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Yogesh TL, Jha AK, Jayaraman S, Jayaraman V. Low-grade dermatofibrosarcoma protuberance - A rare case report. J Oral Maxillofac Pathol 2024; 28:315-320. [PMID: 39157824 PMCID: PMC11329102 DOI: 10.4103/jomfp.jomfp_135_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/15/2023] [Accepted: 10/09/2023] [Indexed: 08/20/2024] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a slow-growing, soft-tissue tumour of early or mid-adult life, affecting both the genders equally. The most common sites are soft tissue of the trunk (50 to 60%), followed by proximal extremities (20 to 30%) and the head and neck region (10 to 15%). Its metastatic potential is low though the local recurrence rate is high. Here, we report a case of a female patient with a large soft tissue growth located at the right cheek, chin and neck region. Local excision was done under the impression of a benign tumour such as lipoma or sebaceous cyst. Histological evaluation showed bland spindle cells arranged in a storiform pattern questioning the provisional diagnosis of the lesion. Further evaluation with the immunohistochemistry (IHC) panel confirmed the diagnosis of DFSP. Since it is a rare tumour of the head and neck region with non-alarming initial presentation and the potential for erroneous diagnosis as another lesion, we present a case of DFSP.
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Affiliation(s)
- T. L. Yogesh
- Department of Oral Pathology and Microbiology, Rajiv Gandhi College of Dental Sciences and Research Centre, Hebbal, Bengaluru, Karnataka, India
| | - Anjani Kumar Jha
- Department of Oral and Maxillofacial Surgery, Mithila Minority Dental College and Hospital, Ekmighat, Darbhanga, Bihar, India
| | - Sindhumati Jayaraman
- Department of Oral Pathology and Microbiology, Rajiv Gandhi College of Dental Sciences and Research Centre, Hebbal, Bengaluru, Karnataka, India
| | - Vidhya Jayaraman
- Department of Oral Pathology and Microbiology, Rajiv Gandhi College of Dental Sciences and Research Centre, Hebbal, Bengaluru, Karnataka, India
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2
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Hallier A, Callier P, Sauge J, Cristofari S, Lombardo GAG, Aubriot-Lorton MH, Stivala A. Novel role of fluorescent in situ hybridization technique (FISH) in recommended surgical margins of dermatofibrosarcoma protuberans: A preliminary study. ANN CHIR PLAST ESTH 2024; 69:124-130. [PMID: 37652836 DOI: 10.1016/j.anplas.2023.08.006] [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: 07/17/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare skin tumor. There is no standard recommendation for its surgical management. The currently used histological analysis are HES (hematoxylin eosin saffron) staining and immunohistochemistry for CD34 expression in particular cases. Fluorescent in situ hybridization (FISH) technique is only used to qualify the DFSP as translocated or non-translocated and is not used as a diagnostic method. The aim of our study was to determine by FISH (as a diagnostic method) whether cancerous cells that could not be identified through HES staining±immunohistochemistry were present at the two-centimeter margins that were found to be tumor-free. METHODS Samples from patients who underwent surgery between 2010 and 2018 were collected. Intralesional and peripheral (at 2cm margins) paraffin slides were included. An average of 7.4 slides per specimen was analyzed. Firstly, the preselected slides were reread by a senior pathologist to confirm the absence of microscopic findings of DFSP at 2cm margins. Secondly a FISH analysis was used as a quantitative diagnostic approach, in order to find the t(17;22) translocation. RESULTS Among the seven specimens that included 2cm margins, two samples presented one or more translocations, which were not visible in standard morphology assessments at two centimeters tumor-free margins. CONCLUSIONS FISH analysis can have a new role in defining tumor-free margins. This would reduce the incidence of disease recurrence after resection and improve the post-operative complementary care.
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Affiliation(s)
- A Hallier
- Department of Maxillofacial, Plastic, Reconstructive and Esthetic Surgery, Dijon University Hospital, Dijon, France
| | - P Callier
- Department of Human Genetics, Dijon University Hospital, Dijon, France
| | - J Sauge
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - S Cristofari
- Sorbonne University, 21, rue de l'École-de-Médecine, 75006 Paris, France
| | - G A G Lombardo
- Azienda Ospedaliera Cannizzaro, Burn & Plastic Surgery, Via Messina, 829 Catania, Italy; Università Unikore di Enna, Piazza dell'Università, 94100 Enna EN, Italy.
| | | | - A Stivala
- Department of Maxillofacial, Plastic, Reconstructive and Esthetic Surgery, Dijon University Hospital, Dijon, France; Plastic, Reconstructive and Aesthetic Surgery, Centre Hospitalier de Mâcon, 350, boulevard Louis-Escande, 71000 Mâcon, France
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Wickramasinghe VC, Saranga KGV, Piyarathne SA, Prashantha AHA, Liyanage AKG. Dermatofibrosarcoma protuberans in a pre-adolescent child. Int J Surg Case Rep 2023; 110:108761. [PMID: 37666158 PMCID: PMC10509873 DOI: 10.1016/j.ijscr.2023.108761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Dermatofibrosarcoma protuberans (DFSP) is a rare skin sarcoma with a slow growth rate and less chance of metastasizing but it is associated with higher morbidity due to its aggressive nature of local infiltration and its recurrence nature. IMPORTANCE When dealing with DFSP in children we could achieve low morbidity with appropriate surgical planning and approach even though aggressive wide local excision was performed. CASE REPORT 12-year boy presented with a lump in his left arm which was initially clinically and ultrasonically diagnosed as lipoma. However, histological examination, coupled with CD34 immunohistochemistry, confirmed the diagnosis as DFSP. CLINICAL DISCUSSION Modern microsurgical methods, such as Mohs micrographic surgery, are advocated as effective treatment options, their availability and feasibility may be limited in certain settings. Therefore, the classic approach of wide local excision remains the treatment of choice in the majority of cases, with radiotherapy recommended for recurrent disease. Proper patient education and regular surveillance will help identify recurrence in time which aids us to provide timely intervention and optimize outcomes for patients with dermatofibrosarcoma protuberans. CONCLUSION Accurate diagnosis using histology coupled with immunohistochemistry, proper surgical technique and regular follow up are the three pillars of managing DFSP.
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Rahman T, Das A, Boro S, Khandelwal K. Giant dermatofibrosarcoma protuberans head and neck: a diagnostic dilemma. Indian J Otolaryngol Head Neck Surg 2023; 75:991-995. [PMID: 37275087 PMCID: PMC10235309 DOI: 10.1007/s12070-022-03274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is rare, generally slow growing tumor, originating from dermal stem cell or undifferentiated mesenchymal cell. DFSP primarily occurs on the trunk and proximal extremities, with reported only 10-15% occurring in the head and neck region. There can be varied presentations of DFSP in atypical sites mimicking a benign appearance and history due to which diagnostic dilemmas can occur. The underlying malignancy needs to be unveiled by histopathology and immunohistochemistry which reveals bland spindle cells in sub epithelium arranged in whorled storiform pattern which was CD34+, suggestive of dermatofibrosarcoma protuberans. Surgical excision is the treatment of choice, wherever possible. We herein report two intriguing cases of DFSP in uncommon sites.
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Affiliation(s)
- Tashnin Rahman
- Department of Head and Neck Surgery, Dr. B. Borooah Cancer Institute, Guwahati, 781002 India
| | - Anupam Das
- Department of Head and Neck Surgery, Dr. B. Borooah Cancer Institute, Guwahati, 781002 India
| | - Sumanjit Boro
- Department of Plastic Surgery, Dr. B. Borooah Cancer Institute, Guwahati, India
| | - Kirti Khandelwal
- Department of Head and Neck Surgery, Dr. B. Borooah Cancer Institute, Guwahati, 781002 India
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Hongo T, Nakamura T, Miyake A, Kato I, Tateishi K, Yamanaka S, Yamamoto T. Evaluation of Tumor Cell Infiltration to the Skull in Dermatofibrosarcoma Protuberans of the Scalp: Case Report and Literature Review. NMC Case Rep J 2022; 8:287-293. [PMID: 35079477 PMCID: PMC8769418 DOI: 10.2176/nmccrj.cr.2020-0297] [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: 08/25/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) originates from the dermal layer of the skin; the optimum treatment is an extended marginal resection. We describe a case of DFSP of the scalp with a skull invasive defect that was thoroughly examined pathologically to determine the optimum length of surgical margins. The tumor cells infiltrated up to 26 mm into the dermal tissues, whereas no infiltrating tumor cells were present in the skull, indicating the combination of marginal resection of the dermal tissues and lower of the skull can be a clinically relevant strategy for treatment of DFSP cases with skull invasion.
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Affiliation(s)
- Takeshi Hongo
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Taishi Nakamura
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Akio Miyake
- Department of Pathology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Ikuma Kato
- Department of Pathology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan.,Department of Pathology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Kensuke Tateishi
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Shoji Yamanaka
- Department of Pathology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
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Kambouri K, Chatzipantelis P, Foutzitzi S, Dimitriadou C, Aggelidou M, Giatromanolaki A, Deftereos S. Dermatofibrosarcoma protuberans in a child, that's why soft tissue lesions are not always innocent in children. Clin Case Rep 2021; 9:e04080. [PMID: 34084498 PMCID: PMC8142409 DOI: 10.1002/ccr3.4080] [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: 02/09/2021] [Accepted: 03/14/2021] [Indexed: 11/18/2022] Open
Abstract
Pediatric soft tissue tumors should be always operated and sent for a biopsy.
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Affiliation(s)
- Katerina Kambouri
- Department of Pediatric SurgeryAlexandroupolis University HospitalDemocritus University of ThraceKomotiniGreece
| | - Paschalis Chatzipantelis
- Department of PathologyAlexandroupolis University HospitalDemocritus University of ThraceKomotiniGreece
| | - Soultana Foutzitzi
- Department of RadiologyAlexandroupolis University HospitalDemocritus University of ThraceAlexandroupolisGreece
| | - Chrysavgi Dimitriadou
- Department of Pediatric SurgeryAlexandroupolis University HospitalDemocritus University of ThraceKomotiniGreece
| | - Maria Aggelidou
- Department of Pediatric SurgeryAlexandroupolis University HospitalDemocritus University of ThraceKomotiniGreece
| | - Alexandra Giatromanolaki
- Department of PathologyAlexandroupolis University HospitalDemocritus University of ThraceKomotiniGreece
| | - Savas Deftereos
- Department of RadiologyAlexandroupolis University HospitalDemocritus University of ThraceAlexandroupolisGreece
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Diago A, Llombart B, Serra-Guillen C, Arana E, Guillén C, Requena C, Traves V, Bancalari B, Bernia E, Ríos-Viñuela E, Sanmartín O. Usefulness of ultrasound in dermatofibrosarcoma protuberans and correlation with histopathological findings: A series of 30 cases. Skin Res Technol 2021; 27:701-708. [PMID: 33455037 DOI: 10.1111/srt.13003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/07/2020] [Accepted: 12/24/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Small series of ultrasound findings in dermatofibrosarcoma protuberans (DFSP) have been published, but the usefulness of this technique as a preoperative planning tool for tumor resection has not been studied. MATERIALS AND METHODS We retrospectively reviewed patients with DFSP at our hospital that underwent ultrasound examination. Depth of invasion was evaluated by ultrasound and histopathology. Accuracy of ultrasound for assessing depth of tumor invasion was estimated. RESULTS Thirty histopathologically confirmed DFSPs were studied. Classic finger-like projections were observed in 73.3% of cases. A posterior hyperechoic area extending deep into the subcutaneous tissue correlated with the honeycomb DFSP pattern and was observed in 53.3% of patients. Concordance between ultrasound and histopathologic depth measurements was excellent. Lateral tumor extension and Doppler activity were not evaluated in our series. CONCLUSION Ultrasound showed excellent prediction of depth of invasion. Further studies are required to define the usefulness of ultrasound for determining lateral tumor extension.
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Affiliation(s)
- Adrian Diago
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Beatriz Llombart
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Estanislao Arana
- Department of Radiology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Carlos Guillén
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Celia Requena
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Victor Traves
- Department of Pathology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Bernardo Bancalari
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Eduardo Bernia
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Elisa Ríos-Viñuela
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Onofre Sanmartín
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
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Llombart B, Serra C, Requena C, Alsina M, Morgado-Carrasco D, Través V, Sanmartín O. Guidelines for Diagnosis and Treatment of Cutaneous Sarcomas: Dermatofibrosarcoma Protuberans. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Llombart B, Serra C, Requena C, Alsina M, Morgado-Carrasco D, Través V, Sanmartín O. Guidelines for Diagnosis and Treatment of Cutaneous Sarcomas: Dermatofibrosarcoma Protuberans. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:868-877. [PMID: 30539729 DOI: 10.1016/j.ad.2018.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/21/2018] [Accepted: 05/23/2018] [Indexed: 12/26/2022] Open
Abstract
Sarcomas comprise a broad group of tumors, many of whose biological behavior and aggressiveness differ from one type to another. The therapeutic approach is generally multidisciplinary and often complex. Developments in surgical and oncological dermatology during the last few decades have positioned dermatologists as specialists in the diagnosis and treatment of skin cancer. The aim of this article is to review the main soft tissue sarcomas that typically affect the skin. Dermatofibrosarcoma protuberans is a low-grade malignant sarcoma. It exhibits slow-growth, is locally invasive, and has low metastatic potential (<3%). Mohs micrographic surgery is the treatment of choice. The COL1A1-PDGFB translocation should be analyzed in cases of unclear diagnosis and when it is necessary to identify candidates for tyrosine kinase inhibitors. Imatinib is indicated for the treatment of locally advanced and metastatic dermatofibrosarcoma protuberans.
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Affiliation(s)
- B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - C Serra
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - M Alsina
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - V Través
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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10
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Veronese F, Boggio P, Tiberio R, Gattoni M, Fava P, Caliendo V, Colombo E, Savoia P. Wide local excision vs. Mohs Tübingen technique in the treatment of dermatofibrosarcoma protuberans: a two-centre retrospective study and literature review. J Eur Acad Dermatol Venereol 2017; 31:2069-2076. [PMID: 28573714 DOI: 10.1111/jdv.14378] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/09/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade mesenchymal skin tumour, characterized by slow infiltrative growth and common local recurrence, with infrequent distant metastases. OBJECTIVE The aim of this study is to better clarify clinicopathological characteristics of this tumour and to evaluate the cure rates of Mohs Tübingen technique (MTT) and wide local excision (WLE). Eventually, we perform a literature review to compare our experience with published data. METHODS A retrospective review was conducted on 135 patients diagnosed, treated and followed up between 1997 and 2014 at two different institutions. Sixty-two patients underwent to WLE and 73 to MTT. The primary end-points were the following: percentage of recurrences, time to progression and recurrence annual risk rate. Then, the PubMed database was searched for DFSP case series treated with standard surgical resection (SSR), WLE, Mohs' micrographic surgery (MMS) and MTT. The annual risk rate of recurrence calculated and reported for the four separate procedures was pooled to compare them. RESULTS Five of the 62 patients with WLE (8.1%) experienced recurrences after a mean follow-up of 4.7 years; the percentage of recurred patients 9 years after MTT was 5.5%, and the annual recurrence risk rate of 0.6%. Pooling these data with those from literature, the recurrence rate varies from 26% to 60% for SSR, from 0% and 41% for WLE, from 0% and 8.3% for MMS and from 0% to 5.5% for MTT. The lowest annual recurrence risk rate was found for MTT. CONCLUSION Significantly lower recurrence rates were recorded in patients treated with classic or Tübingen Mohs' technique. To the best of our knowledge, our case series is the widest treated with MTT ever described in the literature; these data may be useful to guide clinicians in the choice of the gold standard treatment for Dermatofibrosarcoma protuberans.
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Affiliation(s)
- F Veronese
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - P Boggio
- SCDU Dermatology, AOU Maggiore della Carità, Novara, Italy
| | - R Tiberio
- SCDU Dermatology, AOU Maggiore della Carità, Novara, Italy
| | - M Gattoni
- SSVD Dermatology P.O. S. Andrea, Vercelli, Italy
| | - P Fava
- SCDU Dermatology, AOU Città della Salute e della Scienza, Torino, Italy
| | - V Caliendo
- SCDU Dermatology, AOU Città della Salute e della Scienza, Torino, Italy
| | - E Colombo
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - P Savoia
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
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11
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Sclerosing Dermatofibrosarcoma Protuberans Shows Significant Overlap With Sclerotic Fibroma in Both Routine and Immunohistochemical Analysis: A Potential Diagnostic Pitfall. Am J Dermatopathol 2017; 39:83-88. [DOI: 10.1097/dad.0000000000000584] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Sung TH, Tam AC, Khoo JL. Dermatofibrosarcoma Protuberans: A comprehensive review on the spectrum of clinico-radiological presentations. J Med Imaging Radiat Oncol 2016; 61:9-17. [PMID: 27753236 DOI: 10.1111/1754-9485.12549] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 09/11/2016] [Indexed: 11/27/2022]
Abstract
Dermatofibrosarcoma Protuberans (DFSP) is a rare malignant soft-tissue neoplasm which is often misdiagnosed due to its indolent clinical course and non-specific radiological appearances. An observation case series was conducted with retrospective review of clinical and radiological data of DFSP patients presenting to a major tertiary hospital in Hong Kong for radiological assessment between November 2006 and February 2016. Seven patients with confirmed histological diagnosis of DFSP were included. Tumour sizes at presentation ranged from 1 to 5 cm, most commonly (n = 6) occurred over chest wall and abdominal wall. History of previous local trauma or surgery was identified in the majority of cases (n = 4). There was poor correlation between pre-imaging clinical diagnoses and pathological diagnoses. Local recurrence and tumour de-differentiation with sarcomatous changes occurred in the minority of cases (n = 2). A common radiological 'claw' sign at the lesion/skin interface formed by elongated appendages of the tumour superficially was appreciated in most cases (n = 6). A history of previous local trauma or surgery serves as a possible etiological factor for the development of DFSP. High clinical suspicion for the entity is essential in its detection and differentiation from simple wound complications and local recurrence of other benign lesions. The radiological 'claw' sign at the lesion/skin interface might serve as a tell-tale sign for cutaneous tumour involvement. A comprehensive analysis of imaging findings in conjunction with individual clinical presentations is the key to accurate diagnoses and proper management.
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Affiliation(s)
- Tony Ht Sung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Annie Cw Tam
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Jennifer Ls Khoo
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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13
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Elbendary A, Griffin JR, Elston DM, Verma SB. Cellular dermatofibroma: A hyperkeratotic indurated plaque on the thigh. Indian Dermatol Online J 2016; 7:308-10. [PMID: 27559511 PMCID: PMC4976415 DOI: 10.4103/2229-5178.185497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amira Elbendary
- Ackerman Academy of Dermatopathology, New York; Department of Dermatology, Kasr al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - John R Griffin
- Department of Internal Medicine and Pathology and Laboratory Medicine, Texas A&M University Health Science Center, Dallas, Texas, USA
| | - Dirk M Elston
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, South Carolina, USA
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14
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Kukar M, Oxenberg J, Cho EE, Zeitouni NC, Skitzki J. Nonmelanoma Skin Cancers. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Valdivielso-Ramos M, Torrelo A, Campos M, Feito M, Gamo R, Rodriguez-Peralto JL. Pediatric dermatofibrosarcoma protuberans in Madrid, Spain: multi-institutional outcomes. Pediatr Dermatol 2014; 31:676-82. [PMID: 25424208 DOI: 10.1111/pde.12371] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Little is known about the incidence and management of dermatofibrosarcoma protuberans (DFSP) in children. We conducted a retrospective review of all patients younger than 18 years of age treated for DFSP over a period of 11 years (2000-2011) in Madrid, Spain. The sample consisted of 13 children. The average annual incidence of DFSP in the pediatric population corresponded to 1.02 cases per million person-years (95% confidence interval 0.55, 1.73). Sites of involvement were diverse, with 15.3% of tumors found in acral locations. The median tumor size was 3.5 cm × 3 cm and the median time from apparent onset to diagnosis was 36 months. Histopathologic examination revealed conventional (77.0%), pigmented (15.4%), and myxoid (7.6%) variants. The mitotic index was consistently <5 per 10 high-power fields. All lesions were removed using surgical excision. One patient developed a local recurrence because of initial affected margins; none developed metastases. The median duration of clinical follow-up was 70.5 months. This study estimated the average annual incidence rate of DFSP in a population of patients younger than 18 years and reviewed the experience of several hospitals in the management of this tumor.
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Avilés-Izquierdo JA, Conde-Montero E, Barchino-Ortiz L, Lázaro-Ochaita P. Dermoscopic features of dermatofibrosarcoma protuberans. Australas J Dermatol 2014; 55:125-7. [DOI: 10.1111/ajd.12036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 12/18/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - Elena Conde-Montero
- Department of Dermatology; General University Hospital Gregorio Marañón; Madrid Spain
| | - Lucía Barchino-Ortiz
- Department of Dermatology; General University Hospital Gregorio Marañón; Madrid Spain
| | - Pablo Lázaro-Ochaita
- Department of Dermatology; General University Hospital Gregorio Marañón; Madrid Spain
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17
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Estela J, Rico M, Pérez A, Unamuno B, Garcías J, Cubells L, Alegre V. Dermatofibroma of the Face: A Clinicopathologic Study of 20 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2013.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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18
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Stancu B, Mironiuc IA, Crisan M, Mera M. Surgical Treatment of Dermatofibrosarcoma Protuberans Using a Reversed Adipofascial Sural Flap - Case Report. Med Pharm Rep 2014; 87:277-83. [PMID: 26528036 PMCID: PMC4620672 DOI: 10.15386/cjmed-366] [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: 11/02/2014] [Revised: 11/09/2014] [Accepted: 11/11/2014] [Indexed: 11/23/2022] Open
Abstract
Dermatofibrosarcoma protuberans is a rare superficial tumor characterized by high rates of local recurrence and low risk of metastasis. Dermatofibrosarcoma protuberans occurs most commonly on the trunk and proximal extremities, it affects all races, and often develops between the second and the fifth decade of life. The tumor grows slowly, typically over years. We present a rare case of a young male patient, 21 years old, with an asymptomatic calf tumor which was suspected to be an angioma, but after the initial excision histology and imunohistochemistry proved to be a Dermatofibrosarcoma protuberans without safety limits. After 2 weeks, we excised the remaining scar with 4 cm tissue limit and the defect was covered using an adipofascial reversed sural flap from the posterior part of the left calf and after another 2 weeks we applied a skin graft from the thigh. The patient had a good evolution, with full recovery, without local recurrences or metastasis, and the histology was within good safety limits.
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Affiliation(s)
- Bogdan Stancu
- 2 Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ion Aurel Mironiuc
- 2 Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Maria Crisan
- Histology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Mihaela Mera
- Morphopathology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
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19
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Estela JR, Rico MT, Pérez A, Unamuno B, Garcías J, Cubells L, Alegre V. Dermatofibroma of the face: a clinicopathologic study of 20 cases. ACTAS DERMO-SIFILIOGRAFICAS 2013; 105:172-7. [PMID: 24275565 DOI: 10.1016/j.ad.2013.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 09/26/2013] [Accepted: 10/07/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Dermatofibroma is one of the most common benign skin tumors. It typically develops on the lower limbs between the third and fifth decade of life and is more common in women. Clinical diagnosis is often straightforward. Dermatofibromas are associated with a very low rate of local recurrence following excision. OBJECTIVES To describe the clinical and histologic features of dermatofibroma of the face based on our experience. MATERIALS AND METHODS Descriptive retrospective study of the clinicopathologic features of dermatofibromas of the face diagnosed at the dermatology department of Hospital General Universitario de Valencia between 1990 and 2012. RESULTS Twenty cases of dermatofibroma of the face (1.11% of all dermatofibromas diagnosed) were studied. The age at onset varied widely, from 28 to 84 years. The mean age at onset was 57.15 years and the median was 54 years. There were 11 women and 9 men. Mean follow-up was 83 months and there were no local recurrences. All the tumors were confined to the papillary and reticular dermis and the storiform pattern was the most common growth pattern observed. CONCLUSIONS This study of facial dermatofibromas diagnosed at our hospital over a period of 22 years suggests that the face is an uncommon site but that dermatofibromas in this location behave similarly to those occurring elsewhere on the body.
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Affiliation(s)
- J R Estela
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - M T Rico
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - A Pérez
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - B Unamuno
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J Garcías
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Cubells
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - V Alegre
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
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20
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Llombart B, Serra-Guillén C, Monteagudo C, López Guerrero JA, Sanmartín O. Dermatofibrosarcoma protuberans: a comprehensive review and update on diagnosis and management. Semin Diagn Pathol 2013; 30:13-28. [DOI: 10.1053/j.semdp.2012.01.002] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Valdivielso-Ramos M, Hernanz JM. Dermatofibrosarcoma protuberans in childhood. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:863-73. [PMID: 23154247 DOI: 10.1016/j.adengl.2011.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 12/25/2011] [Indexed: 11/24/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a fibrohistiocytic tumor of intermediate malignancy that is very rare in childhood. Only 6% of these tumors present in children. Clinical diagnosis is very difficult in the early stages of disease, but to ensure appropriate treatment it is important to identify DFSP as early as possible and rule out benign conditions that are more common at this age. The clinical presentation and histopathologic and molecular characteristics of DFSP are similar in children and adults. Clinical diagnosis is, however, more difficult in children and requires a high degree of suspicion. The absence of characteristic features and the rarity of this tumor explain why diagnosis is often delayed. Complete surgical excision of the tumor is very important to reduce the risk of recurrence. This article presents a review of current knowledge about the management of DFSP in children and examines the latest treatment options.
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22
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Serra-Guillén C, Llombart B, Sanmartín O. Dermatofibrosarcoma Protuberans. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2011.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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23
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Dermatofibrosarcoma protuberans. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:762-77. [DOI: 10.1016/j.ad.2011.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 10/26/2011] [Accepted: 10/29/2011] [Indexed: 11/24/2022] Open
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24
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Toll A. The Implantation of Mohs Micrographic Surgery in Spain: a Work Still in Progress. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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25
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Stivala A, Lombardo GAG, Pompili G, Tarico MS, Fraggetta F, Perrotta RE. Dermatofibrosarcoma protuberans: Our experience of 59 cases. Oncol Lett 2012; 4:1047-1055. [PMID: 23162649 DOI: 10.3892/ol.2012.887] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 05/11/2012] [Indexed: 11/05/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumor with intermediate malignancy. It is initially located on the skin from where it is able to infiltrate the deep structures and has a tendency to recur locally following inadequate excision. A t(17;22)(q22;q13) chromosome trans-location is the main cytogenetic alteration responsible for the onset of DFSP. Treatment options include complete surgical excision by performing conventional surgery with wide margins (>3 cm) or Mohs micrographic surgery. A retrospective study was conducted in our Department of Plastic and Reconstructive Surgery and all data were collected from medical records of 59 DFSP patients within this department from 1999 to 2011. A total of 13 of 59 (22%) cases were treated with conventional excision; 3 (5%) cases resulted in tumor-free margins, 8 (14%) cases required surgical revision and 2 (3%) cases lead to recurrence. A total of 46 of 59 (78%) cases were treated with wide excision; 43 (73%) cases resulted in tumor-free margins, 3 (5%) cases required surgical revision and 0 (0%) cases lead to recurrence. In conclusion, the data collected reveal the controversy surrounding the adoption of general guidelines regarding safe margins. Further studies are required to investigate the possibility of obtaining genotypically altered margins from margins that may appear phenotypically healthy.
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Affiliation(s)
- Alessio Stivala
- Department of Medical and Surgery Specialties, Section of Plastic Surgery
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26
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Myxoid Dermatofibrosarcoma Protuberans in Childhood. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.06.002] [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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Toll A. The implantation of mohs micrographic surgery in Spain: a work still in progress. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:759-61. [PMID: 22579039 DOI: 10.1016/j.ad.2012.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 01/01/2012] [Indexed: 11/26/2022] Open
Affiliation(s)
- A Toll
- Servicio de Dermatología, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
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28
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Valdivielso-Ramos M, Hernanz JM. Dermatofibrosarcoma Protuberans in Childhood. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:863-873. [PMID: 22482741 DOI: 10.1016/j.ad.2011.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 12/23/2011] [Accepted: 12/25/2011] [Indexed: 11/30/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a fibrohistiocytic tumor of intermediate malignancy that is very rare in childhood. Only 6% of these tumors present in children. Clinical diagnosis is very difficult in the early stages of disease, but to ensure appropriate treatment it is important to identify DFSP as early as possible and rule out benign conditions that are more common at this age. The clinical presentation and histopathologic and molecular characteristics of DFSP are similar in children and adults. Clinical diagnosis is, however, more difficult in children and requires a high degree of suspicion. The absence of characteristic features and the rarity of this tumor explain why diagnosis is often delayed. Complete surgical excision of the tumor is very important to reduce the risk of recurrence. This article presents a review of current knowledge about the management of DFSP in children and examines the latest treatment options.
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29
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Campos M, Zarco C, Acquadro F, Riveiro-Falkenbach E, Rodríguez-Peralto JL. [Myxoid dermatofibrosarcoma protuberans in childhood]. ACTAS DERMO-SIFILIOGRAFICAS 2011; 103:422-6. [PMID: 21872834 DOI: 10.1016/j.ad.2011.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 06/21/2011] [Accepted: 06/29/2011] [Indexed: 11/19/2022] Open
Abstract
Dermatofibrosarcoma protuberans is a locally aggressive skin tumor that affects young and middle-aged adults. A number of histological variants have been described, the myxoid type being one of the least common. Microscopically it is formed of a neoplastic growth that is located in the dermis and hypodermis and has a predominant myxoid component. Peripherally there are infiltrating bundles of spindle-shaped cells that are diffusely positive for the CD34 immunohistochemical marker. We report a case of myxoid dermatofibrosarcoma protuberans on a finger of the left hand of a 14-year-old girl. The tumor had been present for at least 10 years. This is the first pediatric case of myxoid dermatofibrosarcoma protuberans at this site. This histological subtype has mainly been described on the extremities in adults and is very rare in children. We discuss the differential diagnosis with other CD34(+) myxoid mesenchymal tumors.
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Affiliation(s)
- M Campos
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, Spain
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30
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Cinque S, Abeldaño A, Kien M, Pellerano G. Simultaneous diagnosis of mycosis fungoides and dermatofibrosarcoma protuberans in a young patient: is it just a coincidence? Int J Dermatol 2011; 50:1028-9. [PMID: 21781083 DOI: 10.1111/j.1365-4632.2009.04408.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Serra-Guillén C, Sanmartín O, Llombart B, Nagore E, Deltoro C, Martín I, Borella-Estrada R, Requena C, Martorell-Calatayud A, Cervera J, Guillén C. Correlation between preoperative magnetic resonance imaging and surgical margins with modified Mohs for dermatofibrosarcoma protuberans. Dermatol Surg 2011; 37:1638-45. [PMID: 21679274 DOI: 10.1111/j.1524-4725.2011.02077.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is characterized by asymmetrical and poorly defined growth. Magnetic resonance imaging (MRI) has been proposed for the delimitation of this tumor. OBJECTIVES To study the utility of MRI in evaluating the depth of infiltration in DFSP and to compare the efficiency of clinical palpation with that of MRI in delimiting the invasiveness of DFSP. METHODS Observational, prospective study of DFSP cases. The MRI scans for all cases were compared with the exact histological infiltration plane obtained using modified Mohs micrographic surgery (MMS). RESULTS Forty-three DFSPs were included: 22 primary, nine recurrent, and 12 extirpated with positive margins. Sensitivity for detecting deep invasion was 58% on examination using palpation and 67% using MRI. CONCLUSIONS We present the largest series of DFSP cases studied using MRI published to date. In primary cases, MRI has greater sensitivity than palpation for detecting depth of infiltration (67% vs 58%). MRI seems to be useful in primary DFSP in locations other than the head, neck, and upper part of the thorax. MRI is not useful for confirming tumor persistence in extirpated DFSP with positive margins or for studying lateral extension in primary DFSP.
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32
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Llombart B, Sanmartín O, López-Guerrero JA, Monteagudo C, Serra C, Requena C, Poveda A, Vistós JL, Almenar S, Llombart-Bosch A, Guillén C. Dermatofibrosarcoma protuberans: clinical, pathological, and genetic (COL1A1-PDGFB ) study with therapeutic implications. Histopathology 2009; 54:860-72. [PMID: 19635106 DOI: 10.1111/j.1365-2559.2009.03310.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS To analyse the presence of collagen type I alpha 1-platelet-derived growth factor beta (COL1A1-PDGFB) transcripts in 20 cases of dermatofibrosarcoma protuberans (DFSP) and to assess the relationship between COL1A1 breakpoints and clinical and histopathological variables. METHODS AND RESULTS Multiplex reverse transcriptase-polymerase chain reaction was carried out using frozen tissue. Our series contained 14 men and six women. Histologically, most cases were of conventional type (n = 9), followed by fibrosarcoma (n = 4), Bednar tumour (n = 2), sclerosing (n = 2), myoid (n = 1) and atrophic (n = 1) DFSP, and giant cell fibroblastoma (n = 1). Immunohistochemistry revealed CD34 expression in 90% of cases. COL1A1-PDGFB fusion transcripts were present in 89% of cases (exons 18, 19, 20, 25, 26, 31, 33/34, 39, 40, 46, 47 and 48 of COL1A1 with exon 2 of PDGFB). There was no recurrence of DFSP in any of the 19 patients treated by Mohs surgery. A partial response was obtained in the two patients treated with imatinib. CONCLUSIONS The COL1A1-PDGFB fusion was present in all histological subtypes of DFSP, but not all cases expressed the fusion transcript. No association was observed between different COL1A1 breakpoints and clinicopathological parameters. Imatinib mesylate can be useful in locally advanced tumours and metastases.
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Affiliation(s)
- Beatriz Llombart
- Department of Dermatology, University of Valencia, Valencia, Spain.
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