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Van Vyve C, Klein L, Kassem I, Lemaitre J. Dermatofibrosarcoma Protuberans Occurring in an Adult Presenting with Chronic Lymphedema: A Case Study and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e941142. [PMID: 38098218 PMCID: PMC10728883 DOI: 10.12659/ajcr.941142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/08/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare soft-tissue tumor typically located in the trunk. We report a unique case of DFSP in the right inguinal region of an adult presenting with chronic lymphedema. Only 1 case of DFSP and chronic lymphedema association has been previously reported in the literature. Since we could not provide adjuvant radiotherapy (RT), we conducted an extensive review of its application in similar cases, exploring various surgical treatments. CASE REPORT A 42-year-old Cameroonian man with unexplained chronic lymphedema presented with a tumor in the inguinal region of the affected limb. The patient underwent wide local excision (WLE) of the mass, including regional lymph node dissection. Pathological exam confirmed DFSP with a fibrosarcomatous component. Adjuvant RT was considered but not pursued due to the patient;s non-compliance. CONCLUSIONS This DFSP is reported for its rarity of site and the unique co-occurrence with chronic lymphedema. Considering both conditions are uncommon and the rarity of site of the DFSP, we assume that in this patient, chronic lymphedema was a contributing factor of occurrence of the DFSP. Remarkably, no prior reports have detailed an association between chronic lymphedema and DFSP onset. For that reason, we want to point out the value of better follow-up of chronic lymphedema and better knowledge of DFSP treatment options to improve patient healthcare and limit DFSP recurrence. In addition, we found adjuvant RT is an interesting treatment option that might be considered in all patients undergoing surgical excision, even in cases where negative surgical margins were achieved.
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Affiliation(s)
- Clara Van Vyve
- Medical Student, Free University of Brussels, Bruxelles, Belgium
| | - Laurence Klein
- Department of Vascular Surgery, Ambroise Paré University Hospital Center, Mons, Belgium
| | - Ibrahim Kassem
- Department of Pathology, Ambroise Paré University Hospital Center, Mons, Belgium
| | - Jean Lemaitre
- Department of General Surgery, Ambroise Paré University Hospital Center, Mons, Belgium
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Güç ZG, Güç H, Bütün O, Alacacıoğlu A, Demirdöver C. Oncological efficiency of wide local excision in dermatofibrosarcoma protuberans. J Plast Reconstr Aesthet Surg 2023; 77:244-252. [PMID: 36592535 DOI: 10.1016/j.bjps.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/06/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a slow-growing, low- to intermediate-grade malignant sarcoma. Its optimal treatment is resection with wide margins; the likelihood of local control associated with this procedure exceeds 90%. The probability of regional or distant metastases is <5%. OBJECTIVE We examined the clinical, epidemiological, and pathological features, the treatment types, and outcomes of patients to investigate the width of safe surgical margins (SM) and how the width of SMs affected recurrence in DFSP. METHODS We retrospectively examined the records of 60 patients who were initially operated on with wide local excision for DFSP in the period 2008-2019. Optimal cutoff points for SMs were calculated with the receiver operating characteristic curve analysis and found as 1.925 cm histopathologically and 2.26 cm macroscopically. RESULTS During the mean 89.6-month follow-up, local recurrence was seen in 36.7% and distant metastasis in 20% of the patients. Recurrences were significantly related to peripheral resection margins. Analysis by histopathologic cutoff points showed that the local recurrence rate was 84% when SM was ≤1.925 cm, but only 2.85% when >1.925 cm (p = 0.002). Recurrence-free survival was 40.92 months when SM was ≤1.925 cm and 225.75 months when s >1.925 cm (p<0.001). Analysis by macroscopic cutoff points showed that the local recurrence rate was 95.5% when SM was ≤2.26 cm, but only 4% when >2.26 cm (p = 0.001). Recurrence-free survival was 43 months when SM was ≤2.26 cm and 222 months when >2.26 cm (p<0.001). In metastatic patients, progression-free survival was 9 months with cytotoxic chemotherapy, whereas 38.4 months with tyrosine kinase inhibitor (imatinib) (p = 0.002). CONCLUSION This study showed SMs >2.5 cm to be sufficiently safe for WLE and optimized the balance among safe margin width, reconstruction need, and surgical morbidity. In metastatic DFSP patients, tyrosine kinase inhibitor imatinib is more effective than cytotoxic chemotherapy for progression-free survival.
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Affiliation(s)
- Zeynep Gülsüm Güç
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Hasan Güç
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Osman Bütün
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ahmet Alacacıoğlu
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Cenk Demirdöver
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dokuz Eylul University, Izmir, Turkey
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Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer. Cancers (Basel) 2022; 14:cancers14153835. [PMID: 35954498 PMCID: PMC9367341 DOI: 10.3390/cancers14153835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 01/20/2023] Open
Abstract
Simple Summary Although significant progress in pharmacotherapy for skin cancer has been made in the past several years, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgeries including lymph node dissection and skin graft can cause various complications, and these complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery. Abstract Despite the significant progress made in the past several years in pharmacotherapies for skin cancer, such as BRAF/MEK inhibitors, immune checkpoint inhibitors, and Hedgehog pathway inhibitors, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In cases of lymph node metastases with clinically palpable lymphadenopathy, lymph node dissection (LND) is typically performed for most skin cancers. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgery can cause various complications. Although skin graft is frequently used for reconstruction of the surgical defect, extensive graft necrosis may develop if optimal stabilization of the graft is not obtained. LND also sometimes causes complications such as intraoperative or postoperative bleeding and postoperative lymphoceles. Moreover, as in other types of surgery, surgical site infection, intraoperative anxiety, and intraoperative and postoperative pain may also develop. These complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery.
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Yu Q, Zhu Y, Huang R, Li Y, Song L, Zhang X, Tang M, Gu Q, Li P, Zhou N, Li Y. Diagnosis and differential diagnosis of dermatofibrosarcoma protuberans: Utility of high-resolution dynamic contrast-enhanced (DCE) MRI. Skin Res Technol 2022; 28:651-663. [PMID: 35639715 PMCID: PMC9907642 DOI: 10.1111/srt.13164] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a kind of low-grade malignant spindle cell neoplasm, the diagnosis, and treatment, which have markedly attracted clinicians' attention for its repeated recurrence. High-resolution magnetic resonance imaging (HR-MRI) has shown unique capabilities in diagnosis of various cutaneous tumors. MATERIALS AND METHODS Data of 29 patients with clinically suspected DFSPs and undergoing dynamic contrast-enhanced (DCE) HR-MRI preoperatively were prospectively collected. The HR-MRI qualitative features were evaluated and compared. The DCE-associated quantitative parameters and the time-signal intensity curve (TIC) types were provided using DCE sequences. RESULTS A total of 7 DFSPs, nine dermatofibromas (DF, including four cases of cellular variant [CDF]), 12 keloids, and one nodular fasciitis were enrolled. DFSP showed the largest major diameter and the deepest depth. Five DFSPs (71.4%) showed ill-defined margins as well as infiltration of peripheral adipose. All DFSPs showed irregular shape. Most DFSPs presented hyperintensity on T2 WI (71.4%) and iso-intensity on T1 WI (85.7%). Six cases (85.7%) had significant enhancement, and six cases (85.7%) had homogeneous enhancement. There were significant differences of Ktrans , Kep , Ve and iAUC values among DFSPs, DFs, and keloids, and DFSP had the highest values for these parameters. Six DFSPs (85.7%) and four CDFs (100%) showed type-III TICs, while the other lesions showed type-Ⅰor type-Ⅱ TICs. CONCLUSIONS DCE-HR-MRI could show the growth characteristics of DFSPs, which was of great value for the diagnosis and differential diagnosis of DFSPs and was helpful for the determination of treatment options, thereby to improve the prognosis of patients.
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Affiliation(s)
- Qiuyu Yu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yueqian Zhu
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Renjun Huang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Li
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Linyi Song
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoping Zhang
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mengxiao Tang
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qinghua Gu
- Department of Radiology, Suzhou Yongding Hospital, Suzhou, China
| | - Ping Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Naihui Zhou
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yonggang Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Dermatofibrosarcoma Protuberans Recurrence After Wide Local Excision Versus Mohs Micrographic Surgery: A Systematic Review and Meta-Analysis. Dermatol Surg 2022; 48:479-485. [PMID: 35353755 DOI: 10.1097/dss.0000000000003411] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Local recurrence (LR) rates of dermatofibrosarcoma protuberans (DFSP) treated with different surgical modalities are unknown. OBJECTIVE To evaluate the differences in LR rates of DFSP treated with wide local excision (WLE) versus Mohs micrographic surgery (MMS). MATERIALS AND METHODS Pertinent studies of DFSP treated with either WLE or MMS were identified through a search of multiple databases, including Ovid MEDLINE (1946-2018), Embase (1988-2018), Web of Science (1975-2018), and Scopus (1970-2018). Comparative 2-arm and noncomparative single-arm studies were assessed through meta-analyses. RESULTS Of the 517 studies identified, 88 met inclusion criteria (12 comparative studies; 76 single-arm studies). In the 12 comparative studies, 352 patients with DFSP underwent MMS and 777 patients with DFSP underwent WLE. The LR rate was 1.7% after MMS and 3.7% after WLE (odds ratio, 1.549; 95% CI, 0.710-3.381; p = .27). In the 76 noncomparative studies, 980 patients underwent MMS (LR rate, 1.5%; 95% CI, 0.9%-2.1%; p < .001), and 2,215 patients underwent WLE (LR rate, 9.4%; 95% CI, 7.5%-11.3%; p < .001). CONCLUSION The LR rate of DFSP in patients treated with MMS is lower than in patients treated with WLE. Because of high rates of postoperative DFSP LR, MMS should be strongly considered when available.
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Porrino J, Al-Dasuqi K, Irshaid L, Wang A, Kani K, Haims A, Maloney E. Update of pediatric soft tissue tumors with review of conventional MRI appearance-part 1: tumor-like lesions, adipocytic tumors, fibroblastic and myofibroblastic tumors, and perivascular tumors. Skeletal Radiol 2022; 51:477-504. [PMID: 34191084 DOI: 10.1007/s00256-021-03836-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
There are numerous soft tissue tumors and tumor-like conditions in the pediatric population. Magnetic resonance imaging is the most useful modality for imaging these lesions. Although certain soft tissue lesions exhibit magnetic resonance features characteristic of a specific diagnosis, most lesions are indeterminate, and a biopsy is necessary for diagnosis. We provide a detailed update of soft tissue tumors and tumor-like conditions that occur in the pediatric population, emphasizing each lesion's conventional magnetic resonance imaging appearance, using the recently released 5th edition of the World Health Organization Classification of Soft Tissue and Bone Tumors as a guide. In part one of this review, pediatric tumor-like lesions, adipocytic tumors, fibroblastic and myofibroblastic tumors, and perivascular tumors are discussed. In part two, vascular lesions, fibrohistiocytic tumors, muscle tumors, peripheral nerve sheath tumors, tumors of uncertain differentiation, and undifferentiated small round cell sarcomas are reviewed. Per the convention of the WHO, these lesions involve the connective, subcutaneous, and other non-parenchymatous-organ soft tissues, as well as the peripheral and autonomic nervous system.
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Affiliation(s)
- Jack Porrino
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA.
| | - Khalid Al-Dasuqi
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA
| | - Lina Irshaid
- Yale School of Medicine Department of Pathology, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Annie Wang
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA
| | - Kimia Kani
- Department of Radiology, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Andrew Haims
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA
| | - Ezekiel Maloney
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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Tirotta F, Sayyed R, Jones RL, Hayes AJ. Risk factors for the development of local recurrence in extremity soft-tissue sarcoma. Expert Rev Anticancer Ther 2021; 22:83-95. [PMID: 34822313 DOI: 10.1080/14737140.2022.2011723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Local recurrence (LR) is one of the main pitfalls in surgery for extremities soft tissue sarcoma (eSTS). Achieving clear histopathological margins is the most important factor to reduce the risk of LR, but the ability to do so depends on not only surgical technique but also the interplay between tumor biology, anatomical location and surgical approach. The balance between postoperative morbidity and oncological benefits in reducing the risk of LR needs to be considered. AREAS COVERED This review will cover which etiological factors for the development of eSTS lead to an increased risk of LR and discuss histological subtypes that have a high risk of LR and which surgical and neoadjuvant therapeutic strategies can minimize the risk of LR. EXPERT OPINION The traditional view that surgical radicality always results in low rates of LR, while marginality alone always leads to high rates of relapse, is outdated. In the modern era of surgical oncology, limb salvage and high-level function after resectional surgery are the key surgical goals. The best results are achieved by combining effective neoadjuvant treatments with planned bespoke oncological operations that consider the biological and anatomical factors of each individual sarcoma.
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Affiliation(s)
- Fabio Tirotta
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Raza Sayyed
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Andrew J Hayes
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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Shemesh SS, Garbrecht EL, Rutenberg TF, Conway SA, Rosenberg AE, Pretell-Mazzini J. Unplanned excision of soft tissue sarcoma: does it impact the accuracy of intra-operative pathologic assessment at time of re-excision? INTERNATIONAL ORTHOPAEDICS 2021; 45:2983-2991. [PMID: 34415419 DOI: 10.1007/s00264-021-05187-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE An "unplanned excision" refers to soft tissue sarcomas excised without planning imaging studies and a diagnostic biopsy, resulting in the presence of residual disease and usually necessitating a re-excision procedure. We aimed to assess the impact of previous unplanned excisions on the intra-operative pathologic assessment at the time of re-excision, in terms of need to perform repeat assessments and the accuracy to predict margin status of the final pathologic specimen. METHODS Data was collected for all patients with extremity soft tissue sarcoma who had undergone wide local excision limb salvage surgery or amputation between 2012 and 2017. Intra-operative pathologic assessment with frozen sections was performed in all cases and was classified as negative, negative but close (< 1 mm), and positive. RESULTS A total of 173 patients with extremity soft tissue sarcoma were included, 54 in the unplanned excision group and 119 in the planned excision group. The accuracy of intra-operative pathologic assessment to predict the margin status on final pathology was similar between groups (87% unplanned vs. 90.7% planned excisions). However, the need for repeat intra-operative pathologic assessment and subsequent resection due to microscopically positive margins was found to be higher within the unplanned excision group ((p = 0.04), OR = 3.2 (95% CI: 1.1-9.1, p = 0.048)). CONCLUSIONS Intra-operative pathologic assessment of resection margins had a similar accuracy in planned and unplanned excisions; however, unplanned excisions showed a higher risk of re-resection during the same surgical setting.
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Affiliation(s)
- Shai S Shemesh
- Department of Orthopedic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erika L Garbrecht
- Musculoskeletal Oncology Division, Department of Orthopedic Surgery, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Tal Frenkel Rutenberg
- Department of Orthopedic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sheila A Conway
- Musculoskeletal Oncology Division, Department of Orthopedic Surgery, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Andrew E Rosenberg
- Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Juan Pretell-Mazzini
- Musculoskeletal Oncology Division, Department of Orthopedic Surgery, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA.
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Nakamura T, Kawai A, Asanuma K, Hagi T, Sudo A. Clinical Outcome of Dermatofibrosarcoma Protuberance. Report From the Bone and Soft Tissue Tumor (BSTT) Registry in Japan. In Vivo 2021; 35:611-615. [PMID: 33402516 DOI: 10.21873/invivo.12298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Owing to its rarity, dermatofibrosarcoma protuberance (DFSP) is often inappropriately excised. After unplanned excision (UE), additional excision is commonly performed. We aimed to elucidate the effect of additional excision after UE. PATIENTS AND METHODS We examined 306 patients with primary DFSP. We analyzed surgical outcomes in 291 patients who received planned excision (PE) or additional excision after UE. RESULTS Of 306 patients, 194 received PE and the remaining 112 received UE. Of 112 patients, 97 received additional excision after UE. Additional surgery due to complications was more frequent in patients with UE than in those with PE. The 5-year local recurrence-free rate in patients without additional excision after UE was significantly worse than that in those with additional excision after UE. CONCLUSION If UE is performed, we recommend additional excision for preventing local recurrence; however, the surgical wound should be carefully observed.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan;
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tomohito Hagi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
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Sacchetti F, Alsina AC, Morganti R, Innocenti M, Andreani L, Muratori F, Scoccianti G, Totti F, Campanacci DA, Capanna R. Re-excision after unplanned excision of soft tissue sarcoma: A systematic review and metanalysis. The rationale of systematic re-excision. J Orthop 2021; 25:244-251. [PMID: 34099954 PMCID: PMC8165293 DOI: 10.1016/j.jor.2021.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/09/2021] [Indexed: 01/14/2023] Open
Abstract
In Soft Tissue Sarcomas (STS) referral centre many patients have already had an incomplete tumour resection. In the majority of specimen, tumoral residual is detected and linked to a worsen prognosis. Systematic surgical re-resection of the scar tissue area is often performed. Some authors suggested to postpone re-resections until a clinically evident local recurrence is detected. A searching strategy was applied to Pubmed-Central and Ovid Medline. Odds ratio (OR) for local recurrence (LR), distant metastasis (MTS) or overall survival (OS) were calculated comparing patients who had tumour residual to people who hadn't. OR of local recurrences, distant metastasis and OS were calculated in planned vs unplanned-excisions groups. OR to develop a metastasis and OS after a local recurrences were calculated. Residual tumour led to an OR for LR of 3,56, OR of MTS was 3,42; OR of decreased OS was 3,42. Having a LR lead to a OR of 1,55 for MTS and to a OR of decreased OS of 2,32. Patients who underwent a re-excision compared to planned surgery did not have an increased OR of LR and had an OR to develop a MTS of 0,56. Our data confirm that there is a strong correlation between local recurrences, distant relapses and overall survival. Although there is a selection bias; this analysis highlights the optimal oncological outcome in patients who underwent re-resection. The rationale for systematic re-resection after unplanned excision of soft tissue sarcomas is very strong and this treatment remains the gold standard of care in these patients.
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Affiliation(s)
| | | | - Riccardo Morganti
- Department of Statistics for Clinical Study, University Hospital of Cisanello, Pisa, Italy
| | - Matteo Innocenti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Andreani
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Italy
| | - Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesca Totti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Italy
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A Rare Malignant Disease, Dermatofibrosarcoma Protuberans of the Breast: A Retrospective Analysis and Review of Literature. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8852182. [PMID: 33224981 PMCID: PMC7671798 DOI: 10.1155/2020/8852182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/19/2020] [Accepted: 10/25/2020] [Indexed: 11/17/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade fibroblastic mesenchymal tumor derived from the dermis. The aim of this retrospective analysis was to summarize the clinicopathological data from our cases and published cases to offer more evidence for the recognition of dermatofibrosarcoma protuberans (DFSP). A total of 6 breast DFSP patients who had received treatment in our hospital were retrospectively enrolled, and detailed clinicopathological data were gathered for analysis. The median age was 29.5 years (ranging from 17 to 42 years). Most cases presented a red or brown-red, mobile, well-circumscribed, protruding, breast mass (ranging from 1 to 3 cm). For histopathology, all cases (6/6) showed a storiform pattern of spindle cells that were positive for CD34 (6/6) and Vimentin (5/6) and negative for smooth muscle actin (0/6) and S-100 protein (0/6). The majority of patients (5/6) underwent wide local excision, with 2 cases treated with radiotherapy. With a median follow-up of 36 months, all 6 patients survived without recurrence or metastasis. The PubMed database was used to search for similar cases. Eventually, 36 cases were included in this review, while cases without detailed clinical information or not reported in English were excluded from the analysis. To summarize, DFSP of the breast is an extremely rare malignancy characterized by spindle tumor cells arranged in a storiform pattern and positivity for CD34. The core needle biopsy is one of the crucial methods for its preoperative diagnosis. Management of DFSP is mainly based on surgical excision. It is prone to local recurrence, so long-term follow-up is required.
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Sedaghat S, Schmitz F, Sedaghat M, Nicolas V. Appearance of recurrent dermatofibrosarcoma protuberans in postoperative MRI follow-up. J Plast Reconstr Aesthet Surg 2020; 73:1960-1965. [PMID: 32952057 DOI: 10.1016/j.bjps.2020.08.089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/01/2020] [Accepted: 08/18/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the appearance of recurrent dermatofibrosarcoma protuberans (DFSP) in postoperative MRI follow-up and to assess the occurrence of postoperative soft tissue changes detected in MRI. METHODS A total of 464 MRI follow-up scans of 32 patients with histologically proven diagnosis of DFSP were analyzed. MR imaging was performed using a 1.5T MRI system. Recurrent DFSP was examined for signal intensity, contrast behavior, appearance, and extent in MRI. RESULTS The mean age of the patients was 44,5±17,1 years. Recurrences of DFSP occurred 26±23.3 months after primary tumor resection in the mean (Min.: 9, Max.: 60). In 25% of the patients (n = 8), recurrences of DFSP were detected. Recurrent DFSP most often showed a nodular and homogeneous configuration with well-defined borders and marked contrast enhancement, and a hyperintense signal in PD-weighted and turbo inversion recovery magnitude sequences. All recurrences were well detected in the follow-up MRIs regardless of the performed plastic surgery procedure. Lateral and depth margins had no significant impact on the local recurrence rate. In all, 88% of the patients developed subcutaneous tissue edema (p < 0.01), followed by muscle edema (34%, p = 0.02), and postoperative seroma (22%). CONCLUSION Recurrent DFSP mainly appear uniform and clearly delimitable on MRI as nodular, homogeneous, and well-defined lesions with marked contrast enhancement. Therefore, MRI is a valuable tool for postsurgical follow-up. Nearly all patients develop subcutaneous edema after the resection of DFSP.
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Affiliation(s)
- Sam Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany.
| | - Frederick Schmitz
- Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany
| | - Maya Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany
| | - Volkmar Nicolas
- Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany
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13
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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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14
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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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15
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Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon dermal neoplasm that exhibits a high rate of local recurrence and infiltrative behavior, but has a low risk of metastasis. It arises as a slowly progressive, painless pink or violet plaque. Histologically, DFSP is characterized by a monomorphous spindle cell proliferation in a storiform pattern. The gold standard of treatment is surgical resection with negative margins. In cases where obtaining clear margins is not possible, radiation and systemic therapy with tyrosine kinase inhibitors, such as imatinib mesylate, has been shown to be effective.
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Affiliation(s)
- Aubrey Allen
- Brody School of Medicine, East Carolina University, 517 Moye Boulevard, Greenville, NC 27834, USA.
| | - Christine Ahn
- Departments of Dermatology and Pathology, Wake Forest School of Medicine, 4618 Country Club Road, Winston Salem, NC 27104, USA
| | - Omar P Sangüeza
- Departments of Dermatology and Pathology, Wake Forest School of Medicine, 4618 Country Club Road, Winston Salem, NC 27104, USA
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16
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Asilian A, Honarjou N, Faghihi G, Saber M, Mozafarpoor S, Hafezi H. An experience of slow‐Mohs micrographic surgery for the treatment of Dermatofibrosarcoma protuberans: A long‐term cohort study. J Cosmet Dermatol 2020; 19:2701-2705. [DOI: 10.1111/jocd.13319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/31/2019] [Accepted: 01/21/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Ali Asilian
- Department of Dermatology School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Navid Honarjou
- Faculty of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Gita Faghihi
- Department of Dermatology School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Mina Saber
- Department of Dermatology School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Samaneh Mozafarpoor
- Skin Diseases and Leishmaniasis Research Center School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Hossein Hafezi
- Skin Diseases and Leishmaniasis Research Center School of Medicine Isfahan University of Medical Sciences Isfahan Iran
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17
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Goertz O, Pieper A, von der Lohe L, Stricker I, Dadras M, Behr B, Lehnhardt M, Harati K. The Impact of Surgical Margins and Adjuvant Radiotherapy in Patients with Undifferentiated Pleomorphic Sarcomas of the Extremities: A Single-Institutional Analysis of 192 Patients. Cancers (Basel) 2020; 12:cancers12020362. [PMID: 32033261 PMCID: PMC7072160 DOI: 10.3390/cancers12020362] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Undifferentiated pleomorphic sarcomas are a frequent subtype within the heterogeneous group of soft tissue sarcomas. As the attainment of negative margins can be complicated at the extremities, we determined the prognostic significance of surgical margins in our patient population. Methods: We retrospectively determined the relationship between local recurrence-free survival (LRFS), overall survival (OS), and potential prognostic factors in 192 patients with UPS of the extremities who were suitable for surgical treatment in curative intent. The median follow-up time was 5.1 years. Results: The rates of LRFS and OS after 2 years were 75.7% and 87.2% in patients with R0-resected primary tumors and 49.1% and 81.8% in patients with R1/R2-status (LRFS: p = 0.013; OS: p = 0.001). Adjuvant radiotherapy significantly improved LRFS (5-year: 67.6% vs. 48.4%; p < 0.001) and OS (5-year: 82.8 vs. 61.8; p = 0.016). Both, negative margins and adjuvant radiotherapy were found to be independent prognostic factors in multivariate analysis. Conclusions: The data from this study could underscore the beneficial prognostic impact of negative margins on LRFS and OS. However, the width of negative margins seemed to be not relevant. Notably, adjuvant radiotherapy was not only able to decrease the risk of local failure but also improved OS in a significant manner.
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Affiliation(s)
- Ole Goertz
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
- Department of Plastic Surgery, Martin-Luther Hospital, Caspar-Theyss-Strasse 27-29, D-14193 Berlin, Germany
| | - Andreas Pieper
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
| | - Leon von der Lohe
- Department of Plastic Surgery, Martin-Luther Hospital, Caspar-Theyss-Strasse 27-29, D-14193 Berlin, Germany
| | - Ingo Stricker
- Institute of Pathology, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
| | - Mehran Dadras
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
| | - Kamran Harati
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
- Correspondence: ; Tel.: +49-234-302-3445; Fax: +49-234-6379
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18
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Wiesmueller F, Agaimy A, Perrakis A, Arkudas A, Horch RE, Grützmann R, Vassos N. Dermatofibrosarcoma protuberans: surgical management of a challenging mesenchymal tumor. World J Surg Oncol 2019; 17:90. [PMID: 31138233 PMCID: PMC6540534 DOI: 10.1186/s12957-019-1627-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/07/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade malignant mesenchymal tumor of the soft tissue, characterized by slow infiltrative growth and common local recurrence, with rare distant metastases. Patients and methods We present a retrospective study of nineteen patients who were diagnosed with DFSP and operated at our institution in > 10-year period. We examined the clinicopathological parameters with special emphasis on the margin status regarding the clinical outcome and the follow-up. Results A total of eight cases underwent re-excision at our institution following primary excision or incisional biopsy performed at a different institution. Seven cases received excision after incisional biopsy at our institution. Four patients developed recurrent disease following primary excision with histological R0 margins at other institutions and received re-excision at our institution. All excisions at our institution resulted in R0 margins with no recurrence recorded at last follow-up (6 to 175; mean 84 months). The mean margin for those who received resection at our institution was 1.67 cm. Negative margins upon primary excision were achieved using a mean margin width of 2.04 cm. Most common tumor localization was the trunk (10 cases). Conclusion Awareness of this rare entity is important for a prompt diagnosis and a proper management of the disease. The greatest clinical challenge in the management of DFSP is achieving local control. Complete excision of the tumor with surgical margin widths of at least 2 cm is recommended.
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Affiliation(s)
- Felix Wiesmueller
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Aristotelis Perrakis
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany.,Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany. .,Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
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19
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Dermatofibrosarcoma Protuberans of the Neck: A Brief Review of the Literature. Indian J Otolaryngol Head Neck Surg 2018; 71:369-372. [PMID: 31741988 DOI: 10.1007/s12070-018-1314-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022] Open
Abstract
Dermatofibrosarcome protuberance (DFSP) is a rare, slow growing soft tissue sarcoma with fibroblastic origin, which has a great, potential of local invasion and recurrence. Because of its unspecific appearance and slow growth features it is commonly misdiagnosed as other benign lesions that leads to a late accurate diagnosis or an inadequate initial treatment. A young female patient with DFSP on the neck who was initially misdiagnosed as lipoma and then underwent inadequate initial resection is presented in this case.
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20
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Kim CM, Park TJ, Kim BY, Chun SH, Kim IH. Recurrent Dermatofibrosarcoma Protuberans of Scalp in a Distant Location 10 Years after Primary Excision. Ann Dermatol 2018; 30:226-228. [PMID: 29606823 PMCID: PMC5839897 DOI: 10.5021/ad.2018.30.2.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/17/2017] [Accepted: 07/26/2017] [Indexed: 01/29/2023] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a slow growing low-grade cutaneous sarcoma. Local recurrence after excision is common due to the poorly defined periphery that renders histological control of surgical margin difficult, Mohs micrographic surgery is the optimal method for treatment. A 41 years old male patient, who had a previous history of DFSP, came to our dermatology clinic for evaluation of an asymptomatic firm flesh-colored nodule on the forehead. Total excision biopsy was done and the mass was histologically proved as DFSP. Wide excision with reconstruction was performed and showed no sign of recurrence till 18-month follow up. Local recurrence is known to be common for DFSP but a new visible lesion distant from the initial site may be confused as a de novo lesion or a benign neoplasm especially in scalp area, and thus interrupt early detection of DFSP. Herein, we report a case of recurrent DFSP of scalp which recurred distant from the original lesion.
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Affiliation(s)
- Chang Min Kim
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
| | - Tae Jun Park
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
| | - Bo Young Kim
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
| | - Seung Hyun Chun
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
| | - Il-Hwan Kim
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
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21
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Wollina U, Langner D, Schönlebe J, França K, Lotti T, Tchernev G. Dermatofibrosarcoma Protuberans: Retrospective Single Center Analysis Over 16 Years. Open Access Maced J Med Sci 2018; 6:35-37. [PMID: 29483976 PMCID: PMC5816309 DOI: 10.3889/oamjms.2018.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 09/22/2017] [Accepted: 09/24/2017] [Indexed: 11/23/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is rare mesenchymal neoplasia with a high risk of local recurrence but a low risk of metastatic spread. Tumor cells express CD34 and show a characteristic translocation t(17;22)(q22;q13). We analysed the documented cases at the Department of Dermatology and Allergology between 08/2001 and 08/2017. The diagnosis had been confirmed by histology and immunohistology in all cases. We identified four adults and a pediatric patient with DFSP. All patients were treated by wide surgical excision and controlled by three-dimensional histologic margin control. We observed no recurrence and no metastatic spread. We discuss prognostic factors and emerging treatments.
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Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Dana Langner
- Städtisches Klinikum Dresden - Department Dermatology and Allergology, Dresden, Germany
| | - Jacqueline Schönlebe
- Städtisches Klinikum Dresden - Institute of Pathology "Georg Schmorl", Dresden, Germany
| | - Katlein França
- Department of Dermatology and Cutaneous Surgery, Department of Psychiatry & Behavioral Sciences; Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Torello Lotti
- University of Rome, Institute of Deramtology, Rome, Italy
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria.,Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
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22
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Koseła-Paterczyk H, Rutkowski P. Dermatofibrosarcoma protuberans and gastrointestinal stromal tumor as models for targeted therapy in soft tissue sarcomas. Expert Rev Anticancer Ther 2017; 17:1107-1116. [DOI: 10.1080/14737140.2017.1390431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Hanna Koseła-Paterczyk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
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