1
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Martinez PF, Richardson S, Bakovic M, Manrique M, Mantilla-Rivas E, Oh AK, Rogers GF. A Rare Case of Dermatofibrosarcoma in a Pediatric Patient. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5546. [PMID: 38264448 PMCID: PMC10805462 DOI: 10.1097/gox.0000000000005546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/27/2023] [Indexed: 01/25/2024]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare malignant fibroblastic tumor. DFSP has an insidious onset, slow growth, and heterogeneous presentation that can create a delay in diagnosis and increase morbidity. In this case report, we present a child with DFSP that presented as a large, slow-growing mass over the dorsum of the left foot. She underwent successful surgical excision with no functional sequelae.
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Affiliation(s)
- Paul F. Martinez
- From the Department of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Skyler Richardson
- From the Department of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Melanie Bakovic
- From the Department of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Monica Manrique
- From the Department of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Esperanza Mantilla-Rivas
- From the Department of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Albert K. Oh
- From the Department of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
| | - Gary F. Rogers
- From the Department of Plastic and Reconstructive Surgery, Children’s National Hospital, Washington, D.C
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2
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Tanaka T, Nakayama R, Mori T, Asano N, Aramaki-Hattori N, Nakamura M, Matsumoto M. Additional Wide Resection of Infantile Dermatofibrosarcoma Protuberans after Unplanned Excision: A Case Report. Case Rep Oncol 2023; 16:331-339. [PMID: 37497423 PMCID: PMC10368097 DOI: 10.1159/000530639] [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: 11/11/2022] [Accepted: 04/04/2023] [Indexed: 07/28/2023] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive intermediate soft tissue neoplasm that occurs in the dermis. DFSP generally occurs in young to middle-aged adults and rarely in infancy. Because of its extreme rarity, DFSP is difficult to diagnose and treat, especially when it occurs in infancy. In this paper, we reported a case of infantile DFSP in which we performed additional wide resection with a 3-cm horizontal margin for a mass that had previously undergone unplanned excision. No tumor recurrence has been seen for 3 years postoperatively. We suggest that the possibility of DFSP should always be considered when an enlarging superficial mass is identified on the trunk, even in an infant. Additionally, radical local treatment is as important for DFSP in infancy as it is for DFSP in adults, even after unplanned excision.
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Affiliation(s)
- Tomoharu Tanaka
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoaki Mori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naofumi Asano
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noriko Aramaki-Hattori
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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3
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Nakajima Y, Fusumae T, Hirai I, Nakamura Y, Mori T, Nakayama R, Tsuchiya M, Hashimoto R, Funakoshi T. Congenital dermatofibrosarcoma protuberans presenting as a depressed plaque: Clinical presentation and chronology. J Dermatol 2022; 50:e127-e128. [PMID: 36478365 DOI: 10.1111/1346-8138.16659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/22/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Yuuri Nakajima
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Takayuki Fusumae
- Department of Dermatology Keio University School of Medicine Tokyo Japan
- Division of Dermatology National Hospital Organization Tokyo Medical Center Tokyo Japan
| | - Ikuko Hirai
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Yoshio Nakamura
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Tomoaki Mori
- Department of Orthopedics Keio University School of Medicine Tokyo Japan
| | - Robert Nakayama
- Department of Orthopedics Keio University School of Medicine Tokyo Japan
| | - Marie Tsuchiya
- Department of Dermatology National Center for Child Health and Development Tokyo Japan
| | - Rena Hashimoto
- Department of Dermatology National Center for Child Health and Development Tokyo Japan
| | - Takeru Funakoshi
- Department of Dermatology Keio University School of Medicine Tokyo Japan
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4
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Xu S, Zhao L, Wang J. Atrophic dermatofibrosarcoma protuberans: a clinicopathological study of 16 cases. Pathology 2019; 51:615-620. [PMID: 31447095 DOI: 10.1016/j.pathol.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/01/2019] [Accepted: 06/10/2019] [Indexed: 11/16/2022]
Abstract
We present a case series of atrophic dermatofibrosarcoma protuberans (DFSP) to further characterise its clinical and pathological features. Sixteen cases were enrolled in the study. There were five males and 11 females with a median age of 28 years. The vast majority occurred in the trunk (12/16, 75%), whereas a minority involved the upper limb or limb gird (2/16, 12.5%), and head and neck region (2/16, 12.5%). The most common presentation was a depressed plaque-like lesion with a greyish-red to purplish-blue colour. Histologically, the lesion was dermal-based consisting of monomorphous spindle cells arranged in parallel fascicles with focal areas displaying storiform architecture. In addition, one case showed remarkable hyalinisation of the matrix, two cases contained scattered pigmented dendritic cells and one case had admixed giant cell fibroblastoma-like component, respectively. The diagnosis was confirmed by immunohistochemical study, and by further fluorescence in situ hybridisation analysis in six cases. Follow-up thus far has revealed a relatively low rate of local recurrence (1/10, 10%). Familiarity with the distinctive clinical and pathological features of atrophic DFSP helps avoid misdiagnosis. Like a classical DFSP, morphological variants can also occur in an atrophic DFSP, including pigmented, sclerosing and hybrid subtypes, albeit rare.
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Affiliation(s)
- Song Xu
- Department of Pathology, The First People's Hospital of Kunshan, Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu Province, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lu Zhao
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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5
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Duffy R, Liaqat M, Lawrence N, Manders S. Dermatofibrosarcoma protuberans in a pediatric patient with ataxia telangiectasia syndrome. Pediatr Dermatol 2019; 36:400-401. [PMID: 30854690 DOI: 10.1111/pde.13779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ataxia telangiectasia (AT) is a rare autosomal recessive neurodegenerative disorder caused by a mutation in the ATM gene. An impaired immune response due to the gene mutation leads to an increased risk of infection and malignancy. We present a rare case of dermatofibrosarcoma protuberans arising in a patient with AT.
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Affiliation(s)
- Robert Duffy
- Cooper Medical School of Rowan University, Camden, NJ
| | - Maryam Liaqat
- Division of Dermatology, Cooper University Hospital, Camden, NJ
| | - Naomi Lawrence
- Division of Dermatology, Cooper University Hospital, Camden, NJ
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6
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Le ST, Kamal HY, Khachemoune A. Mohs micrographic surgery for cutaneous malignancies: A focus review of its indications in pediatric age groups. Pediatr Dermatol 2018; 35:434-440. [PMID: 29575263 DOI: 10.1111/pde.13460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mohs micrographic surgery (MMS) is a highly specialized technique that has been successful in the treatment of a variety of skin tumors. The technique can be performed as an outpatient procedure and encompasses surgical excision and intraoperative assessment of tumor margins in one setting by the same physician. The process ensures precise margin control with maximal preservation of healthy tissues. Mohs micrographic surgery has been practiced worldwide, including in the United States, Europe (United Kingdom, Germany, Spain, Netherlands, Switzerland), and Australia. Although it is commonly performed in adults with greater success, it has been discussed less frequently in children. In this article, we describe several cutaneous tumors in children and the role of Mohs micrographic surgery in their management. A PubMed search was conducted to review the most common cutaneous tumors in children treated using Mohs micrographic surgery. In this review, we discuss indications for Mohs micrographic surgery and pertinent studies examining success rates in children. Mohs micrographic surgery has been used to treat several tumors in children and offers the advantage of high cure rates and tissue conservation. This report emphasizes the benefits of Mohs micrographic surgery in children and highlights several cutaneous tumors for which it has been used to treat successfully.
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Affiliation(s)
- Stephanie T Le
- Drexel/Hahnemann University Hospital, Philadelphia, PA, USA
| | | | - Amor Khachemoune
- State University of New York Downstate and Veterans Affairs Medical Center, Brooklyn, NY, USA
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7
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Laske J, Sergon M, Mentzel T, Beissert S, Maschke J. Congenital dermatofibrosarcoma protuberans clinically mimicking a melanocytic naevus treated with serial excisions. J Eur Acad Dermatol Venereol 2017. [PMID: 28622423 DOI: 10.1111/jdv.14412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Laske
- Klinik für Dermatologie, Universitätsklinikum Dresden, Dresden, Germany
| | - M Sergon
- Institut für Pathologie, Universitätsklinikum Dresden, Dresden, Germany
| | - T Mentzel
- Dermatopathologie Friedrichshafen, Friedrichshafen, Germany
| | - S Beissert
- Klinik für Dermatologie, Universitätsklinikum Dresden, Dresden, Germany
| | - J Maschke
- Klinik für Dermatologie, Universitätsklinikum Dresden, Dresden, Germany
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8
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Patil P, Tambe S, Nayak C, Ramya C. Dermatofibrosarcoma Protuberans in a 9-Year-Old Child. Indian Dermatol Online J 2017; 8:195-197. [PMID: 28584757 PMCID: PMC5447340 DOI: 10.4103/idoj.idoj_51_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue neoplasm of low-to-intermediate grade malignant potential. Childhood onset of DFSP is rare. It is most commonly seen on the trunk and proximal extremities. In children, a high index of suspicion is necessary to avoid delays in diagnosis that can lead to further morbidity. Here, we report a case of DFSP in a 9-year-old female child. Excision biopsy of lesion was performed with 1 cm margin. After confirmation of the diagnosis by histopathology, the patient was observed for recurrence, but there was no recurrence after 1 and half years of follow up.
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Affiliation(s)
- Priyanka Patil
- Department of Dermatology, Topiwala National Medical College and B.Y.L. Nair Hospital, Mumbai, Maharashtra, India
| | - Swagata Tambe
- Department of Dermatology, Topiwala National Medical College and B.Y.L. Nair Hospital, Mumbai, Maharashtra, India
| | - Chitra Nayak
- Department of Dermatology, Topiwala National Medical College and B.Y.L. Nair Hospital, Mumbai, Maharashtra, India
| | - C Ramya
- Department of Dermatology, Topiwala National Medical College and B.Y.L. Nair Hospital, Mumbai, Maharashtra, India
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9
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Brockman RM, Humphrey SR, Moe DC, North PE, King DM, Jensen JN, Siegel DH, Drolet BA. Mimickers of Infantile Hemangiomas. Pediatr Dermatol 2017; 34:331-336. [PMID: 28523875 DOI: 10.1111/pde.13127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infantile hemangiomas (IHs) are the most common tumors of infancy and usually follow a typical course of growth and involution. We report four soft tissue tumors that were referred to the pediatric dermatology clinic as IHs and the process by which they were diagnosed and treated. Clinicians should be aware of presentations of these uncommon, but serious soft tissue tumors. Many of these mimickers have a vastly different clinical prognosis, and early intervention to limit sequelae is crucial. Biopsy of atypical lesions should be considered early in the diagnostic process since they have varied prognosis and treatment strategies.
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Affiliation(s)
- Ross M Brockman
- Department of Pediatrics, Blank Children's Hospital, Des Moines, Iowa
| | - Stephen R Humphrey
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David C Moe
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paula E North
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David M King
- Department of Orthopedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John N Jensen
- Plastic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dawn H Siegel
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Beth A Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
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10
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Posso-De Los Rios CJ, Lara-Corrales I, Ho N. Dermatofibrosarcoma protuberans in pediatric patients: a report of 17 cases. J Cutan Med Surg 2016; 18:180-5. [PMID: 24800706 DOI: 10.2310/7750.2013.13099] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor. In children, there are acquired and congenital presentations. Due to clinical similarities with other conditions, diagnosis may be delayed. OBJECTIVE To review the clinical characteristics and treatment of DFSP in pediatric patients. METHODS A retrospective chart review was performed from January 2002 to September 2012. Inclusion criteria were patients under 18 years of age with a histopathologic diagnosis of DFSP. Data on demographics, clinical characteristics, treatments, and outcomes were collected. RESULTS Information was gathered from 17 patients; 9 (53%) were female. Congenital lesions were reported in 7 patients. The mean delay of diagnosis was 5.7 years; the most common anatomic location was the trunk in 8 of 17 (47%) cases. Treatment options included wide local surgery, Mohs surgery, and imatinib mesylate. CONCLUSION A detailed medical history and identification of the natural course of common conditions seen in pediatric patients are important to identify less common lesions and to suspect DFSP.
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11
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Han HH, Lim SY, Park YM, Rhie JW. Congenital Dermatofibrosarcoma Protuberans: A Case Report and Literature Review. Ann Dermatol 2015; 27:597-600. [PMID: 26512174 PMCID: PMC4622894 DOI: 10.5021/ad.2015.27.5.597] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/19/2015] [Accepted: 02/05/2015] [Indexed: 11/08/2022] Open
Abstract
Congenital dermatofibrosarcoma protuberans (DFSP) is an extremely rare skin tumor that is commonly misdiagnosed, or is often diagnosed long after the initial presentation. Although many cases of DFSP are diagnosed in adulthood, there are some differences between adult DFSP and congenital DFSP. We report a case of congenital DFSP that was initially misdiagnosed as a simple vascular lesion. The delay in diagnosis led to the considerable growth of the lesion, such that a huge scar was left after the surgical treatment. The major differences between adult and congenital DFSP are discussed through a literature review. Clinicians should be aware of the characteristics of congenital DFSP, to reduce misdiagnosis and the delay of diagnosis from the initial presentation.
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Affiliation(s)
- Hyun Ho Han
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Yeon Lim
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Won Rhie
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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12
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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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Abstract
Classically, dermatofibrosarcoma protuberans (DFSP) is a disease of adults. The world literature revision shows that several pediatric cases have been reported so far; this might suggest that the number of infants with the condition might be larger than that estimated previously. Here, we report the 183rd case of histologically confirmed DFSP in young age. A 14-year-old white male patient came under our care for a slowly growing, pale brownish lesion on the neck skin. A biopsy specimen showed a DFSP. Subsequently, a wide surgery excision with 3 cm of resection margins including the underlying fascia was performed. To date, the patient has been in follow-up for 6 years without evidence of recurrent disease. The clinical features and treatment of DFSP diagnosed in childhood and adolescence reported in the published literature are reviewed to provide new insights about this rare entity. The aim is to emphasize the importance of biopsy for histologic evaluation in the cases that show a persistent or a large cutaneous plaque or nodule without pathognomonic clinical features that permit a clinical diagnosis. An accurate knowledge of the disease is the prerequisite for a wider recognition and appropriate treatment.
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14
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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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15
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Kornik RI, Muchard LK, Teng JM. Dermatofibrosarcoma protuberans in children: an update on the diagnosis and treatment. Pediatr Dermatol 2012; 29:707-13. [PMID: 22780227 DOI: 10.1111/j.1525-1470.2012.01767.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a fibrohistiocytic tumor of low grade malignant potential. Although rare, pediatric cases pose a particular challenge in diagnosis and management. In children, the clinical appearance may be heterogeneous and a high index of suspicion is necessary to avoid delays in diagnosis which can lead to further morbidity. Histologic examination, often with the use of appropriate immunostains, is necessary for diagnosis. Advances in the understanding of the molecular genetics of DFSP have led to further diagnostic and therapeutic modalities. DFSP is thought to result from a translocation between platelet-derived growth factor beta (PDGFB, 22q13.1) and type 1 collagen (COL1A1, 17q21≈22) leading to a fusion protein (PDGFB) which stimulates the PDGF receptor. Detection of this translocation in tissue via PCR or fluorescence in situ hybridization (FISH) can be helpful in difficult cases. While surgery with wide local excision or Mohs micrographic surgery is the mainstay of treatment, the use of targeted therapy with imatanib mesylate shows promise in large or unresectable tumors. Knowledge of the clinical features, histology, genetics, and treatment options is important for successful management of these tumors.
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Affiliation(s)
- Rachel I Kornik
- Department of Dermatology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53715, USA
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16
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Gong Q, Wang Z, Li X, Fan Q. Primitive myxoid mesenchymal tumor of infancy: Report of two cases and review of the literature. Pathol Int 2012; 62:549-53. [DOI: 10.1111/j.1440-1827.2012.02836.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Black J, Coffin CM, Dehner LP. Fibrohistiocytic tumors and related neoplasms in children and adolescents. Pediatr Dev Pathol 2012; 15:181-210. [PMID: 22420728 DOI: 10.2350/11-03-1001-pb.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fibrohistiocytic tumors (FHTs) in children and adolescents range from the benign fibrous histiocytoma, or dermatofibroma, to a variety of intermediate and malignant neoplasms, such as dermatofibrosarcoma protruberans and high-grade undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma). Those tumors as a group are comprised of fibroblasts, myofibroblasts, and histiocytes-dendritic cells with a variably prominent inflammatory infiltrate consisting of lymphocytes and eosinophils. Dendritic cells are also a major constituent of another group of neoplasms that include Langerhans cell histiocytosis, follicular and interdigitating cell sarcomas, and juvenile xanthogranuloma. These latter tumors are considered in this discussion for the sake of differential diagnosis and their possible histogenetic relationship to FHTs. Recent studies have suggested that the relationship between the fibroblast and histiocyte in the FHTs may reflect the intrinsic capacity to transdifferentiate from one to the other morphologic and functional state. The so-called "facultative fibroblast," as a cell with fibroblastic and histiocytic properties, was discussed in the context of the fibrous xanthoma 50 years ago. Possibly the entire histogenetic concept of FHTs should be reconsidered in light of current studies.
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Affiliation(s)
- Jennifer Black
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.
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18
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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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19
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Kesserwan C, Sokolic R, Cowen EW, Garabedian E, Heselmeyer-Haddad K, Lee CCR, Pittaluga S, Ortiz C, Baird K, Lopez-Terrada D, Bridge J, Wayne AS, Candotti F. Multicentric dermatofibrosarcoma protuberans in patients with adenosine deaminase-deficient severe combined immune deficiency. J Allergy Clin Immunol 2012; 129:762-769.e1. [PMID: 22153773 PMCID: PMC3294021 DOI: 10.1016/j.jaci.2011.10.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 10/21/2011] [Accepted: 10/24/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare malignant skin tumor associated with a characteristic chromosomal translocation (t[17;22][q22;q13]) resulting in the COL1A1-platelet-derived growth factor β(PDGFB) fusion gene. This malignancy is rarely diagnosed in childhood. OBJECTIVE We observed an unexpected high incidence of this DFSP in children affected with adenosine deaminase-deficient severe combined immunodeficiency (ADA-SCID) and set out to evaluate the association of these 2 clinical entities. METHODS Twelve patients with ADA-SCID were evaluated with a complete dermatologic examination and skin biopsy when indicated. Conventional cytogenetic and molecular analyses (fluorescence in situ hybridization, RT-PCR, or both) were performed when possible. RESULTS Eight patients were found to have DFSP. Six patients had multicentric involvement (4-15 lesions), primarily of the trunk and extremities. Most lesions presented as 2- to 15-mm, round atrophic plaques. Nodular lesions were present in 3 patients. In all cases CD34 expression was diffusely positive, and diagnosis was confirmed either by means of cytogenetic analysis, molecular testing, or both. The characteristic DFSP-associated translocation, t(17;22)(q22;q13), was identified in 6 patients; results of fluorescence in situ hybridization were positive for fusion of the COL1A1 and PDGFB loci in 7 patients; and RT-PCR showed the COL1A1-PDGFB fusion transcript in 6 patients. CONCLUSIONS We describe a previously unrecognized association between ADA-SCID and DFSP with unique features, such as multicentricity and occurrence in early age. We hypothesize that the t(17;22)(q22;q13) translocation that results in dermal overexpression of PDGFB and favors the development of fibrotic tumors might arise because of the known DNA repair defect in patients with ADA-SCID. Although the natural course of DFSP in the setting of ADA-SCID is unknown, this observation should prompt regular screening for DFSP in patients with ADA-SCID.
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Affiliation(s)
- Chimen Kesserwan
- the Genetics and Molecular Biology Branch and the Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda
| | - Robert Sokolic
- the Genetics and Molecular Biology Branch and the Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda
| | - Edward W. Cowen
- the Dermatology Branch, National Institutes of Health, Bethesda
| | - Elizabeth Garabedian
- the Genetics and Molecular Biology Branch and the Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda
| | | | | | | | - Clarymar Ortiz
- the Section of Cancer Genomics, National Institutes of Health, Bethesda
| | - Kristin Baird
- the Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda
| | | | - Julia Bridge
- the Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha
| | - Alan S. Wayne
- the Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda
| | - Fabio Candotti
- the Genetics and Molecular Biology Branch and the Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda
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Abstract
Nonrhabdomyosarcoma soft-tissue sarcomas (NRSTS) represent a subgroup of sarcomas that encompass more than 50 distinct histologies. All are rare, but some are more common in patients younger than 20 years of age. The management of patients with many histologies overlap. However, this review will focus on issues unique to a select few NRSTS that are most common in pediatric and adolescent patients. Here, we will discuss the recent advances in the diagnosis, surgical management, and treatment of NRSTS. Adequate surgical local control of the primary tumor is a critical component of the treatment strategy will be emphasized in this review because it determines local and distant recurrence.
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Huh WW, Fitzgerald N, Mahajan A, Sturgis EM, Beverly Raney R, Anderson PM. Pediatric sarcomas and related tumors of the head and neck. Cancer Treat Rev 2011; 37:431-9. [DOI: 10.1016/j.ctrv.2011.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 04/12/2011] [Accepted: 04/18/2011] [Indexed: 01/07/2023]
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22
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Mahé E, Sei JF, Chaussade V, Di Lucca-Chrisment J, Serra M, Tchakerian A, Clérici T, Zimmermann U, Saiag P. [Mohs micrographic surgery in two children with dermatofibrosarcoma protuberans]. Arch Pediatr 2011; 18:885-8. [PMID: 21705203 DOI: 10.1016/j.arcped.2011.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 10/12/2010] [Accepted: 05/21/2011] [Indexed: 10/18/2022]
Abstract
Dermatofibrosarcoma protuberans is a rare low-grade malignant tumor. The pseudopodia structure of the tumor requires 3-5 cm surgical margins. Mohs micrographic surgery (MMC) can reduce these margins to 1.3 cm while controlling all the histological excision margins. Children seem to be a good indication for this technique because it reduces the amount of skin removed. We report 2 cases of pediatric DFS treated with CMM to illustrate the usefulness of this technique in pediatrics. Two girls, aged 12 and 13 years, had a dermatofibrosarcoma located on the breast and sternum, respectively. CMM was proposed. One operative session was needed with direct closure in a second phase. MMS is a useful surgical technique for childhood tumors. If dermatofibrosarcoma is a very good indication in children, other skin tumors could benefit from this approach.
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Affiliation(s)
- E Mahé
- Service de dermatologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-colonel Prud'hon, 95107 Argenteuil cedex, France.
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23
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Gooskens SLM, Oranje AP, van Adrichem LNA, de Waard-van der Spek FB, den Hollander JC, van de Ven CP, van den Heuvel-Eibrink MM. Imatinib mesylate for children with dermatofibrosarcoma protuberans (DFSP). Pediatr Blood Cancer 2010; 55:369-73. [PMID: 20582941 DOI: 10.1002/pbc.22494] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare malignant soft tissue tumor in children. DFSP is characterized by a specific fusion of the platelet-derived growth factor beta (PDGFbeta) with the collagen type 1alpha1 (COL1alpha1) gene which renders these tumors responsive to targeted therapy with tyrosine kinase inhibitors, such as imatinib mesylate, as is reported in adults. In the current report, we describe the first small pediatric DFSP series, in which response to imatinib mesylate contributed to successful treatment outcome.
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Affiliation(s)
- Saskia L M Gooskens
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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Love WE, Keiler SA, Tamburro JE, Honda K, Gosain AK, Bordeaux JS. Surgical management of congenital dermatofibrosarcoma protuberans. J Am Acad Dermatol 2009; 61:1014-23. [PMID: 19925926 DOI: 10.1016/j.jaad.2009.05.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 05/01/2009] [Accepted: 05/17/2009] [Indexed: 11/30/2022]
Abstract
Congenital dermatofibrosarcoma protuberans (DFSP) is a rare tumor with varying clinical presentations that is commonly misdiagnosed. Treatment of congenital DFSP is complicated by delays in diagnosis and its propensity for subclinical spread. Of 61 reported cases, 11 (18%) were treated with Mohs micrographic surgery (MMS) and 46 (75%) were treated with wide local excision (WLE). One case was treated with imatinib, and the remaining 3 did not differentiate between receiving MMS or WLE. In the cases of congenital DFSP treated with MMS the clearance rate was 100% with an average follow-up of 4.3 years. The clearance rate seen with WLE was 89% with an average follow-up period of 1.9 years. The average margins taken during MMS (1.7 cm) were smaller than those taken with WLE (2.8 cm). Fifty percent of cases with available follow-up undergoing WLE required multiple surgeries. Based on superior cure rates with long-term follow-up, smaller surgical margins, and fewer surgical sessions, MMS should be considered as first-line treatment for congenital DFSP.
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Affiliation(s)
- W Elliot Love
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
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25
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Yu Z, Parham DM. Paediatric soft tissue tumours: from histology to molecular diagnosis. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.mpdhp.2009.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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