DFSP of the Breast: Histomorphological, Immunohistochemical, and Molecular Features of a Rare Case in an Unusual Location

We present a case of a 21-year-old female with a vague nontender mass in the lower inner quadrant of the left breast discovered incidentally on chest imaging following trauma. A breast ultrasound demonstrated an 8×6×8 mm irregular hyperechoic mass at the 7 o'clock position of the left breast, 9 cm from the nipple. The mass was graded Breast Imaging Reporting and Data System (BI-RADS) category 4 (suspicious finding). An ultrasound-guided biopsy of the mass showed a proliferation of monotonous spindled cells in a storiform pattern with tapered nuclei with infiltration into the adipose tissue. No normal breast elements were identified in the biopsy. Myofibroblastoma was the first differential diagnosis; however, the characteristic infiltrative pattern of the tumor mandated additional tests including fluorescence in situ hybridization to rule out a dermatofibrosarcoma protruberance (DFSP). Immunohistochemical staining showed positive staining for CD34, which can be positive in myofibroblastoma also. However, fluorescence in situ hybridization demonstrated a platelet-derived growth factor B (22q13.1) gene rearrangement confirming a diagnosis of DFSP. The patient underwent a wide local excision of the DFSP for definitive treatment. She is doing well with no recurrence reported so far, after 15 months of follow-up. Conventional DFSP does not metastasize but is prone to recurrence making wide margins imperative for definitive treatment.

Case report: Dermatofibrosarcoma of the breast

Dermatofibrosarcoma protuberans (DFSP) is an uncommon neoplasm of the skin and soft tissue, commonly appearing on the trunk and extremities. The occurrence of DFSP in the breast is extremely rare. It has low to intermediate malignant potential with a high rate of local recurrence and invasion. We present a case of a 28-year- old female with a skin lesion on the breast associated with an underlying breast lump. We aim to discuss the sonographic and magnetic resonance findings of breast dermatofibrosarcoma.

Dermatofibrosarcoma protuberans in the breast: Case report

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The occurrence of dermatofibrosarcoma protuberans in the breasts is rare.

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Histological examination is helpful for identifying dermatofibrosarcoma protuberans.

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Treatment of dermatofibrosarcoma protuberans; surgical resection.

Introduction and importance

Dermatofibrosarcoma protuberans (DFSP) represents about 1% of soft tissue sarcomas with an estimated incidence of 0.8–5.0 cases per million per year. The involvement of DFSP in breast is very rare and very few cases have been reported in the literature. DFSP was recurred in situ, not spread to distant site. The complete surgical excision with wide, pathologically negative margins of 3 cms is the optimal treatment for primary or recurrent tumor.

Presentation of case

A 46-year-old woman presented with palpable lump in the in the right breast. On ultrasonography, a lesion appeared as hypoechoic, circumscribed mass of approximately 37 mm × 30 mm in diameter in the upper central part of the right breast. The mass of right breast was demonstrated DFPS by pathologic examination. Chest computerized tomography (CT) scan and 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography (PET) showed only primary lesion in subcutaneous layer and no enlarged lymph node. The patient underwent excision of the tumor widely. There was no evidence of DFSP local recurrence after five years of follow-up of the patient.

Discussion

DFSP is a rare tumor arising from dermis and subcutaneous mesenchymal tissue. Whereas, characteristic imaging feature of DFSP in the breast are not well-defined. The primary treatment for DFSP is considered to be surgical excision.

Conclusion

DFSP in breast is extremely uncommon and can mimic a primary breast tumor. Surgical excision with adequate resection margins is recommended to ensure local control of the disease.

Dermatofibrosarcoma Protruberans of the Breast Skin Simulating Mammary Carcinoma

Dermatofibrosarcoma protuberans is a rare soft tissue sarcoma that arises from the dermis and invades deeper tissues. Usually, it behaves as an intermediate grade malignancy but in rare instances, it can metastasize. Frequent occurrences have been observed in trunk and extremities but involvement of the breast has rarely been reported. Therefore, dermatofibrosarcoma protuberans (DFSP) breast often masquerades primary breast malignancy on clinical and radiological grounds. Histomorphology and immunohistochemistry are helpful in making a definitive diagnosis. In the present case, monomorphic spindle cells were seen arranged in classical storiform pattern with large areas of myxoid change. Many times, such myxoid areas pose a diagnostic challenge and necessitate differentiation from other myxoid neoplasms. Herein, immunohistochemistry offers an advantage where tumor cells show strong reactivity for CD34 antibody. Wide surgical excision remains the treatment of choice. The salient clinical features, histogenesis, histomorphology, and immunohistochemical findings have been described with strong emphasis on the diagnostic and therapeutic management of this rare entity.

Operative management of dermatofibrosarcoma protuberans of the breast

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous tumor with a tendency towards local recurrence. A 26-year-old woman presented with a 3 × 2 cm raised, purple-hued lesion on her left breast. Excisional biopsy identified the lesion as a DFSP. She underwent two additional operations to achieve widely clear margins. Operative excision is the primary treatment of dermatofibrosarcoma protuberans of the breast.

Dermatofibrosarcoma protuberans of the breast: A case report

Dermatofibrosarcoma protuberans (DFSP) is a rare, metastasizing tumor of the deep dermis and subcutaneous tissue. While it frequently occurs in the trunk and extremities, breast involvement has rarely been reported. In the present case, imaging and pathological technologies were used to detect DFSP of the breast. Surgical excision with wide margins (>3 cm) and pathology revealed spindle cells arranged in storiform patterns and short fascicles which were crucially CD34-positive, enabling a definitive diagnosis prior to surgery.

Dermatofibrosarcoma protuberans of the breast: a case report

Dermatofibrosarcoma protuberans (DFSP) is an uncommon mesenchymal tumour of the dermis and subcutis, which most commonly appears on the body and the extremities. Its occurrence in the breast is rare, and when it does, it can mimic a primary, benign breast lesion. We present a case of DFSP over the breast of a patient together with the associated imaging findings that can potentially help us differentiate this tumour from a primary breast lesion. The awareness of this entity allows a prompt diagnosis to be made and the disease to be properly managed.

Dermatofibrosarcoma presenting as a nodule in the breast of a 75-year-old woman: a case report

Introduction

Dermatofibrosarcoma protuberans is a rare neoplasm of soft tissues and its location in the breast is extremely uncommon. Confusion is possible with other primary breast lesions.

Case presentation

A 75-year-old Caucasian woman presented with a mass in her left breast 21 years after being diagnosed with invasive ductal carcinoma of the right breast, treated by a right mastectomy and axillary dissection followed by radiotherapy and breast reconstruction. Mammography revealed a dish-shaped skin nodule formation in the upper outer quadrant of her left breast. Echography confirmed the presence of a lesion measuring 1.4 × 0.8 cm. Based on imaging, the diagnosis was a probable angiosarcoma. Due to the presence of a pacemaker for cardiac arrhythmia and full anticoagulation therapy for a pulmonary embolism, magnetic resonance imaging and a biopsy were not done. We proceeded directly to a quadrantectomy and the final diagnosis revealed a dermatofibrosarcoma protuberans, 1. 8 cm in its greatest microscopic dimension, located 0.1 cm from the upper surgical margin. To ensure the wide resection margins required for this type of neoplasm, a re-excision was performed.

Conclusion

A dermatofibrosarcoma protuberans of the breast is an uncommon discovery. The aim of this case report is to highlight the importance of the surgical procedure in cases of the discovery of dermatofibrosarcoma protuberans. Re-excision may be necessary to ensure adequate resection margins.

Dermatofibrosarcoma protuberans of the breast skin

A case of a 26-year-old woman with dermatofibrosarcoma protuberans of the breast skin is described. She had noticed a palpable mass with redness 15 years previously, but it had begun to grow rapidly with swelling and redness two months before presenting. Ultrasonography and biopsy demonstrated a possibility of sarcoma of the breast. Wide excision was performed to confirm the diagnosis. Histologically, the tumor was composed of a uniform population of fibroblasts in a distinct storiform pattern. CD34 immunostaining showed diffuse reactivity. Platelet-derived growth factor β break-apart fluorescence in situ hybridization analysis showed a split-signal pattern which supported the diagnosis of dermatofibrosarcoma protuberans in the skin of the breast. It is important to diagnose a soft tissue lesion accurately when it occurs in the breast.