1
|
Gong Y, Xi H, Shi Y, Gu J. Atrophic pigmented dermatofibrosarcoma protuberans: A case and short review. J Cosmet Dermatol 2023; 22:3192-3194. [PMID: 37655514 DOI: 10.1111/jocd.15960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/24/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Yu Gong
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Hao Xi
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuling Shi
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Gu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
2
|
Zhang Z, Lu Y, Shi C, Chen M, He X, Zhang H. Pediatric dermatofibrosarcoma protuberans: A clinicopathologic and genetic analysis of 66 cases in the largest institution in Southwest China. Front Oncol 2023; 13:1017154. [PMID: 36776313 PMCID: PMC9916051 DOI: 10.3389/fonc.2023.1017154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
Background Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous tumor in children. Most published articles are sporadic or small series and lack systematically molecular analyses. The aim of our study is to better understand the clinicopathologic and genetic features of these rare lesions. Methods All patients diagnosed with DFSP aged ≤ 18 years were retrospectively reviewed from January 2006 to May 2022. Results A total of 66 cases (32 male and 34 female patients) were identified, with ages ranging from 0.3 to 18 years (median, 13 years). Tumor locations predominantly occurred on the trunk (38/66, 57.6%), followed by the extremities (20/66, 30.3%) and head/neck (8/66, 12.1%). Histological findings revealed classic (41/66, 62.1%), myxoid (4/66, 6.1%), pigmented (6/66, 9.1%), plaque-like (3/66, 4.5%), giant cell fibroblastoma (GCF; 6/66, 9.1%), and fibrosarcomatous (6/66, 9.1%) variants of DFSP. Immunochemistry revealed minority tumors (9/66, 13.6%) showing patchy or negative staining for CD34. Fluorescence in situ hybridization (FISH) indicated that 49 of 53 tested cases including all detected biopsy specimens (11/11) contained COL1A1-PDGFB fusion, in which the average copy number gain of COL1A1-PDGFB was 0.68. There were four cases negative for COL1A1-PDGFB rearrangement, one of which was found to harbor a novel COL3A1-PDGFB fusion by next-generation sequencing (NGS). Treatment for 63 patients comprised 40 marginal excisions and 23 wide local excisions (WLEs), including 1 with imatinib therapy. Follow-up information was available on 49 patients with a duration of 12-161 months (median, 60 months). Fourteen patients developed tumor recurrence, all with initial marginal excisions. The others survived with no evidence of disease. Conclusions This study of pediatric DFSP indicates certain discrepancies in clinicopathologic characteristics between children and adults. The majority of pediatric DFSPs contain COL1A1-PDGFB fusion, the same as their adult counterparts. The COL3A1-PDGFB chimerism might be associated with the special morphology of GCF, which needs further investigation. FISH is valuable in biopsy tissues and cases with atypical CD34 immunostaining, while supplementary NGS could be helpful to identify the cytogenetically cryptic DFSP. Overall, an urgent accurate diagnosis is needed to formulate an optimal therapeutic strategy in the pediatric population.
Collapse
Affiliation(s)
- Zhang Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Lu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Changle Shi
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
3
|
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.
Collapse
Affiliation(s)
| | | | - Shu Nie
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | |
Collapse
|
4
|
Rare Variants of Dermatofibrosarcoma Protuberans: Clinical, Histologic, and Molecular Features and Diagnostic Pitfalls. Dermatopathology (Basel) 2023; 10:54-62. [PMID: 36810566 PMCID: PMC9944072 DOI: 10.3390/dermatopathology10010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/14/2023] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a dermal malignant mesenchymal tumor. Most variants are associated with a high risk of local recurrence and a low risk of metastasis. The classic histomorphology of this tumor is made up of uniform, spindle-shaped cells, arranged in a storiform pattern. Tumor cells characteristically infiltrate the underlying subcutis in a honeycomb pattern. Less common variants of DFSP have been identified: myxoid, pigmented, myoid, granular cell, sclerosing, atrophic, and fibrosarcomatous. Only the fibrosarcomatous variant has been shown to differ significantly from classic DFSP in terms of clinical outcome; fibrosarcomatous DFSP has been shown to be associated with a greater risk of local recurrence and metastatic potential than classic DFSP. However, the other variants may pose diagnostic difficulty as they resemble other types of spindle cell neoplasms, especially in small biopsy specimens. This article reviews the clinical, histologic, and molecular features of DFSP variants, as well as possible pitfalls in their diagnosis and how to resolve them.
Collapse
|
5
|
Gong X, Li J, Ding A, Chen J, Tao X, Xiong P, Rao Y, Liu Y, Sun Q. Multimodal ultrasound for preoperative evaluation of dermatofibrosarcoma protuberans: a series of 40 cases. BMC Cancer 2022; 22:1137. [DOI: 10.1186/s12885-022-10211-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Dermatofibrosarcoma protuberans (DFSP) is a rare, low to intermediate-grade sarcoma, which needs imaging examination. Small series of ultrasound findings in DFSP have been published; however, the usefulness of elastography and contrast-enhanced ultrasound (CEUS) in DFSP has not been studied. We aim to study multimodal ultrasound findings and report the correlation between imagings and tiny extension in DFSP for preoperative evaluation.
Methods
Two-D ultrasound, 3-D color ultrasound, elastography, and CEUS findings were retrospectively evaluated. Forty histopathologically confirmed DFSPs were studied.
Results
On 2-D ultrasound, 26(65%) appeared as mostly hypoechoic lesions with occasional hyperechoic dots within the tumor matrix and lobulated lateral borders. Eight (20%) lesions were multilayered. Ninety-five percent of lesions showed increased vascularity. On 3-D ultrasound, DFSPs showed branch-shaped, striped, and wrapped color patterns. Power Doppler showed mainly artery of a moderate arterial peak systolic blood flow and low resistance index. DFSP is hard on elastography. On CEUS, DFSPs showed a long peak time, low peak and a small amount of perfusion around the tumor, 73.7% (14/19) of lesions showed a heterogeneous contrast enhancement and 89.5% (17/19) of lesions showed hyper-enhancement. CEUS showed better concordance than US with histology on the maximum diameter and depth (P < 0.05).
Conclusions
Multimodal ultrasound showed significant characteristics in DFSP, which would improve diagnostic accuracy. CEUS could be an effective tool to determine tiny tumor extension.
Collapse
|
6
|
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
| |
Collapse
|
7
|
Bai J, Liu B, Liu T, Qiao J, Fang H. Atrophic Pigmented Dermatofibrosarcoma Protuberans: A Case Report and Literature Review. Front Oncol 2021; 11:669754. [PMID: 34221984 PMCID: PMC8245761 DOI: 10.3389/fonc.2021.669754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma characterized by the proliferation of spindle cells arranged in a storiform pattern. Here we report a case of DFSP presenting as a bluish-black atrophic plaque. The tumor had the histopathologic characteristics of both the pigmented and atrophic variants of DFSP. We describe the histopathologic, molecular, and imaging features of this patient and review other cases of DFSP that have been reported in the literature. Early identification of this DFSP variant can help clinicians implement clinical management strategies to prevent recurrence.
Collapse
Affiliation(s)
- Juan Bai
- Dermatology Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Liu
- Department of Dermatology, Beilun Traditional Chinese Medicine Hospital, NingBo, China
| | - Taoming Liu
- Dermatology Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Dermatology Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Fang
- Dermatology Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
8
|
Gutierrez N, Calame A, Erickson C, Cohen PR. Atrophic Dermatofibroma: A Unique Dermatofibroma Variant. Cureus 2021; 13:e14570. [PMID: 34035995 PMCID: PMC8136451 DOI: 10.7759/cureus.14570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dermatofibromas are benign skin tumors with several variants, including the rare, uncommonly described atrophic dermatofibroma. To the best of our knowledge, there are currently 105 reported cases of atrophic dermatofibromas in the literature. This variant typically presents as a flat or depressed macule whose color can range from brown to white to red; in contrast to classic dermatofibromas that typically occur on the legs, atrophic dermatofibromas have a tendency to occur on the upper back and arms. An atrophic dermatofibroma can be clinically diagnosed; however, given the broad spectrum of clinical features of this lesion, a biopsy may be required. Characteristic pathologic features include epidermal acanthosis, basilar hyperpigmentation, fibroblast hyperplasia, and decreased or absent elastic fibers within the lesion. The pathogenesis of this lesion is not yet fully understood; however, it has been postulated that the loss of elastic fibers plays a key role in its development and characteristic atrophic appearance. We present the cases of two men with biopsy-confirmed atrophic dermatofibromas: a 47-year-old man with a pigmented macule on the right upper back and a 68-year-old man with an erythematous patch on the left posterolateral shoulder. The clinical and pathologic features of atrophic dermatofibromas are also summarized.
Collapse
Affiliation(s)
- Nikolas Gutierrez
- General Practice, 1st Marine Division, 1st Combat Engineer Battalion, Camp Pendleton, USA
| | - Antoanella Calame
- Dermatology/Dermatopathology, Compass Dermatopathology, San Diego, USA.,Dermatology, Scripps Memorial Hospital, La Jolla, USA
| | | | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
| |
Collapse
|
9
|
Large Atrophic Plaque on the Chest: Answer. Am J Dermatopathol 2021; 43:308-309. [PMID: 33742999 DOI: 10.1097/dad.0000000000001791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|