Dermatofibrosarcoma protuberans - the use of neoadjuvant imatinib for treatment of an uncommon breast malignancy: a case report

Diagnostic Difficulties and Complexities in the Management of Dermatofibrosarcoma Protuberans in the Breast: A Case Report and Review of the Literature

Dermatofibrosarcoma protuberans (DFSP) is an extremely rare sarcoma with an incidence between 0.8-5.0 cases per one million persons per year. DFSP accounts for less than 0.1% of all malignancies and approximately 1-6% of all soft tissue sarcomas. Only a few cases of DFSP have been found within the breast tissue. We report a case of DFSP in a 30-year-old female within the left breast. The sarcoma presented as a painless, rubbery, mobile lump that gradually increased in size. It was initially identified on an ultrasound scan and subsequently confirmed with MRI and core biopsy. DFSP is a rare condition and treatment guidelines are not well established. The current recommendation is for surgical excision with 2-cm margins. Mastectomy may be considered in some circumstances. In our case, the aim was for surgical resection with 2-cm margins at both breast tissue and skin, but insufficient margins were taken. The recommendation for re-excision of the inadequate margins was declined. It is uncertain what the implications of this are given the lack of research on DFSP in the breast. Therefore, close surgical surveillance will be imperative. We present this case to highlight the difficulties associated with the diagnosis, treatment, and management of DFSP due to the lack of literature on this disease.

Effective Treatment for Primary Locally Aggressive Intermediate and Malignant Soft Tissue Tumors of the Breast

Objective

This study aimed to examine the rare locally aggressive intermediate tumors and malignant primary breast mesenchymal tumors in patients receiving surgical treatment.

Summary of background data

Locally aggressive intermediate tumors were subdivided into nonmetastasizing and rarely metastasizing, and the malignant group was subdivided as a single subgroup called able to metastasize. A retrospective examination of surgical notes and clinical charts was carried out reviewing gender, age, symptoms, duration of symptoms, tumor size, clinical presentation, radiation history, kind of surgery undergone, adjuvant radiotherapy, adjuvant chemotherapy, local recurrences, systemic metastases, and mortality.

Results

Mitotic index and Ki-67 were statistically different between locally aggressive and malignant groups (P < 0.001). One local recurrence occurred in only 1 patient diagnosed as dermatofibrosarcoma protuberans among all patients. None of the entities showed distant metastasis or mortality. In this result, clear margin of surgery in locally aggressive intermediate group and combination of surgery with radiation therapy in the malignant group was the most important determinant for the prospect of the patients with mean follow-up of 28 months.

Conclusion

The main treatment for localized mesenchymal breast tumors is surgery. When the disease is locally advanced or malignant with high mitotic index, radiotherapy with surgery is predominantly used. Targeted therapies are promising with the limited place of chemotherapy.