1
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Zhang X, Sun D, Zheng H, Rao Y, Deng Y, Liang X, chen J, Yang J. Comprehensive analysis of transcriptome characteristics and identification of TLK2 as a potential biomarker in dermatofibrosarcoma protuberans. Front Genet 2022; 13:926282. [PMID: 36134026 PMCID: PMC9483842 DOI: 10.3389/fgene.2022.926282] [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: 04/22/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma characterized by local invasion and recurrence. RNA sequencing (RNA-seq) allows the qualification of cellular RNA populations and provides information on the transcriptional state. However, few studies have comprehensively analyzed DFSP transcriptional data. Methods: Fourteen DFSP samples with paired non-neoplastic soft tissue from Chinese patients undergoing Mohs micrographic surgery were used for RNA-seq analysis. Differential expression analysis and enrichment analysis for RNA-seq data were performed to identify fusion genes, biomarkers, and microenvironment characteristics of DFSP. Results: This study systemically describes the transcriptomic characteristics of DFSP. First, we performed gene fusion analysis and identified a novel FBN1-CSAD fusion event in a DFSP patient with fibrosarcomatous transformation. Then, we identified TLK2 as a biomarker for DFSP based on functional enrichment analysis, and validated its accuracy for diagnosing DFSP by immunohistochemical staining and joint analysis with public data. Finally, microenvironment analysis described the infiltration characteristics of immune and stromal cells in DFSP. Conclusion: This study demonstrates that RNA-seq can serve as a promising strategy for exploring molecular mechanisms in DFSP. Our results provide new insights into accurate diagnosis and therapeutic targets of DFSP.
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Affiliation(s)
- Xiao Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Di Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Zheng
- Department of Pathology, Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yamin Rao
- Department of Pathology, Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuqi Deng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Liang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun chen
- Department of Dermatology, Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jun Chen, ; Jun yang,
| | - Jun Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jun Chen, ; Jun yang,
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Suryawisesa IBM, Gotama OP. Dermatofibrosarcoma: Case Report Series. ASIAN JOURNAL OF ONCOLOGY 2022. [DOI: 10.1055/s-0042-1751121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AbstractDermatofibrosarcoma protuberans (DFSP) is an uncommon, painless, slow-growth, superficial soft tissue malignant sarcoma corresponding to less than 0.1% of all malignancies. The primary treatment for DFSP is surgical excision, which is wide local excision (WLE) with tumor-free margins, Mohs micrographic surgery (MMS), and partial or total amputation. The goal of surgical excision is to achieve negative resection margins, thus reducing the local recurrence rate. These three cases reported large dermatofibrosarcoma, which began as a small nodule and progressed within approximately a year and were treated subsequently with wide excisions surgery. The unique and challenging part for most surgeons is removing the mass with a concentric excision due to its specific growth pattern. To achieve negative resection margins, the width of the tumor-free margins and infiltrating depth are two essential factors to be considered for complete excision for both WLE and MMS surgical techniques. Adjuvant therapy, including radiotherapy and targeted therapy, is reserved for unresectable, advanced stage, or recurrent tumors.
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Affiliation(s)
- Ida B. M. Suryawisesa
- General Surgery and Oncologic Surgery Department, Faculty of Medicine, Udayana University/ Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Oki P. Gotama
- General Surgery Department, Faculty of Medicine, Udayana University/ Sanglah General Hospital, Denpasar, Bali, Indonesia
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3
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Reilly DJ, Loo YL, Alexander WM, Wilks DJ, MacGregor D, Coombs CJ. Diagnostic and Management Considerations in Pediatric Dermatofibrosarcoma Protuberans. Ann Plast Surg 2022; 88:319-322. [PMID: 34387577 DOI: 10.1097/sap.0000000000002970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare fibrohistiocytic tumor of dermal origin. Six percent of all cases present in children, with a childhood incidence of 1 per million. METHODS This is a retrospective review of all cases of pediatric DFSP managed at a single institution over a 23-year period. RESULTS Seventeen patients (10 male; mean age, 9.9 years) were managed during the study period. The median follow-up was 29 months. All patients had surgical excision. Three patients required further excision to achieve uninvolved final margins. There were no recurrences observed. CONCLUSIONS Pediatric DFSP should be managed by a soft tissue tumor multidisciplinary team, with experienced pathologists and reconstructive surgeons. Where R0 resections are obtained, patients can experience recurrence-free survival.
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Affiliation(s)
- Daniel J Reilly
- From the Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital
| | - Yew Loong Loo
- From the Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital
| | - William M Alexander
- From the Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital
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4
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Pediatric Pigmented Fibrosarcomatous Dermatofibrosarcoma Protuberans: Answer. Am J Dermatopathol 2022; 44:75-76. [PMID: 34889817 DOI: 10.1097/dad.0000000000002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Wahjudi TD, Kutzner H, Bleeke M, Hoeger PH. Multicentric dermatofibrosarcoma protuberans in a child with severe combined immunodeficiency due to adenosine deaminase deficiency. Pediatr Dermatol 2021; 38:875-878. [PMID: 33931899 DOI: 10.1111/pde.14597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the case of a 4-year-old boy, post-human stem cell transplantation for severe combined immunodeficiency (SCID) due to adenosine deaminase deficiency (ADA), who developed multiple dermatofibrosarcoma protuberans (DFSP). We hypothesize a role for chimerism leading to accumulation of toxic metabolites which can cause DNA strand breaks and inhibit lymphocyte activation. Patients with ADA-SCID should remain under lifelong dermatologic surveillance as DFSP lesions can be quite inconspicuous.
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Affiliation(s)
- Tatjana D Wahjudi
- Departments of Paediatrics, Catholic Children´s Hospital Wilhelmstift, Hamburg, Germany
| | - Heinz Kutzner
- Institute of Dermatopathology, Friedrichshafen, Germany
| | - Matthias Bleeke
- Divison of Paediatric Stem Cell Transplantation and Immunology, University Medical Center Eppendorf, Hamburg, Germany
| | - Peter H Hoeger
- Departments of Paediatrics, Catholic Children´s Hospital Wilhelmstift, Hamburg, Germany.,Department of Paediatric Dermatology, Catholic Children´s Hospital Wilhelmstift, Hamburg, Germany
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6
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Choong P, Lindsay D, Khoo M, Saifuddin A. Dermatofibrosarcoma protuberans: the diagnosis of high-grade fibrosarcomatous transformation. Skeletal Radiol 2021; 50:789-799. [PMID: 33001221 DOI: 10.1007/s00256-020-03617-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Dermatofibrosarcoma protuberans (DFSP) is an intermediate-grade tumour which may undergo fibrosarcomatous transformation to a high-grade sarcoma (DFSP-FST). DFSP-FST requires wide local resection, and therefore, pre-operative identification is important. The aims of this study are to see if DFSP and DFSP-FST can be differentiated based on MRI appearances, and to determine the ability of ultrasound-guided core needle biopsy (US-CNB) to identify DFSP-FST. MATERIALS AND METHODS Retrospective review of patients with a histological diagnosis of DFSP with/without transformation to DFSP-FST. Patient age, gender, lesion location and maximal size were recorded, as were several MRI features. MRI studies were reviewed independently by 2 musculoskeletal radiologists and the assessed features were then compared with final surgical resection histology. Histological results of US-CNB were also compared with final surgical pathology. RESULTS A total of 42 patients were included, 26 males and 16 females with a mean age of 41.3 years (range 3-78 years). The upper limb was involved in 12 cases, the lower limb in 17 and the trunk in 13. Final surgical histological diagnosis was DFSP in 21 (50%) cases and DFSP-FST in 21 (50%) cases. Mean tumour dimension for DFSP was 32 mm and DFSP-FST 68 mm (p < 0.001). MRI features indicative of DFSP-FST included multi-lobular morphology (p = 0.03), T2W hypointensity compared with fat (p = 0.03), internal flow voids (p = 0.03) and peri-tumoral oedema (p < 0.001). Only 3 cases of DFSP-FST were correctly diagnosed on US-CNB. CONCLUSIONS Various MRI findings can suggest a diagnosis of DFSP-FST, but US-CNB is unreliable at identifying high-grade fibrosarcomatous transformation.
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Affiliation(s)
- Paul Choong
- Spinal Cord Injuries Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Daniel Lindsay
- Department of Histopathology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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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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8
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Caroppo F, Salmaso R, Fontana E, Fortina AB. A case of congenital dermatofibrosarcoma protuberans in a 2-year-old child. JAAD Case Rep 2020; 6:606-607. [PMID: 32613051 PMCID: PMC7317163 DOI: 10.1016/j.jdcr.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Francesca Caroppo
- Pediatric Dermatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Roberto Salmaso
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Elena Fontana
- Pediatric Dermatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
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9
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Krewer J, Rolle U, Koscielniak E, Vokuhl C, Mentzel T, Seitz G, Feuchtgruber S, von Kalle T, Scheer M, Münter M, Bielack SS, Fuchs J, Niggli F, Hettmer S, Klingebiel T, Sparber-Sauer M. Dermatofibrosarcoma protuberans in children and adolescents: Primary and Relapsed disease-Experience of the Cooperative Weichteilsarkomstudiengruppe (CWS). J Surg Oncol 2020; 122:263-272. [PMID: 32430916 DOI: 10.1002/jso.25943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade tumor. Little is known about best treatment of primary and relapsed disease (RD). METHODS Treatment and outcome of 40 patients with DFSP prospectively registered within the CWS-96 and -2002P trials and the registry SoTiSaR (1996-2016) were analysed. RESULTS Median age was 8 years (range, 0.64-17.77). Fluorescence in situ hybridization analysis to detect COL1A1-PDGFB fusion genes was positive in 86% (12/14) of evaluated patients. Primary resection was performed in all patients. Patients had IRS group I (n = 28), II (n = 9), and III (n = 2); not available (n = 1). To achieve complete remission (CR), a secondary resection was performed in 18 patients resulting in microscopically complete (R0, n = 34/40) and microscopically incomplete (R1, n = 5/40) resection. All patients achieved CR. The 5-year event-free survival (EFS) and overall survival was 86% (±12; CI, 95%) and 100% (±0; CI, 95%), respectively. R0 resection/IRS I was significantly favorable for the 5-year EFS. Local relapse occurred after a median time of 1.1 years (range, 0.04-5.1) in 15% (6/40) after CR. All patients with RD underwent resection and achieved CR. Three patients had fibrosarcomatous DFSP, two were alive after R0 resection. CONCLUSION Complete surgical resection is mandatory to prevent relapse of DFSP.
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Affiliation(s)
- Julia Krewer
- Department of Pediatric Surgery and Urology, University of Frankfurt, Frankfurt, Germany
| | - Udo Rolle
- Department of Pediatric Surgery and Urology, University of Frankfurt, Frankfurt, Germany
| | - Ewa Koscielniak
- Klinikum Stuttgart-Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany.,Department of Pediatric Hematology and Oncology, Children's Hospital, Tuebingen, Germany
| | - Christian Vokuhl
- Department of Pathology, Section of Pediatric Pathology, Bonn, Germany
| | - Thomas Mentzel
- Dermatopathologie Friedrichshafen/Bodensee, Friedrichshafen, Germany
| | - Guido Seitz
- Department of Pediatric Surgery, University Children's Hospital Marburg, Marburg, Germany
| | - Simone Feuchtgruber
- Klinikum Stuttgart-Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Thekla von Kalle
- Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Olgahospital, Institute of Radiology, Stuttgart, Germany
| | - Monika Scheer
- Klinikum Stuttgart-Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
| | - Marc Münter
- Klinikum Stuttgart, Institute of Radiotherapy, Stuttgart, Germany
| | - Stefan S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany.,Department of Pediatric Hematology and Oncology, University of Muenster, Muenster, Germany
| | - Joerg Fuchs
- Department of Pediatric Surgery and Urology, University Children's Hospital, Tuebingen, Germany
| | - Felix Niggli
- Department of Pediatric Oncology, University of Zurich, Zurich, Switzerland
| | - Simone Hettmer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Klingebiel
- Department of Children and Adolescents, University of Frankfurt, Frankfurt, Germany
| | - Monika Sparber-Sauer
- Klinikum Stuttgart-Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pediatrics 5 (Oncology, Hematology, Immunology), Stuttgart, Germany
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10
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Safety and Efficacy of Mohs Micrographic Surgery in Children and Adolescents: A Systematic Review. Dermatol Surg 2019; 46:880-884. [DOI: 10.1097/dss.0000000000002282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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11
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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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12
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Buteau AH, Keeling BH, Diaz LZ, Larralade M, Luna P, Krishnan C, Levy ML. Dermatofibrosarcoma protuberans in pediatric patients: A diagnostic and management challenge. JAAD Case Rep 2018; 4:155-158. [PMID: 29387771 PMCID: PMC5789519 DOI: 10.1016/j.jdcr.2017.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Anna H. Buteau
- Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Brett H. Keeling
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Lucia Z. Diaz
- Department of Pediatrics and Medicine, Division of Dermatology, Dell Medical School at the University of Texas at Austin, Austin, Texas
- Correspondence to: Lucia Z. Diaz, MD, Dell Medical School at The University of Texas at Austin, Department of Dermatology, 601 East 15 Street, CEC C2.470, Austin, TX 78701.Dell Medical School at The University of Texas at AustinDepartment of Dermatology601 East 15 Street, CEC C2.470AustinTX78701
| | - Margarita Larralade
- Pediatric Dermatology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Paula Luna
- Pediatric Dermatology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | | | - Moise L. Levy
- Department of Pediatrics and Medicine, Division of Dermatology, Dell Medical School at the University of Texas at Austin, Austin, Texas
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13
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Iyengar R, Kiwanuka E, Mangray S, Cruz AP, Katarincic J, Bhatt R. Diagnosis and Management of Dermatofibrosarcoma Protuberans in a 3-Year-Old Patient. J Hand Surg Am 2017; 42:756.e1-756.e5. [PMID: 28549894 DOI: 10.1016/j.jhsa.2017.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 02/02/2023]
Abstract
In this case report, we present a 3-year-old boy with a diagnosis of dermatofibrosarcoma protuberans (DFSP) on the dorsum of his right hand. Although rarely metastatic, DFSP is highly locally invasive and can cause considerable local morbidity. In the hand, DFSP is uncommon in the young pediatric patient. In our patient, the tumor extended down to the second and third metacarpal heads and was treated with a multistaged excision of his tumor to achieve negative margins under slow Mohs micrographic surgery.
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Affiliation(s)
- Rajiv Iyengar
- Division of Plastic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Elizabeth Kiwanuka
- Division of Plastic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Shamlal Mangray
- Department of Pathology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Antonio P Cruz
- Division of Dermatology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Julia Katarincic
- Department of Orthopedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Reena Bhatt
- Division of Plastic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI.
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14
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Bradford KL, Moretti FA, Carbonaro-Sarracino DA, Gaspar HB, Kohn DB. Adenosine Deaminase (ADA)-Deficient Severe Combined Immune Deficiency (SCID): Molecular Pathogenesis and Clinical Manifestations. J Clin Immunol 2017; 37:626-637. [PMID: 28842866 DOI: 10.1007/s10875-017-0433-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 08/07/2017] [Indexed: 12/18/2022]
Abstract
Deficiency of adenosine deaminase (ADA, EC3.5.4.4), a housekeeping enzyme of purine metabolism encoded by the Ada gene, is a cause of human severe combined immune deficiency (SCID). Numerous deleterious mutations occurring in the ADA gene have been found in patients with profound lymphopenia (T- B- NK-), thus underscoring the importance of functional purine metabolism for the development of the immune defense. While untreated ADA SCID is a fatal disorder, there are multiple life-saving therapeutic modalities to restore ADA activity and reconstitute protective immunity, including enzyme replacement therapy (ERT), allogeneic hematopoietic stem cell transplantation (HSCT) and gene therapy (GT) with autologous gene-corrected hematopoietic stem cells (HSC). We review the pathogenic mechanisms and clinical manifestations of ADA SCID.
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Affiliation(s)
- Kathryn L Bradford
- Department of Pediatrics, University of California, Los Angeles (UCLA), 3163 Terasaki Life Science Bldg., 610 Charles E. Young Drive East, Los Angeles, CA, 90095, USA
| | - Federico A Moretti
- Centre for Immunodeficiency, Molecular Immunology Unit, University College London Institute of Child Health, London, UK
| | | | - Hubert B Gaspar
- Centre for Immunodeficiency, Molecular Immunology Unit, University College London Institute of Child Health, London, UK
| | - Donald B Kohn
- Department of Pediatrics, University of California, Los Angeles (UCLA), 3163 Terasaki Life Science Bldg., 610 Charles E. Young Drive East, Los Angeles, CA, 90095, USA.
- Department of Microbiology, Immunology and Molecular Genetics, UCLA, Los Angeles, CA, USA.
- Department of Molecular & Medical Pharmacology, UCLA University of California, Los Angeles, CA, USA.
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15
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Abstract
OPINION STATEMENT Dermatofibrosarcoma protuberans (DFSP) is a slow growing tumor with a very low metastatic potential but with significant subclinical extension and great capacity for local destruction. Thus, the first surgeon approached with such challenging tumor must attempt to cure the patient with a method that spares healthy tissue and ensures an optimal oncological, functional, and esthetic result. The treatment of DFSP often requires a multidisciplinary approach. Depending on location, dermatologic surgeons, surgical oncologists, head and neck surgeons, neurosurgeons, plastic surgeons, and occasionally medical oncologists may be involved with the management. Mohs micrographic surgery (MMS) is the preferred method when available. In our institution, most of the DFSP cases are often advanced cases; thus, dermatologic surgeons obtain clear margins peripherally and other surgical specialties assist with resection of the fascia and any critical deeper structures. When MMS is not available, wide local excision (at least 2- to 3-cm margins of resection) with exhaustive pathologic assessment of margin status is recommended, and it is best to confirm tumor extirpation prior to any reconstruction. Subclinical extension of the tumor could be related to the size; how long it has been growing or histological markers that are unknown right now. No clinical trials comparing MMS vs WLE are available, and further research should be focused on these subjects as well as the use of imatinib and other targeted therapies for recurrent and metastatic tumors and for neoadjuvant treatment.
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Affiliation(s)
- Alvaro E Acosta
- Dermatology Department, Instituto Nacional de Cancerología, Universidad Nacional de Colombia, Carrera 19C No. 90-14, Bogotá, Colombia.
| | - Catalina Santa Vélez
- Dermatology Oncology Universidad Militar Nueva Granada, Instituto Nacional de Cancerología, Calle 1a No. 9-85, Bogotá, Colombia
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16
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Downey C, Requena L, Bagué S, Sánchez Martínez MÁ, Lloreta J, Baselga E. Agminated Fibroblastic Conective Tissue Nevus: A New Clinical Presentation. Pediatr Dermatol 2016; 33:e240-3. [PMID: 27296971 DOI: 10.1111/pde.12896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Connective tissue nevi are benign hamartomatous lesions in which one or several of the components of the dermis (collagen, elastin, glicosaminoglycans) show predominance or depletion. Recently, de Feraudy et al broadened the spectrum of connective tissue nevus, describing fibroblastic connective tissue nevus (FCTN), which is characterized by proliferation of CD34(+) cells of fibroblastic and myofibroblastic lineage. Only solitary papules and nodules have been described. We present the first case of FCTN with multiple agminated lesions on the leg of an infant and the difficulties encountered in the differential diagnosis with dermatofibrosarcoma protuberans.
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Affiliation(s)
- Camila Downey
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Madrid, Spain
| | - Silvia Bagué
- Department of Pathology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Josep Lloreta
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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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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18
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Jubert E, del Pozo L, Saus C, Martín-Santiago A. Why Is Mohs Micrographic Surgery Underused in the Treatment of Dermatofibrosarcoma Protuberans in Children? ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.01.009] [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] Open
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19
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¿Por qué la cirugía micrográfica de Mohs está infrautilizada en el tratamiento del dermatofibrosarcoma protuberans infantil? ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:158-62. [DOI: 10.1016/j.ad.2015.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/21/2015] [Accepted: 06/06/2015] [Indexed: 11/20/2022] Open
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20
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Yen H, Pan SC, Huang CH, Wong TW. Complete remission of a periorbital dermatofibrosarcoma protuberans with adjuvant imatinib mesylate in a child. JAAD Case Rep 2015; 1:172-4. [PMID: 27051721 PMCID: PMC4808742 DOI: 10.1016/j.jdcr.2015.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hsi Yen
- Department of Dermatology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Shin-Chen Pan
- Section of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Chien-Hun Huang
- Department of Dermatology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Tak-Wah Wong
- Department of Dermatology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Department of Biochemistry and Molecular Biology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
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21
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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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22
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Dalle S. [What's new in oncology?]. Ann Dermatol Venereol 2013; 139 Suppl 5:S217-22. [PMID: 23522708 DOI: 10.1016/s0151-9638(12)70136-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In cutaneous oncology, the year 2012 was marked by the consolidation of earlier results as well as the emergence of new therapeutic perspectives. The consolidated results most notably concern the use of MAP-kinase inhibitors (anti-MEK, anti-BRAF) in the treatment of patients with metastatic melanoma. Vismodegib (an SMO inhibitor), used in the treatment of multiple basocellular carcinomas that are inoperable or that have developed in patients suffering from Gorlin syndrome, has been the subject of publication of large-scale studies. Of the new therapeutic advances, let us mention the use of inhibitors or monoclonal antibodies directed against the PD1 receptor and its ligand PD-L1, the combination of MEK and BRAF inhibitors in the treatment of metastatic melanoma, and treatment in adjuvant situations with these same inhibitors. Beyond these significant advances that must be credited to cutaneous oncology, new questions are emerging relative to the side effects observed with these targeted therapies. The onset of multiple epidermoid carcinomas or primary melanomas treated with BRAF inhibitors is a striking illustration of the paradoxes arising from the clinical transfer of scientific progress. The intellectual perspectives are therefore numerous. It is hoped that this work will succeed in making these innovative drugs available to the patients who will have contributed to their development through their participation in clinical trials.
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Affiliation(s)
- S Dalle
- Service de Dermatologie, Centre Hospitalier Lyon Sud, 165, chemin du Grand Revoyet, 69495 Pierre Bénite cedex 08, France.
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