respectively. Continuous surveillance will be maintained for at least 5 years.

An unusual case of dermatofibrosarcoma protuberans misdiagnosed as vascular malformation for over 30 years: A case report

INTRODUCTION

Dermatofibrosarcoma protuberans (DFSP) is a rare and slowly growing soft tissue tumor and it is frequently misdiagnosed and mismanaged like more common masses. Therefore diagnostic delays are common and may result in challenging reconstructions.

CASE PRESENTATION

We report the peculiar case of a 36-year-old patient with dermatofibrosarcoma protuberans of the right iliac fossa misdiagnosed as vascular malformation for over 30 years. Due to the delayed diagnosis resulting in a large tumor to be resected, surgical reconstruction was performed with a miniabdominoplasty approach with an excellent cosmetic and functional result.

DISCUSSION

The review of the literature showed that mismanagements and delayed diagnosis of this sarcoma are frequent. Large skin and soft-tissue defects are frequently encountered in the surgical treatment of this tumor, and adequate knowledge of the reconstructive options is mandatory to provide the best possible outcome.

CONCLUSIONS

Superficial skin masses could be easily misdiagnosed. These diagnostic delays may lead to increased patient morbidity and more challenging reconstructive procedures. In this scenario, preoperative biopsies of suspicious lesions may be useful to avoid mismanagement of rare malignant neoplasms such as DFSP. In some challenging cases, the use of a surgical approach typical of cosmetic procedures may be useful to obtain satisfactory aesthetic and functional results.

Bednar's tumor at right shoulder in an adult male: a case report of a rare entity

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.