Dermatofibrosarcoma protuberans with fibrosarcomatous transformation of the head and neck

Dermatofibrosarcoma Protuberans: An Updated Review of the Literature

Dermatofibrosarcoma protuberans (DFSP) is a rare proliferative condition representing skin sarcomas which is known to locally recur yet very rarely metastasizes. Its genetic background is a reciprocal translocation t(17;22)(q22;q13) that produces COL1A1-PDGFB gene fusion. Complete resection is the primary treatment. The aim of this review is to outline the pathogenesis, diagnosis, and management of DFSP. A clear-cut distinction between low-to-moderate-grade DFSP with excellent prognosis and high-grade fibrosarcomatous DFSP with a much worse prognosis is underlined. Malignant transformation within DFSP (or high histologic grade), older age, being female, large primary tumor size (≥10 cm), narrow surgical margins of excision (<3 cm), surgical margin positivity for tumor cells, short time to recurrence, numerous recurrences, tumor that was recently rapidly enlarging, and presence of pain in the tumor have all been proposed as clinicopathological risk factors for recurrence and metastasis. A tendency for local growth and local relapses of well- and moderately differentiated DFSPs is an argument for their surgical excision, possibly combined with reconstructive surgery, even in patients of advanced age. Another main point of this review is that cases of DFSP with fibrosarcomatous transformation are a challenge and require careful medical attention. Both anatomopathological evaluation of the presence of lymphovascular space invasion and sentinel lymph node biopsy at DFSP surgery merit further study.

Dermatofibrosarcoma protuberans in a pre-adolescent child

INTRODUCTION

Dermatofibrosarcoma protuberans (DFSP) is a rare skin sarcoma with a slow growth rate and less chance of metastasizing but it is associated with higher morbidity due to its aggressive nature of local infiltration and its recurrence nature.

IMPORTANCE

When dealing with DFSP in children we could achieve low morbidity with appropriate surgical planning and approach even though aggressive wide local excision was performed.

CASE REPORT

12-year boy presented with a lump in his left arm which was initially clinically and ultrasonically diagnosed as lipoma. However, histological examination, coupled with CD34 immunohistochemistry, confirmed the diagnosis as DFSP.

CLINICAL DISCUSSION

Modern microsurgical methods, such as Mohs micrographic surgery, are advocated as effective treatment options, their availability and feasibility may be limited in certain settings. Therefore, the classic approach of wide local excision remains the treatment of choice in the majority of cases, with radiotherapy recommended for recurrent disease. Proper patient education and regular surveillance will help identify recurrence in time which aids us to provide timely intervention and optimize outcomes for patients with dermatofibrosarcoma protuberans.

CONCLUSION

Accurate diagnosis using histology coupled with immunohistochemistry, proper surgical technique and regular follow up are the three pillars of managing DFSP.

Fibrosarcomatous dermatofibrosarcoma protuberans: a rapidly growing 30 cm mass on the posterior scalp

Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing sarcoma of the skin and subcutaneous tissue, accounting for around 5 cases per million per year. Fibrosarcomatous transformation of DFSP occurs in 10%-15% of DFSP cases, with a higher risk of local recurrence, metastasis, and death. We present a case of a male in his 30s with a complaint of rapidly progressive mass in the occipital region of the head. Within 1 year, the mass enlarged by >30 cm. Physical examination revealed a skin-colored 40×30 cm mass with an overlying skin necrosis at the posterior scalp. Brain, neck, and chest computed tomography (CT) scans were performed. The mass was surgically excised by wide excision with a 2 cm margin. Pathological report confirmed fibrosarcomatous DFSP Grade 3 with decreased CD34 expression. Delayed reconstruction of free flap and split-thickness skin graft were subsequently performed. No recurrence was detected 3 months postoperatively.

Additional Wide Resection of Infantile Dermatofibrosarcoma Protuberans after Unplanned Excision: A Case Report

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.

Dermatofibrosarcoma Protuberans Over Right Lumbar Region: A Case Report

Dermatofibrosarcoma protuberans is a rare, low-grade dermal soft-tissue tumor with a high propensity for recurrence but a low propensity for metastatic spread. It mostly affects the head, neck, proximal extremities, and trunk. We report a case of dermatofibrosarcoma protuberans over the right lumbar region. The patient presented with swelling in the right lumbar region measuring 3 cm × 3 cm. The local region ultrasonography (USG) revealed a well-defined hypoechoic lesion in the subcutaneous area. The patient was provisionally diagnosed with a peripheral nerve sheath tumor under evaluation. USG-guided fine needle aspiration cytology (FNAC) suggested a spindle cell tumor. Wide local excision of the tumor was performed. Monomorphic spindle cells in a storiform pattern were observed by histological evaluation. The neighboring adipose tissue was invaded by the tumor cells in a honeycomb-shaped pattern. The histological features were suggestive of Dermatofibrosarcoma Protuberans. Due to the high likelihood of recurrence, it is crucial to monitor these patients for an extended period of time.

A novel aberration of COL1A1-PDGFB fusion as an insertion in chromosome 15 in one case of dermatofibrosarcoma protuberans involving a rare location

Dermatofibrosarcoma protuberans (DFSP) is a rare sarcoma of the skin arising from the dermis. Its location is most commonly presented on the trunk of middle-aged adults and rarely on the face. The characteristic genetic aberration in the form of a reciprocal translocation t(17;22)(q21;q13) or a ring fusing the COL1A1 and PDGFB genes is found in 90% of DFSP. We present a case of a 42-year-old man who presented with a DFSP on the left cheek with foci of myxoid-fibrosarcomatous transformation. A conventional chromosomal analysis revealed a complex karyotype without a supernumerary ring chromosome or a linear translocation t(17;22). Comparative genome hybridization and fluorescence in-situ hybridization revealed the fusion of COL1A1 and PDGFB probes inserted in chromosome 15. This is a unique case of DFSP characterized by a rare body location, unique histopathological features, and novel chromosome COL1A1-PDGFB insertion, and may help guide future diagnostic and patient care modalities.

Clinicopathological correlation of malignant skin tumors: A retrospective study of 5 years

OBJECTIVE

Skin cancers are relatively uncommon malignancies worldwide, but there is a progressive increase in the incidence over the last few decades.

METHODS

We have studied the clinical and histopathological features of malignant skin tumors received in the department of pathology of our tertiary care institute over a period of 3 years and 8 months. A detailed analysis of clinical, gross, and microscopic findings was performed, followed by clinicopathological correlation.

RESULTS

One hundred and one specimens of skin tumors were received during this period, of which 37 (36.27%) were malignant tumors. Keratinocytic tumors were most common (81.08%) followed by appendageal tumors (10.81%). Squamous cell carcinoma (SCC) was the most frequent malignancy followed by basal cell carcinoma (BCC). Malignant melanoma, hidradenocarcinoma, malignant proliferating trichilemmal tumor (MPTT), sebaceous carcinoma, and fibrosarcomatous dermatofibrosarcoma were also observed. Variants such as hybrid verrucous SCC, basosquamous carcinoma, infiltrating BCC, and MPTT with spindle SCC were also found. Malignant skin tumors were most frequent in the seventh decade (40.54%). Males and females were almost equally affected. Overall, head and neck region was the most common site for malignant skin tumors.

CONCLUSION

The vast diversity of skin tumors produces difficulty in diagnosis. Any lesion, for which the diagnosis is uncertain, based on the history and clinical examination, should be biopsied for histopathological examination to rule out malignancy.

Surgical and Functional Considerations of Dermatofibrosarcoma Protuberans Involving Facial Nerve Danger Zones

Background: Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive tumor, uncommonly occurring on the head and neck where these deeply infiltrating tumors might violate underlying neurovascular structures. Treatment is typically surgical, whether by Mohs micrographic surgery (MMS) or wide local excision (WLE). However, there is a paucity of literature describing functional neurologic outcomes following surgical extirpation of facial DFSP. Thus, we sought to examine the functional neurologic outcomes in patients undergoing either MMS or WLE for facial DFSP. Methods: Two patients with DFSP involving facial nerve danger zones treated by the multidisciplinary team with MMS and subsequent reconstruction were studied. Additionally, a comprehensive literature review of facial DFSP with regard to neurologic functional status was performed. Results: From our research, only 10 of 46 patients with facial DFSP had neurologic functional status reported, with four of these cases having notable facial nerve deficits. Of our cases, both patients experienced transient neurologic deficits and neither had evidence of recurrence. Conclusion: The proper assessment and reporting of postoperative functional recovery should be undertaken following facial DFSP resection and consideration should be given to a multidisciplinary treatment approach.

Dermatofibrosarcoma protuberans associated with a hamartochondroma of the lung: Diagnostic discussion of a pulmonary nodule

Dermatofibrosarcoma protuberans is a malignant tumor of the soft tissue which is characterized by local recurrence with an exceptional metastasize, and for this reason, patients with dermatofibrosarcoma protuberans require a long-term follow-up. This clinical case presents a 41-year-old patient, with no pathological history, who has a malignant tumor of the chest wall, with a pulmonary nodule, which appears on the chest computed tomography scan like a well-rounded parenchymal nodule measuring 15 mm in diameter. This case was discussed in the multidisciplinary meeting which concluded that it is a dermatofibrosarcoma protuberans with metastasis of the lung. In the context of these data, it is thought that the pulmonary nodule is of metastatic origin according to the decision of the multidisciplinary meeting, while the final diagnosis was a hamartochondroma, which is a benign tumor of the lung. The interest of this clinical case is to discuss the possible diagnoses of the pulmonary nodule in the context of malignant wall tumor.

The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans

Usually most patients with dermatofibrosarcoma protuberans (DFSP) may present rather late when the tumor is in protuberant phase due to its rarity and indolent onset. It has a high propensity for local recurrence and destructive nature. Management of DFSP requires a biopsychosocial and Multidisplinary approach regardless of the clinical or immunohistochemical variant. Surgery is the Gold standard management of localized disease. DFSP rarely exhibits any lymphatic or hematogenous dissemination. It is because of its high recurrence rate associated with Wide Local Excision (WLE), the introduction of Mohs micrographic surgery (MMS) has really helped in reducing the rates of recurrence of DFSP. Thus, the aim of this meta-analysis and systemic review is to advocate for MMS over WLE for DFSP and other cutaneous malignancies using DFSP as a prototype. The objective of this study were to conduct a meta-analysis on comparative surgical methods used in the cure of DFSP with regards to WLE verses MMS, to evaluate the cure rates with relation to recurrence rates, offer a recommendation on the various treatment modalities based on the location of lesion, and use of adjuvant therapy in different clinical-medical setups. A comprehensive retrospective analysis search in EMBASE, Google Scholar and Medline (PubMed) for studies published from 2008 to 2018 containing the surgical management of DFSP with WLE verses MMS were reviewed. Five studies of moderate-quality evidence (level B) with a pooled patient load of 684 was analyzed and found for recurrence of DFSP after WLE and MMS to be 9.10% and 2.72% respectively after an average follow-up time for both groups of 5.32 years with a female predominance of 1.58. The trunk is the commonest site for the DFSP lesion which was at 52.80% then the upper and lower extremities zones and the head and neck zones at 31.75% and 15.45% respectively. The pooled adjusted odds ratio (OR) analysis indicated that there was a direct relationship with regards the reduced recurrence rate of DFSP in the MMS group compared to the WLE group (OR:0.31;95%; CI :0.17-0.56). Furthermore, there was significant association between the reduced recurrence rate with the MMS in DFSP patients with a statistical P-value of 0.0001 at 95% CI. The expected increased recurrence rate by zones was in WLE head and neck zone at 38.19% then trunk and extremities zone at 13.34%. In the MMS group it was at of 23.4% as compared to 16.0% in the head and neck zone. Mohs Micrographic Surgery (MMS) is more efficacious in the cure rate and recurrence reduction of DFSP and should be advocated for as first line therapy especially in high recurrence prone zones.

Dermatofibrosarcoma protuberans – the impact of radiation therapy: a single institution series

Background

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive intermediate malignancy.

Objective

The purpose of this retrospective analysis is to determine the efficacy of radiation therapy (RT) in local control of DFSP.

Patients and methods

The recurrence-free survival (RFS) for 45 patients treated for DFSP at our institution was estimated and compared between surgery alone and postoperative RT groups.

Results

Age range of the patients were in the third and fourth decades; males:females=2:1; most common site: anterior abdominal wall; tumours >5 cm in size in 75%; low grade in 77·8%; margins positive in 31·8% and <5 mm margins in 45·5%. Two-thirds of patients had at least one recurrence before presentation to our institution. RT dose was >50 Gy in 88% of patients. The patients treated with postoperative RT had poorer prognostic factors compared with surgery alone: they were males (17 versus 13 patients), and presented with high-grade tumours (5 versus 1 patients), multiple recurrences prior to presentation (25 versus 20 patients) and positive or <5 mm margins (22 versus 12 patients). Median follow-up for surgery alone group was 17 (1–152) months and for postoperative RT group, this was 54 (5–121) months. RFS at 5 years was 77·1% for surgery alone and 87·9% for postoperative RT group but was not statistically significant. The median time to recurrence was 4 years.

Conclusion

RT delays the time to recurrence in DFSP. RT improves the outcome of DFSP for recurrent tumours and with positive margins.

Dermatofibrosarcoma protuberans coexisting in a patient with a vascular malformation-a rare coincidence

Dermatofibrosarcoma protuberans with fibrosarcomatous differentiation (DFSP-FS) is a rare soft tissue tumor with more aggressive behavior and it is not clear what causes this type of skin cancer. We describe the case of a 48-year-old woman who was born with a vascular malformation in the sternal region and presented suddenly with a soft tissue sarcoma (DFSP-FS) in the same territory. She was initially treated by embolization as the sarcoma was misdiagnosed but the tumor within 6 months seemed to be growing rapidly and reached a giant dimension with ulceration and required surgical intervention. The patient underwent a surgical removal of the mass but as the pathology report included a DFSP-FS with close margins,a second operation was required. A wide local excision was performed and reconstruction of defect by using bilateral pectoralis major muscle flaps and a full thickness skin graft from the abdominal wall. Post operatively the patient was treated with radiotherapy.

Dermatofibrosarcoma protuberans of the scalp, with fibrosarcomatous areas masquerading as epidermal inclusion cyst

Lesions on the scalp are frequently encountered in clinical practice. Commonly diagnosed lesions include epidermal inclusion cysts (EICs), dermoid cysts and lipomas. Dermatofibrosarcoma protuberans (DFSP) is a low-grade malignant skin tumour occurring mostly in the extremities. However, its occurrence on the scalp is unusual, with an incidence of <5%. This lesion is rarely known to undergo fibrosarcomatous transformation. We present two such rare cases of DFSP of the scalp, with fibrosarcomatous transformation, masquerading clinically as EIC.

A Challenging Giant Dermatofibrosarcoma Protuberans on the Face

Dermatofibrosarcoma protuberans (DFSP) is a malignant fibrohistiocytic tumor that appears exclusively on the skin. It is a low-grade malignant soft tissue tumor of subcutaneous tissues that has a propensity for local recurrence but seldom metastasizes. It may rarely occur on the head and neck accounting for less than one percent of total head and neck malignancies. We present a man with a giant DFSP on the face. Oncological, functional, and aesthetic aspects are set forth.

Transformation of Dermatofibrosarcoma Protuberans into a Fibrosarcoma

Dermatofibrosarcoma protuberans is a rare cutaneous mesenchymal tumor characterized by a low potential of malignancy with a very low rate of metastasis but an important rate of local recurrence. Its transformation into a fibrosarcoma is exceptional, responsible for a higher metastatic potential. This transformation implies a closer surveillance. Through a case report and literature review, we will try to expose epidemiological, clinical, histological, therapeutic, and outcome particularities of this entity.

A Tete - a - tete of benign, borderline and malignant fibrohistiocytic tumor

Dermatofibrosarcoma protruberans is a relatively uncommon slow growing, locally aggressive fibrous tumor of the skin. It has a prospensity of progressing to fibrosarcomatous change in 5% of the cases. We present a case of a 56 yr old male with presented to the outpatient department of surgery, Sri Siddhartha Medical College, Tumkur with a chest swelling in 2013. FNAC was inconclusive and the mass was excised. On histopathology, areas of benign fibrohistiocytic tumor, dermatofibrosarcoma protruberans and fibrosarcomatous dermatofibrosarcoma were identified in the same tumor. Immunohistochemistry confirmed the diagnosis of DFSP with fibrosarcomatous change. Although, transformed DFSP is more aggressive, the prognosis is influenced by the extent of excision and with wide excision, there may be little increased risk for recurrence and metastasis over that of conventional DFSP.

Dermatofibrosarcoma protuberans: a case report and review of the literature

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) represents less than 0.1% of all tumors, but it is considered the most common skin sarcoma. Wide local excision (=5 cm) has been largely replaced by Mohs micrographic surgery; however, recurrence is not rare. Description of the case: A 35-year-old man presented with a large tumor on the upper side of his back and underwent local excision with the possible preoperative diagnosis of lipoma. Upon histological examination, the diagnosis of DFSP was made, and the patient underwent wide local excision with skin flap reconstruction and was referred for adjuvant radiotherapy.On twenty months follow-up, no recurrence has been observed.

CONCLUSION

DFSP is the most common cutaneous sarcoma. It originates in the dermis and tends to infiltrate underlying structures, including muscles, tendons, fascia and bone. In our case, the tumor was confined to the skin and subcutaneous tissue, however, our patient underwent adjuvant radiotherapy to avoid a possible relapse that would infiltrate deeper structures. Long-term follow-up is strongly recommended. Hippokratia 2016, 20(1): 80-83.

Wide Local Excision for Dermatofibrosarcoma Protuberans: A Single-Center Series of 90 Patients

Background. Dermatofibrosarcoma protuberans (DFSP), a rare low-grade sarcoma of fibroblast origin, tends to extend in a finger-like fashion beyond macroscopic tumor margins. Therefore, incomplete removal and subsequent recurrence are common. This study aimed to determine the efficacy of wide local excision (WLE) for controlling local recurrence of DFSP. Methods. The medical records of 90 DFSP patients who received WLE at our hospital between June 1992 and January 2015 were retrospectively reviewed. WLE was conducted including a 3 cm (range, 1 to 5 cm) safety margin according to tumor size, location, and recurrence status. Clinical and tumor characteristics and surgical methods were evaluated for risk factor analysis and local recurrence-free survival. Results. DFSP occurred most often in patients in their 30s (30%) and on the trunk (51.1%). Five patients (5.5%) experienced local recurrence during the 43.4-month follow-up period. Recurrence was found at a mean of 10.8 months after WLE. Although no factors were significantly associated with recurrence, recurrences were more frequent in head and neck. Recurrence-free survival was 87% in 6 years and 77% in 7 years. Conclusions. WLE with adequate lateral and deep margins can effectively control local recurrence rate and is a simple and effective method to treat DFSP.

A Clinicopathologic Review of a Case Series of Dermatofibrosarcoma Protuberans with Fibrosarcomatous Differentiation

Background:

Dermatofibrosarcoma protuberans with fibrosarcomatous differentiation (DFSP-FS) is a rare variant of DFSP with a more aggressive clinical course, characterized by higher rates of local recurrence, metastasis, and death.

Methods:

We conducted a clinicopathologic review of all DFSP-FS cases that occurred in Alberta, Canada, from 1997 to 2007.

Results:

Of the 75 DFSP cases reviewed, 4 demonstrated fibrosarcomatous differentiation. Three patients were female and one was male, and the age range was 25 to 76 years. Three tumors invaded to skeletal muscle, whereas one invaded to subcutaneous tissue only. Although perineural invasion was noted in all four cases, none exhibited lymphovascular space invasion. One local recurrence developed, and two of four tumors metastasized. Metastasis was associated with tumor size, tumor necrosis, grenz zone involvement, ulceration, thickness, and tumor grade. One patient died within 5 years of diagnosis.

Conclusion:

DFSP-FS represents a more aggressive subtype of DFSP. Several features of DFSP-FS may impart a higher risk of metastasis.

Imaging findings of head and neck dermatofibrosarcoma protuberans

BACKGROUND AND PURPOSE

Dermatofibrosarcoma protuberans is a rare, locally aggressive sarcoma of the skin in children and adults, usually involving the trunk and extremities and less commonly the head and neck. Despite clinical reports in the literature on the management of dermatofibrosarcoma protuberans, there are limited articles describing its imaging features.

MATERIALS AND METHODS

We retrospectively reviewed the demographics and imaging findings in all 24 patients with pathologically proven dermatofibrosarcoma protuberans of the head and neck seen at a tertiary cancer center between 2001 and 2010.

RESULTS

Twenty-two of the 24 lesions were nodular and well circumscribed; 19 of the 24 were located on the scalp. On imaging, all 24 lesions involved subcutaneous tissues. The lesions ranged in size from 0.6-9.5 cm (mean, 3.7 cm; standard deviation, 2.3 cm). Twelve lesions involved the soft tissues either at or extending directly to the midline. Thirteen lesions were associated with bulging of the skin surface. Fourteen lesions were imaged with CT and 14 with MR imaging. Whereas variable enhancement patterns were noted on CT and MR imaging, dermatofibrosarcoma protuberans was usually T2-hyperintense and demonstrated marked enhancement. None of the lesions was associated with bone invasion, perineural spread, or nodal/distant metastasis.

CONCLUSIONS

Knowledge of the imaging characteristics of dermatofibrosarcoma protuberans may alert neuroradiologists to include dermatofibrosarcoma protuberans in the differential diagnosis of lesions about the head and neck with similar imaging characteristics.

Dermatofibrosarcoma protuberans: Role of wide local excision

Objectives:

The main objective of the present study was to study the outcome of surgical treatment of dermatofibrosarcoma protuberans.

Materials and Methods:

This study included 45 patients both retrospective and prospective from December 1995 to December 2010.

Results:

Out of 45 patients, 30 were males and 15 females with the male to female ratio of 2:1. Mean age of presentation was 38.4 + 13.2 years. Commonest mode of presentation was raised firm multinodular lesion with fixity to overlying skin. Site distribution was 42.22% trunk, 57.88% extremities and head and neck. None of the patients had lymph node involvement All patients underwent wide local excision. On histological examination, 8 patients had positive margins. Overall recurrence rate was 22.22%. (please clarify what is the difference between the rate of recurrence following surgery and the overall recurrence rate) Only 2 patients developed metastasis to lungs in the course of their follow-up. Out of 45 patients, 35 remained recurrence free over a varying period of 5 months to 13 years (mean 68 months). Ten patients developed one or more local recurrences. Average time from initial treatment to recurrence was 32 months. All patients with recurrent tumors were subjected to salvage treatment, i.e., re-excision. Average recurrence-free period was 36 + 44 months within a mean follow-up of 68 months.

Conclusion:

Because of the potential of local recurrence, therapy for DFSP should be directed toward adequate local excision of the primary lesion. Minimal resection should include a surrounding margin, comprising 3-cm margin of normal skin and removal of underlying deep fascia. Compromising on margins invites higher chances of local recurrence.

Cryotherapy for local recurrent dermatofibrosarcoma protuberans: experience in 19 patients

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive, cutaneous, malignant tumor characterized by a high propensity for local relapse. Wide and deep local excision with reconstructive surgery is the current standard therapy for DFSP, with a local recurrence rate (LRR) of nearly 40%. In this study, we cured 19 patients with local recurrence of DFSP with 39 sessions of percutaneous cryoablation performed between July 2004 and August 2008. The LRRs after one, two and three cryosurgery sessions per patient were 68%, 54% and 0%, respectively. Moreover, the LRR did not differ with tumor location or size. Furthermore, all patients had a progression-free survival of >5 years. Only minor complications such as fever, local edema, mild nerve injury and local pain occurred, and were resolved within 1 week with symptomatic treatment. In our experience, percutaneous cryoablation is a relatively safe and efficient technique for the treatment of local recurrence of DFSPs.

Magnetic resonance imaging of vulvar dermatofibrosarcoma protuberans - report of a case

Background

Dermatofibrosarcoma protuberans (DFSP) of the vulva is a rare low-grade soft tissue sarcoma. Magnetic resonance imaging (MRI) findings of vulvar DFSP were essentially unreported in the literature.

Case report

We report a DFSP of vulva with its clinical, histological and MRI features. As far we know this is the first case of histologically confirmed vulvar DFSP presenting with MR images. The diagnosis of DFSP is usually made by histopathologic and clinical findings.

Conclusions

MRI is useful both for the diagnosis of DFSP and following up the patients since it has high soft tissue resolution and no risk of radiation exposure. With MRI the relation to the adjacent anatomical structures, extension and depth of the tumour and possible lymph node involvement can also be demonstrated.

Dermatofibrosarcoma protuberans in a child: a case report

Background. Dermatofibrosarcoma protuberans (DFSP) is an intermediate grade soft tissue neoplasm originating from the dermal layer of the skin. It usually occurs in adults; however, it can rarely be seen in infancy and childhood. Diagnosis of DFSP in children is quite difficult-given-rarity of this lesion, its variegated appearance, and its presentation sometimes at unusual sites. Case. We present the case of five-year-old boy who came with painless lesion on a forehead. Fine needle aspiration cytology (FNAC) suggested possibility of mesenchymal neoplasm. Patient was advised excision biopsy. Final diagnosis of DFSP was made based on histopathological findings. The patient was then advised reexcision surgery with wide margins. The patient was lost to followup and later turned up after two months with recurrence of a similar swelling at the same site. Conclusion. DFSP in children is rare and difficult to diagnose. Treatment of childhood DFSP is often delayed leading to incomplete excision. Hence, there is need to recognize and appropriately manage this uncommon childhood neoplasm.

Half forehead reconstruction with a single rotational scalp flap for dermatofibrosarcoma protuberans treatment

Background

Dermatofibrosarcoma protuberans (DFSP) is a soft tissue neoplasm of intermediate to low-grade malignancy. Although metastasis rarely occurs, DFSP has a locally aggressive behavior with a high recurrence rate. In the head and neck area, resection involving a wide margin of healthy tissue can be difficult because of functional and cosmetic considerations. We describe a novel reconstructive method for half forehead defects with an innovative single local wide scalp flap following excision of DFSP with a 3 cm margin of healthy tissue.

Methods

Two patients underwent wide resection of forehead DFSP and reconstruction with a single rotational scalp flap. The scalp flap blood supply was provided from three main vessels: the superficial temporal artery, occipital artery and posterior auricular artery.

Results

No early or late complications were observed in either patient with no local recurrence after 18 months of follow-up. The donor area could be closed primarily in both cases and the flaps survived completely.

Conclusion

This innovative technique allowed a radical excision of forehead DFSP with sufficient healthy margins, thus potentially decreasing tumor recurrence rate. Reconstruction was achieved avoiding microsurgery, skin expanders and large skin grafts. Moreover, all main reconstructive criteria, such as functional and cosmetic tissue characteristics, were completely fulfilled.

Dermatofibrosarcoma protuberans of the scalp with fibrosarcomatous degeneration and pulmonary metastasis

Dermatofibrosarcoma protuberans is a rare locally aggressive cutaneous tumor of intermediate malignancy. It is a slow-growing neoplasm with a marked propensity to recur after resection. Head and neck involvement is unusual and distant metastases are quite rare but tend to be more frequent in tumors that undergo fibrosarcomatous degeneration. We present the imaging and corresponding histopathology in a case of dermatofibrosarcoma protuberans of the scalp demonstrating fibrosarcomatous degeneration and lung metastasis.