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Yang X, Chen H, Li M, Chen Y, Liu H. Increased 68 Ga-FAPI Uptake in Dermatofibrosarcoma Protuberans. Clin Nucl Med 2022; 47:710-711. [PMID: 35605047 DOI: 10.1097/rlu.0000000000004280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 47-year-old woman presented with a 6-month history of palpable masses in the right hip. The patient was subsequently enrolled in our clinical trial of 68 Ga-FAPI PET/CT study on tumors. Intense 68 Ga-FAPI activities were noted in the right hip lesions, suggestive of malignancies. Pathological examination using tissue obtained on surgical resection rendered a diagnosis of dermatofibrosarcoma protuberans.
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Affiliation(s)
| | | | - Mengyu Li
- Breast Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
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2
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Rodríguez-Alfonso B, Simó-Perdigó M, Orcajo Rincón J. Functional imaging in soft tissue sarcomas: Update of the indications for 18F-FDG-PET/CT. Rev Esp Med Nucl Imagen Mol 2020. [DOI: 10.1016/j.remnie.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rodríguez-Alfonso B, Simó-Perdigó M, Orcajo Rincón J. Functional image in soft tissue sarcomas: An update of the indications of 18F-FDG-PET/CT. Rev Esp Med Nucl Imagen Mol 2020; 39:233-243. [PMID: 32616457 DOI: 10.1016/j.remn.2020.06.001] [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: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022]
Abstract
Soft tissue sarcomas (STS) are a rare and heterogeneous group of tumors. They account for 1% of solid malignant tumors in adults and 7% in children and are responsible for 2% of cancer mortality. They require a multidisciplinary approach in centers with experience. This collaboration aims to update the scientific evidence to strengthen, together with clinical experience, the bases for the use and limitations of 18F-FDG-PET/CT in STSs. The general recommendations for the use of PET/CT in STS at present are summarized as the initial evaluation of soft tissue tumours when conventional image does not establish benignity with certainty and this determines the approach; in biopsy guiding in selected cases; in the initial staging, as additional tool, for rhabdomyosarcoma and STS of extremities or superficial trunk and head and neck tumours; in the suspicion of local recurrence when the CT or MRI are inconclusive and in the presence of osteosynthesis or prosthetic material and in assessment of therapy response to local/systemic therapy in stages ii/iii. In addition, PET/CT has the added value of being a surrogate marker of the histopathological response and it provides prognostic information, both in the baseline study and after treatment.
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Affiliation(s)
- B Rodríguez-Alfonso
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro de Majadahonda, Majadahonda, Madrid, España.
| | - M Simó-Perdigó
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Orcajo Rincón
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, España; Miembro del Grupo Español de Investigación en Sarcomas (GEIS)
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Dermatofibrosarcoma Protuberans: Update on the Diagnosis and Treatment. J Clin Med 2020; 9:jcm9061752. [PMID: 32516921 PMCID: PMC7355835 DOI: 10.3390/jcm9061752] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 12/23/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a slow growing, low- to intermediate-grade dermal soft-tissue tumor. It has a high local recurrence rate but low metastatic potential. It is characterized by a uniform spindle cell arrangement, classically with a storiform pattern and CD34 immunoreactivity. The histomorphology and immunophenotype overlap with a broad range of other neoplasms. The standard treatment is complete surgical excision. The surgical procedures include wide local excision (WLE) with tumor free margins, Mohs micrographic surgery (MMS) and amputation. Unresectable DFSPs are treated with radiation therapy and/or targeted therapy. DFSP has characteristic t(17; 22) (q22; q13), resulting in a COL1A1- PDGFB fusion transcripts in more than 90% of DFSPs. Molecular detection of the gene rearrangement or fusion transcripts is helpful for the diagnosis of patients with atypical morphology and for screening candidates for targeted therapy with tyrosine kinase inhibitors. The aims of the present review are to update the clinical presentation, tumorigenesis and histopathology of DFSP and its variants for diagnosis and differential diagnosis from other benign and malignant tumors, to compare the advantages and drawbacks of WLE and MMS, to propose the baseline for selecting surgical procedure based on tumor’s location, size, stage and relationship with surrounding soft tissue and bone structures, and to provide a biologic rationale for the systemic therapy. We further propose a modified clinical staging system of DFSP and a surveillance program for the patients after surgical excision.
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Banach BS, Antic T, Bridge JA, Cipriani NA, Frye L, Krausz TN, Biernacka A. Fine-needle aspiration of dermatofibrosarcoma protuberans metastasizing to hemithorax with superior vena cava compression: Case report and literature review. Diagn Cytopathol 2019; 47:797-802. [PMID: 30919592 DOI: 10.1002/dc.24179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/03/2019] [Accepted: 03/07/2019] [Indexed: 11/07/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a low-grade spindle cell tumor of the skin commonly arising on the trunk and extremities which tends to be slow growing yet locally aggressive. DFSPs are associated with a good prognosis when surgical excision with negative margins is achieved. Although local recurrences occur up to 50% of incompletely resected cases, distant metastases are very rare. Here, we report a case of DFSP metastasizing to the right hemithorax diagnosed by an endobronchial ultrasound-guided fine-needle aspiration (FNA) 9 years after initial presentation. The aspirate showed a bland spindle cell proliferation that was morphologically similar to the original skin excision; the storiform pattern was particularly prominent in tumor-tissue fragments in the cellblock. Immunostaining showed strong, diffuse positivity for CD34. Molecular studies demonstrated a characteristic COL1A1/PDGFB fusion in both original and metastatic specimens. A review of the literature revealed that metastatic DFSP most often involves the lungs, occurs usually in cases with fibrosarcomatous transformation and after a local recurrence, and presents on average 4.5 years after the original diagnosis. This case did not show fibrosarcomatous transformation or local recurrence prior to metastasis 9 years later. In summary, it is important to consider the potential for metastases years after a nonrecurring primary DFSP, despite its rarity. Cytologic features when complemented by ancillary studies and awareness of the patient's prior clinical history permit a confident diagnosis of metastatic DFSP by FNA. In addition, by confirming the characteristic translocation, tyrosine-kinase inhibitor imatinib can provide additional treatment options for unresectable metastatic DFSP.
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Affiliation(s)
- Bridget S Banach
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Tatjana Antic
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Julia A Bridge
- Department of Pathology and Microbiology, University of Nebraska Medical Center, The Translational Genomics Research Institute, Phoenix, Arizona
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Laura Frye
- Department of Pulmonary Medicine, The University of Chicago, Chicago, Illinois
| | - Thomas N Krausz
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Anna Biernacka
- Department of Pathology, The University of Chicago, Chicago, Illinois
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Radiologic-Pathologic Correlations of Fibrosarcomatous Dermatofibrosarcoma Protuberans With Various Histological Features on Enhanced MRI and PET/MRI. Clin Nucl Med 2016; 41:241-3. [PMID: 26704730 DOI: 10.1097/rlu.0000000000001099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a cutaneous tumor of intermediate-grade malignant potential, and it rarely shows dedifferentiation to high-grade fibrosarcoma, which is called "fibrosarcomatous DFSP." We present the enhanced MRI and PET/MRI findings and our comparison with pathological findings in a case of fibrosarcomatous DFSP with various histological features.
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Kashyap R, Muddu VK, Anantamakula S, Sri S. Usefulness of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in dermatofibrosarcoma protuberans on treatment with imatinib. Indian J Nucl Med 2016; 31:191-3. [PMID: 27385888 PMCID: PMC4918481 DOI: 10.4103/0972-3919.181528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare locally aggressive tumor with distant metastases being unusual. We present a case of metastatic DFSP treated with imatinib showing complete metabolic response to treatment.
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Affiliation(s)
- Raghava Kashyap
- Department of Nuclear Medicine and Positron Emission Tomography, Mahatma Gandhi Cancer Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Vamshi Krishna Muddu
- Department of Medical Oncology, Mahatma Gandhi Cancer Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Sameera Anantamakula
- Department of Nuclear Medicine and Positron Emission Tomography, Mahatma Gandhi Cancer Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Satya Sri
- Department of Pathology, Indus Hospital, Visakhapatnam, Andhra Pradesh, India
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Duncan JR, Carr D, Kaffenberger BH. The utility of positron emission tomography with and without computed tomography in patients with nonmelanoma skin cancer. J Am Acad Dermatol 2016; 75:186-96. [PMID: 26992283 DOI: 10.1016/j.jaad.2016.01.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/16/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
Combined positron emission tomography (PET) and computed tomography (CT) scans are widely used in the staging and monitoring of most malignancies. The differential for PET-positive cutaneous lesions includes primary skin cancers, infections, cutaneous metastases from distant malignancies, and benign neoplasms. In dermatology, PET/CT scans have been most widely studied in patients with melanoma and Merkel cell carcinoma. The role of PET/CT scans in the management of other cutaneous malignancies is less clear, but it has shown great promise in the management of patients with squamous cell carcinoma and cutaneous lymphoma. This review seeks to address the usefulness of PET/CT scans in nonmelanoma skin cancer and to provide guidance regarding the management of patients with incidental PET-positive nodules. Currently, there is limited experience with PET/CT scans for staging and monitoring of non-head and neck metastatic basal cell and squamous cell carcinomas, and results show limited sensitivity and specificity. We also address the evidence for management of an incidental PET-positive cutaneous nodule and recommend obtaining a biopsy specimen in patients with a known noncutaneous malignancy, a history of primary skin cancer, or a high risk of either cutaneous or noncutaneous malignancy.
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Affiliation(s)
| | - David Carr
- Division of Dermatology, Wexner Medical Center at Ohio State University, Ghanna, Ohio
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10
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Basu S, Goliwale F. 18F-FDG PET/CT Prediction of an Aggressive Clinical Course for Dermatofibrosarcoma Protuberans. J Nucl Med Technol 2015; 44:88-9. [PMID: 26338485 DOI: 10.2967/jnmt.115.163212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/24/2015] [Indexed: 01/19/2023] Open
Abstract
The ability to assess tumor biology is a benefit of molecular imaging with (18)F-FDG PET/CT, which performs better than anatomic imaging in evaluating malignancies. We present an unusual case of fatal dermatofibrosarcoma protuberans, a usually indolent entity for which high-grade (18)F-FDG uptake was predictive of an aggressive clinical course unabated by tyrosine kinase inhibitor imatinib mesylate, to which the patient showed a poor response.
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Affiliation(s)
- Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, India; and
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18F-FDG PET/CT in a seldom case of primary duodenal dermatofibrosarcoma protuberans with lung and skeletal metastases. Clin Nucl Med 2014; 40:e140-2. [PMID: 24999683 DOI: 10.1097/rlu.0000000000000455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous soft tissue sarcoma tumor that arises from the dermis of the skin. Sarcomas of the intestines are rare, and a DFSP arising from the small intestine is a very rare occurrence. Here we present F-FDG PET/CT imaging findings of a 60-year-old man with DFSP in the duodenum with metastases to the lung, mesentery, and skeleton.
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