Dermatofibrosarcoma protuberans: recent clinical progress

Lipofibromatosis-like neural tumors: Report of a case and review of 73 reported cases

Lipofibromatosis-like neural tumors (LPF-NTs) are a recently discovered group of spindle cell tumors defined by the presence of a lipofibromatosis-like pattern, CD34 and/or S100 reactivity, and frequent neurotrophic receptor tyrosine kinase 1 (NTRK1) gene rearrangements. As new cases emerge, the spectrum of features observed in LPF-NTs continues to evolve. Here we describe the case of an 11-year-old with LPF-NT with a dermatofibrosarcoma protuberans-like honeycomb pattern, CD34 and S100 co-expression, and an NTRK1 rearrangement. We also review the clinical and molecular features of the 73 cases of LPF-NT previously described in the literature.

Dermatofibrosarcoma protuberans surgery: Experiences of four African surgical oncology units and literature review

BACKGROUND AND OBJECTIVES

Dermatofibrosarcoma is a locally malignant tumor. This gives surgery a place of choice. The advent of imatinib has improved outcomes. Our aim is to describe the indications, techniques and results of surgery.

METHODS

A retrospective, multicenter, descriptive study conducted in four West African surgical oncology units. It covers dermatofibrosarcoma surgery performed between January 1, 1988 and December 31, 2020. We took into account the surgical procedure, the mode of skin coverage, adjuvant treatments and survival. Comparisons were possible using Student's t-test and Pearson's χ² .

RESULTS

We recorded 81 cases of dermatofibrosarcoma. Surgery was effective in 90.1% of cases. Wide resection was the principle with a mean resection margin of 3.8 ± 1.9 cm. healing by primary intention, flaps and healing by secondary intention were the methods of skin coverage in 30.1%, 24.7% and 41.1% respectively. The type of skin coverage was related to the topography and size of the tumor (p < 0.0001). The healing time is associated with the type of skin cover. The recurrence rate was not related to the type of skin coverage (p = 0.8).

CONCLUSIONS

Wide and deep resection in the absence of Mohs micrographic surgery ensures healthy margins. Oncoplasty reduces the healing time without increasing the risk of recurrence.

A unique case of Dermatofibrosarcoma Protuberans arising from an inguinal hernial repair scar in a Middle Eastern male - A Case Report

INTRODUCTION AND IMPORTANCE

Dermatofibrosarcoma Protuberans (DFSP) is a rare and fatal variant of Spindle Cell Sarcoma. It has an annual incidence rate of 0.8 to 4.5 cases per one million individuals. It's locally aggressive and has vague and masquerading clinical presentations. Misdiagnosis is devastating as it can lead to time wasting, expenditure of unnecessary resources, and possibly raise morbidity and mortality for patients. It is warranted to raise preoperative clinical awareness to achieve prompt surgical therapeutic interventions to reach an up-to-par prognosis.

CASE PRESENTATION

We demonstrate the case of a 50-year-old previously healthy Middle Eastern male patient, who was referred to our General Surgery clinic with the chief complaint of an expansive bulge in his left iliac fossa. Preoperative imaging could not exclude a neoplastic cause behind the presentation. Based on the clinical picture, a surgical intervention was decided.

CLINICAL DISCUSSION

Our patient's treatment was consummated by means of classical surgical resection of the lesion with adequate negative margins and referring him to an oncologist specialized in DFSP to undergo the necessary adjuvant treatment. Definitive diagnosis was firmly entrenched postoperatively after finalization of the histopathological and immunohistochemical analyses of the resected protuberance.

CONCLUSION

DFSP is an eminently rare entity, especially DFSPs which originate from a surgical scar -as was our patient's- and fluctuates in its clinical presentation, thus, it is our responsibility to depict, study this malignant tumor, and document its incidence, so that we can make ironclad clinical decrees to plummet the morbidity and mortality of this relentless neoplasia.

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

BACKGROUND

Dermatofibrosarcoma protuberans is a rare soft tissue malignancy that, if left untreated, can be locally destructive and life-threatening. Dermatofibrosarcoma protuberans is uncommon in the breast, and the similarity of its morphologic features with other spindle cell malignancies can make correct identification difficult. Immunohistochemistry and molecular testing can aid in the correct diagnosis when there is diagnostic uncertainty. Imatinib, a selective tyrosine kinase inhibitor, has been used for adjuvant treatment of dermatofibrosarcoma protuberans following surgical resection. When used as a neoadjuvant treatment, imatinib offers the opportunity to decrease tumor size prior to surgery to lessen the chance for disfigurement.

CASE PRESENTATION

We present the case of a Caucasian woman who was 46-year-old when she first noted a mass in her right breast in 2015; she was initially diagnosed as having metaplastic breast carcinoma. Mastectomy and systemic chemotherapy were planned; however, after review of pathology at a referral center, the diagnosis was changed to dermatofibrosarcoma protuberans. She was treated with 4 months of neoadjuvant imatinib with adequate tumor shrinkage to perform breast conservation.

CONCLUSION

This patient's case stresses the importance of correctly diagnosing this rare breast tumor through the histopathologic appearance of dermatofibrosarcoma protuberans, molecular pathogenesis, and immunohistochemistry. These techniques can help differentiate dermatofibrosarcoma protuberans from metaplastic breast carcinoma and other spindle cell lesions of the breast. This is critical, as the treatment options for metaplastic breast carcinoma significantly differ from treatment options for dermatofibrosarcoma protuberans. This case describes the use of imatinib as a neoadjuvant option to reduce preoperative tumor size and improve surgical outcomes.

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.

Management of dermatofibrosarcoma protuberans of the face using lower trapezius musculocutaneous pedicle flap reconstruction: a case report

Dermatofibrosarcoma protuberans (DFSP) is a rare neoplasm which represents <0.1% of all tumors but it is considered the most common skin sarcoma. It is a slow-growing tumor that arises from the dermis and invades deeper tissues. The precise origin of DFSP is not well known. It is most frequently seen on the trunk, extremities, and head and neck. The standard treatment of the localized huge DFSP consists of a wide local surgical resection with recommended surgical margins of 2-3 cm. Local recurrence after incomplete excision is common. We present a case of 35-year-old man with enormous bulky mass on the face. Upon histological examination, the diagnosis of DFSP was made, and the patient underwent en bloc wide local excision of the mass followed by the use of Trapezius musculocutaneous pedicle flap reconstruction. On 32 months follow-up, no recurrence has been reported.

Dermatofibrosarcoma protuberans in pediatric patients: a report of 17 cases

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor. In children, there are acquired and congenital presentations. Due to clinical similarities with other conditions, diagnosis may be delayed.

OBJECTIVE

To review the clinical characteristics and treatment of DFSP in pediatric patients.

METHODS

A retrospective chart review was performed from January 2002 to September 2012. Inclusion criteria were patients under 18 years of age with a histopathologic diagnosis of DFSP. Data on demographics, clinical characteristics, treatments, and outcomes were collected.

RESULTS

Information was gathered from 17 patients; 9 (53%) were female. Congenital lesions were reported in 7 patients. The mean delay of diagnosis was 5.7 years; the most common anatomic location was the trunk in 8 of 17 (47%) cases. Treatment options included wide local surgery, Mohs surgery, and imatinib mesylate.

CONCLUSION

A detailed medical history and identification of the natural course of common conditions seen in pediatric patients are important to identify less common lesions and to suspect DFSP.

Clinicopathological features of dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans (DFSP) is a superficial cutaneous tumor of low malignant potential characterized by a high rate of local recurrence. The histopathological appearance shows uniform spindle neoplastic cells arranged in a predominantly storiform pattern, typically with positive staining for cluster of differentiation (CD)34 and vimentin on immunohistochemistry. A minority of cases of DFSP have areas of sarcomatous transformation. Wide surgical excision is the cornerstone of treatment for DFSP. The objective of the present study was to determine the clinicopathological features of DFSP. Pathological records were searched for cases of DFSP in the database of the Department of Pathology, Faculty of Medicine Ramathibodi Hospital (Mahidol University, Bangkok, Thailand) between 1994 and 2013. The results showed 68 cases with DFSP. The mean age at diagnosis was 40 years (range, 3-86 years). Among this group of patients, 26 cases (38.2%) experienced local recurrence and 6 (8.8%) exhibited sarcomatous transformation of DFSP. The factors that predict the recurrence of DFSP are an incorrect first pathological diagnosis and an inadequate surgical margin. The factors that predict the sarcomatous transformation of DFSP are a larger tumor size and an incorrect first pathological diagnosis. In patients who have tumors with spindle cells arranged in a storiform pattern, CD34 immunohistochemical staining provides the definitive diagnosis. Exact histopathological categorization is important to select the appropriate treatment and predict the clinical outcome.

A strategy for the successful management of dermatofibrosarcoma protuberans

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive soft tissue sarcoma with extensive subclinical involvement. The National Comprehensive Cancer Network guidelines recommend immediate reconstruction in most cases. Our study reviewed the methods of treatment of DFSP at our institution, examined the types of closure used after surgical excision, and analyzed the prevalence of positive margins on permanent pathology after immediate closure after conventional non-Mohs excision of DFSP.

METHODS

The charts of 25 patients treated with surgical excision and 16 with Mohs surgery from 1990 to 2009 for lesions consistent with DFSP were reviewed for clinical variables including disease state, tumor site, closure type, permanent pathology margin status, disease recurrence/persistence, and excisional margin size.

RESULTS

The trunk, followed by the head and neck, were the most common sites for DFSP. No patients had distant metastasis at diagnosis or experienced recurrence in either the surgical excision or the Mohs surgery group. Twelve (48%) patients were found to have positive margins after initial surgical resection. All lesions treated with Mohs surgery had clear histological margins at completion. Average margin size for surgical excision patients was 2.33 cm (range, 0.75-4.5 cm), and 1.36 cm (range, 0.74-2.55 cm) for Mohs excision. The average duration of follow-up was 107.9 months.

CONCLUSIONS

The extent of DFSP is difficult to determine intraoperatively with traditional surgical excision, which leads to a higher rate of positive margins. Considering this difficulty and the complications of reconstruction with positive margins, we believe that reconstruction after tumor resection should be dependent on definitive pathologic clearance of the tumor.

Malignant cutaneous adnexal tumours of the head and neck: an update on management

Adnexal tumours form a heterogeneous group of relatively rare neoplasms. Many of them have a poor prognosis and treatment can sometimes be difficult and controversial. We summarise the latest publications relating to malignant cutaneous adnexal tumours of the head and neck, and give an update on their management. We discuss Merkel cell carcinoma and other rare malignant adnexal tumours including dermatofibrosarcoma protuberans and atypical fibroxanthoma.

CD99 expression in dermatofibrosarcoma protuberans and dermatofibroma

BACKGROUND

Differentiating between dermatofibrosarcoma protuberans (DFSP) and hypercellular dermatofibroma (DF) can sometimes be challenging, and a panel of immunostains is often employed. Expression of conventional markers oftentimes overlaps. We evaluated CD99 expression in DFSP and DF and its utility in distinction between these 2 entities.

METHODS

CD99 immunostaining was performed on 34 DFSPs and 24 hypercellular DFs. The intensity of staining was graded as "weak," "moderate," or "strong," and the proportion of positive cells was graded as follows: "scattered" when individual cells comprised <5% of the total cellularity of the lesion; "focal" with >5% but <25% of the cells; or "diffusely distributed" with staining of >25% of lesional spindle cells.

RESULTS

Overall, DFSPs showed positive CD99 staining in 21 (61.76%) cases. Moderate and weak patterns of staining were the most frequent, seen in 13 (38.2%) and 7 (20.6%) cases, respectively. CD99 staining in DFSPs was predominantly scattered or patchy (4 and 11 lesions respectively) with less than 25% of cells expressing CD99. In comparison, all 24 DF cases showed strong CD99 positivity in >25% of the spindle cell component (P = 0.0003). The most striking difference related to the distribution of staining. In DFSP, tumor cells in the superficial dermis, when present, were always CD99 negative. In contrast, DF cells in the superficial dermis always demonstrated strong CD99 positivity.

CONCLUSIONS

DF strongly expresses CD99 in a diffuse pattern that may serve as evidence in distinction from DFSP. As the differences in staining were most pronounced in the superficial portions of the tumor, CD99 staining may be well suited to superficial biopsy specimens, where distinction in hematoxylin and eosin sections may be most problematic.

Combining targeted agents with modern radiotherapy in soft tissue sarcomas

Improved understanding of soft-tissue sarcoma (STS) biology has led to better distinction and subtyping of these diseases with the hope of exploiting the molecular characteristics of each subtype to develop appropriately targeted treatment regimens. In the care of patients with extremity STS, adjunctive radiation therapy (RT) is used to facilitate limb and function, preserving surgeries while maintaining five-year local control above 85%. In contrast, for STS originating from nonextremity anatomical sites, the rate of local recurrence is much higher (five-year local control is approximately 50%) and a major cause of death and morbidity in these patients. Incorporating novel technological advancements to administer accurate RT in combination with novel radiosensitizing agents could potentially improve local control and overall survival. RT efficacy in STS can be increased by modulating biological pathways such as angiogenesis, cell cycle regulation, cell survival signaling, and cancer-host immune interactions. Previous experiences, advancements, ongoing research, and current clinical trials combining RT with agents modulating one or more of the above pathways are reviewed. The standard clinical management of patients with STS with pretreatment biopsy, neoadjuvant treatment, and primary surgery provides an opportune disease model for interrogating translational hypotheses. The purpose of this review is to outline a strategic vision for clinical translation of preclinical findings and to identify appropriate targeted agents to combine with radiotherapy in the treatment of STS from different sites and/or different histology subtypes.

Reconstructive strategies for dermatofibrosarcomas of the face: role of regenerative dermal templates

BACKGROUND

Dermatofibrosarcomas protuberans is a challenging cutaneous tumor from an oncologic and reconstructive surgical point of view. Involvement of functionally and aesthetically sensitive areas, such as facial units, in young patients accounts for more demanding cases. An updated evaluation of most beneficial excisional/reconstructive strategies in these cases is still lacking.

METHODS

We investigated the potential of regenerative dermal templates in staged postoncologic reconstructive management of a young woman affected by a dermatofibrosarcomas protuberans of the forehead involving the frontal bone.

RESULTS

Final result was optimal in terms of cosmetic and functional recovery, obtaining a pliability, softness, and color similar to surrounding healthy skin.

CONCLUSION

In facial dermatofibrosarcomas protuberans, staged reconstruction with regenerative dermal templates provides a conservative yet safe and effective management, achieving optimal aesthetic outcomes. We suggest its adoption as first-line treatment in facial dermatofibrosarcomas protuberans that cannot be repaired by direct suture and in equivalent benign yet challenging cases.

Surgical Treatment of Dermatofibrosarcoma Protuberans Using a Reversed Adipofascial Sural Flap - Case Report

Dermatofibrosarcoma protuberans is a rare superficial tumor characterized by high rates of local recurrence and low risk of metastasis. Dermatofibrosarcoma protuberans occurs most commonly on the trunk and proximal extremities, it affects all races, and often develops between the second and the fifth decade of life. The tumor grows slowly, typically over years. We present a rare case of a young male patient, 21 years old, with an asymptomatic calf tumor which was suspected to be an angioma, but after the initial excision histology and imunohistochemistry proved to be a Dermatofibrosarcoma protuberans without safety limits. After 2 weeks, we excised the remaining scar with 4 cm tissue limit and the defect was covered using an adipofascial reversed sural flap from the posterior part of the left calf and after another 2 weeks we applied a skin graft from the thigh. The patient had a good evolution, with full recovery, without local recurrences or metastasis, and the histology was within good safety limits.

Photoletter to the editor: Atrophic dermatofibrosarcoma protuberans with minimal clinical manifestation

Dermatofibrosarcoma protuberans is an uncommon soft tissue neoplasm. In the vast majority of cases it presents as a nodule or a firm tumor that can reach massive dimensions producing the protuberant nodules for which it is named. We report a case of a 34-year-old woman presented at our department with an 8-year history of a small and discretely erythematous supraclavicular atrophic plaque. Skin biopsy lead to the diagnosis of dermatofibrosarcoma protuberans and a wide local excision of the tumor was performed in collaboration with the Plastic Surgery department. In this clinical case we describe an uncommon variant of the disease with minimal clinical manifestation that can cause serious diagnostic difficulties. The small and discrete atrophic plaque of our patient could have been easily ignored with serious clinical and prognostic implications for the patient.

PDGFB rearrangement in dermatofibrosarcoma protuberans: correlation with clinicopathologic characteristics and clinical implications

Dermatofibrosarcoma protuberans (DFSP) is characterized genetically by the translocation t(17;22)(q22;q13), which creates a COL1A1/PDGFB fusion gene. The implications of this gene for the clinicopathologic features of the disease are not fully understood. Fifty-one cases of DFSP from 46 patients were reclassified as DFSP (n=29) and DFSP-fibrosarcomatous variant (DFSP-FS; n=22). Fluorescence in situ hybridization was performed using a dual-color break-apart probe to detect rearrangements involving PDGFB, and CD34 immunohistochemistry staining was done. The DFSP-FS was found in older patients, and the tumors were larger, with a smaller mean area of staining for CD34. PDGFB rearrangement was found in 45 cases (95.7%). The mean gene copy number was 3.82 (range 2.2-6.45) and was higher in DFSP-FS than in classic DFSP (4.54 vs. 3.47; P < .001). The PDGFB copy number showed a moderate positive correlation with the number of mitotic figures and tumor size. Patients undergoing wide excision or having no involvement of the resection margin had no relapses. These results suggest a role for COL1A1/PDGFB in sarcomatous change in DFSP over time. Detection of COL1A1/PDGFB rearrangement by fluorescence in situ hybridization is useful for confirmation of the diagnosis. Patients who present with metastatic DFSP-FS show less typical histologic findings and loss of CD34 staining, leaving PDGFB rearrangement as the preferred adjunctive method for diagnosis from small biopsies and for prediction of the value of imatinib therapy.

Genetic counseling in carriers of reciprocal translocations involving two autosomes

One of the main genetic causes involve in the pathogenesis of recurrent abortion is parental chromosomal abnormalities. The central concept in genetic counseling with such families is to estimate the probability of recurrence of unfavorable pregnancy outcomes. The main questions that consultants usually ask are: Why did this happen? What is the risk to be done again?Our cases were two families with repeated miscarriage. The pedigrees were drawn, the chromosomes of couples were studied, and estimation for recurrent risk was done. We tried to answer those two main questions and clear the results for them.Parental chromosome abnormalities were founded after karyotyping with GTG technique at 450 band resolution, revealing 46 chromosomes with balanced translocation of autosomes in one of the partner in both families. Recurrent risk was estimated as "high" for their future pregnancies in each family.Couples in which one partner is the carrier of such balanced translocation have increased risks of infertility, recurrent abortion, and delivery of chromosomally abnormal offspring. Genetic counseling of such couples, therefore, presents a unique challenge and should be considered in dealing with such families.

Uncommon cutaneous neoplasms of the head and neck

This article concentrates on the less-common cutaneous malignancies such as merkel cell, atypical fibroxanthoma, malignant fibrous histiocytoma, dermatofibrosarcoma protuberans, microcystic adnexal carcinoma, and sebaceous carcinoma. The clinical and histopathologic descriptions of each, most current and emerging etiologies, diagnosis, staging, treatment, and prognosis are discussed.

Atrophic dermatofibrosarcoma protuberans

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is an uncommon malignant mesenchymal tumor that arises in the dermis and is characterised by latency in its initial detection. As a rare form, atrophic or morphea-like DFSP has been documented. Atrophic DFSP resemble other benign lesions such as morphea, idiopathic atrophoderma, atrophic scar, anetoderma or lipoatrophy. It behaves like classic DFSP. It commonly favours young to middle aged adults. It has a slow infiltrative growth and a high rate of local recurrence if not completely excised. Metastases are rare and occur after repeated local recurrence. Surgical excision is the best line of treatment. Long term follow up is required to detect recurrence.

MAIN OBSERVATIONS

We report a case of atrophic DFSP in a 52-year-old female patient. Diagnosis was achieved according to clinical, histopathological and immunohistochemical findings. Tumor was surgically excised with safety margin and the patient is still under follow up.

CONCLUSIONS

Atrophic DFSP is a rare variant of DFSP. It is a tumor of low to moderate grade malignancy. Surgical excision is the best line of management. Long term follow up is necessary.

Recurrent bilateral dermatofibrosarcoma protuberans of eyelids

A 26-year-old man had a history of multiple nodules involving the upper and lower eyelids bilaterally, for which he had undergone wide local excision along with eyelid reconstruction. Three years later, he presented to the authors with recurrence of the tumor masses. Tumor debulking surgery was performed bilaterally, with eyelid reconstructive surgery. Histopathology of the excised mass showed spindle-shaped cells in the dermis, which were arranged in a storiform pattern. Immunohistochemically, the tumor expressed vimentin diffusely and CD-34 focally. Histopathologic findings of storiform pattern of tumor cells and positive immunohistochemical stains for CD-34 led to the diagnosis of dermatofibrosarcoma protuberans. The clinical course was marked by repeated local recurrences following multiple debulking procedures. Local control could not be achieved in this case and at last follow up, the tumor was surgically unresectable.

The role of targeted molecular inhibitors in the management of advanced nonmelanoma skin cancer

Surgical treatment remains the standard of care for nonmelanoma skin cancer and is successful for the vast majority of patients with these tumors. The treatment of patients with metastatic or unresectable nonmelanoma skin cancer, however, has until recently been based solely on traditional methods of chemotherapy and radiation. However, these methods have high rates of treatment failure, morbidity, and mortality, and alternative treatment modalities for patients with aggressive or advanced disease are needed. As in other areas of cancer therapeutics, recent research elucidating the molecular basis of cancer development, and the subsequent arrival of targeted molecular inhibitors for cancer therapy, have been met with much excitement. In this review, we seek to illuminate recent developments and future possibilities in the use of targeted molecular inhibitors for treatment of advanced squamous cell carcinoma, basal cell carcinoma, and dermatofibrosarcoma protuberans.

Sonographic Demonstration of Dermatofibrosarcoma Protuberans

This case study presents the sonographic features of recurrent dermatofibrosarcoma protuberans, an uncommon soft tissue neoplasm. The original primary tumor presented five years earlier and was surgically excised. The current presentation demonstrates sonographic evaluation of several superficial left lower quadrant masses suspicious for tumor recurrence. This was confirmed by core needle biopsy and was followed by wide surgical excision. No evidence of metastasis was found, and no chemo or radiotherapy was offered.

Dermatofibrosarcoma protuberans arising in the context of Shwachman-Diamond syndrome

Dermatofibrosarcoma protuberans (DFSP) is an uncommon malignant spindle-cell tumor usually presenting in adulthood. The epidemiology of DFSP has recently been reviewed, and there have been 152 reported cases of DFSP in patients below the age of sixteen. We present the case of a DFSP arising in a young patient with Shwachman-Diamond syndrome (SDS).

Dermatofibrosarcoma protuberans: clinical diagnoses and treatment results of 260 cases in China

BACKGROUND AND OBJECTIVES

Dermatofibrosarcoma protuberans (DFSP) is a low-grade malignant tumor but has high local recurrence rate. The objectives of this study were to analyze their clinicopathologic factors and review the experience of multidisciplinary treatments.

METHODS

A total of 260 patients who were treated between 1985 and 2006 in Fudan University Shanghai Cancer Center were evaluated. Outcomes were compared focusing on recurrence and survival. Classical DFSP and transformed DFSP were the two subtypes.

RESULTS

After local excision, 50.2% of the patients were found to have residual tumors. The recurrence rate after local excision was significantly higher than that after wide excision (45.0% vs. 8.5%, P < 0.0001). Patients undergoing wide excision with margins ≥3 cm were found to have lower recurrence rate compared with those margins 1.5-2.5 cm (5.7% vs. 13.6%, P = 0.043). Compared with classical DFSPs, transformed DFSPs had significantly higher recurrence rate (34.5% vs. 6.3%, P < 0.0001), higher metastatic rate (23.5% vs. 0.4%, P < 0.0001), and worse prognosis (10-year survival rate 66.0% vs. 98.6%, P < 0.0001).

CONCLUSIONS

Performing adequate initial resection is important for patients with DFSP. Once DFSP was diagnosed, wide excision with a best margin of ≥3 cm is necessary. Transformed DFSPs are more aggressive tumors which need more energetic treatments.

Treatment of advanced dermatofibrosarcoma protuberans with imatinib mesylate with or without surgical resection

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma of the skin characterized by the presence of specific COL1A1-PDGFB fusion protein, which appears as a consequence of the t(17;22) (q22;q13) translocation.

OBJECTIVE

The aim of the study was to perform an analysis of patients with advanced DFSP treated with imatinib, with or without surgery, in clinical practice outside trials.

PATIENTS AND METHODS

We analysed the data of 15 patients (6 male, 9 female; median age 56 years) with locally advanced/initially inoperable and/or metastatic DFSP treated with imatinib 400-800 mg daily between 12/2004 and 06/2009. All diagnoses were ascertained cytogenetically (fluorescent in situ hybridization). Median follow-up time was 16 months (range: 4-81).

RESULTS

Metastases were present in six cases (two lungs, two soft tissue, two lymph nodes). Fibrosarcomatous transformation (FS-DFSP) was confirmed in seven patients (47%). A 2-year progression-free survival (PFS) rate was 60%, and a 2-year overall survival (OS) rate was 78% (median time for PFS/OS was not reached). The best overall responses were: 10 partial responses (67%, including 5 FS-DFSP-1 progressed during the follow-up), 2 stable diseases (13%) and 3 progressive diseases (20%). Seven patients (47%) underwent resection of residual disease and remained free of disease.

CONCLUSIONS

We have confirmed the profound anti-tumour effect of imatinib in DFSP harbouring t(17;22) with long-term responses. Imatinib therapy may in some cases lead to tumour resectability of lesser disfiguration.

Dermatofibrosarcoma protuberans with fibrosarcomatous transformation of the head and neck

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous neoplasm associated with a high cure rate. We present a case of aggressive DFSP with fibrosarcomatous areas in the head and neck. A 28-year-old Mediterranean female presented with a 45-day history of rapidly growing cutaneous lesion of the face. Surgical biopsy confirmed the diagnosis of DFSP. Subsequently, the patient underwent wide local surgical resection, followed by reconstruction. Histopathology report revealed fibrosarcomatous transformation and the patient underwent adjuvant radiotherapy. The patient continues to be disease free at the 35-month follow-up.

Although DFSP behave as non-aggressive malignancy, surgery with complete removal of the affected area is the intervention of choice. Moreover, adjuvant treatment and follow-up of the patient is essential in order to prevent recurrence.

Platelet-Derived Growth Factors in Non-GIST Soft-Tissue Sarcomas Identify a Subgroup of Patients with Wide Resection Margins and Poor Disease-Specific Survival

Background. Optimal treatment of nongastrointestinal stromal tumor soft-tissue sarcomas (non-GIST STSs) is resection with wide margins. This study investigates the prognostic impact of the angiogenesis-associated platelet-derived growth factors (PDGFs) and their receptors (PDGFRs) in non-GIST STS patients with wide and nonwide resection margins. Method. Tumor samples and clinical data from 249 patients with non-GIST STS were obtained, and tissue microarrays were constructed for each specimen. Immunohistochemistry was used to evaluate the expression of PDGF-A, -B, -C, and -D and PDGFR-α and -β. Results. In the multivariate analysis of patients with wide resection margins, high expression of PDGF-B (P = .013, HR = 2.954, and 95% CI = 1.255–6.956) and the coexpression of PDGF-B and PDGFR-α (overall; P = .016, high-low/low-high; P = .051, HR = 2.678, 95% CI = 0.996–7.200, high/high; P = .004, HR = 3.930, 95% CI = 1.542–10.015) were independent negative prognostic markers for disease-specific survival. Conclusion. PDGF-B and the coexpression of PDGF-B and PDGFR-α are strong and independent prognostic factors in non-GIST STSs with wide resection margins.

Profiling of VEGFs and VEGFRs as prognostic factors in soft tissue sarcoma: VEGFR-3 is an independent predictor of poor prognosis

BACKGROUND

In non-gastrointestinal stromal tumor soft tissue sarcoma (non-GIST STS) optimal treatment is surgery with wide resection margins. Vascular endothelial growth factors (VEGFs) and receptors (VEGFRs) are known to be key players in the initiation of angiogenesis and lymphangiogenesis. This study investigates the prognostic impact of VEGFs and VEGFRs in non-GIST STS with wide and non-wide resection margins.

METHODS

Tumor samples from 249 patients with non-GIST STS were obtained and tissue microarrays were constructed for each specimen. Immunohistochemistry was used to evaluate the expressions of VEGF-A, -C and -D and VEGFR-1, -2 and -3.

RESULTS

In the univariate analyses, VEGF-A (P=0.040) in the total material, and VEGF-A (P=0.018), VEGF-C (P=0.025) and VEGFR-3 (P=0.027) in the subgroup with wide resection margins, were significant negative prognostic indicators of disease-specific survival (DSS). In the multivariate analysis, high expression of VEGFR-3 (P=0.042, HR=1.907, 95% CI 1.024-3.549) was an independent significant negative prognostic marker for DSS among patients with wide resection margins.

CONCLUSION

VEGFR-3 is a strong and independent negative prognostic marker for non-GIST STSs with wide resection margins.

Late local recurrence of dermatofibrosarcoma protuberans in the skin of female breast

Dermatofibrosarcoma protuberans (DFSP) of the breast is exceptionally obscure and late local recurrence of this entity on this site is even more uncommon. We describe such a case in a 48-year-old woman, who at the age of 35 had a DFSP excised from her right breast. Thirteen years later, she developed an ovoid mass in her right breast over the postsurgical scar area. Wide local excision of the tumor with generous tissue margin was performed and microscopic and immunohistochemical findings established the diagnosis of recurrent DFSP. No further treatment was administered and she remains well 18 months later, without tumor recurrence. We report an exceptionally rare case of local recurrence of DFSP in the female breast and discuss in detail the diagnostic and therapeutic implications of this pathology.

Adjuvant chemotherapy in localized soft tissue sarcomas: still not proven

Soft tissue sarcoma is a rare and heterogeneous group of tumors in terms of histological subtypes, molecular alterations, clinical presentation, and prognosis. Yet, these tumors are most often treated similarly in the localized phase. The standard treatment of these patients requires multidisciplinary management, in particular, careful diagnostic procedures and surgery by an expert physician, preceded or followed by external radiotherapy. The utility of adjuvant chemotherapy has been explored in 14 trials comparing adjuvant chemotherapy with no treatment. Several trials reported a lower risk for local relapse and lower risk for metastatic relapse, but only a few small trials reported longer overall survival. A meta-analysis of all trials failed to demonstrate a significant difference in the relapse-free survival (RFS) or overall survival rates. Two additional trials, reported afterward, presented conflicting results, with a significant benefit in terms of the RFS rate for the trial of the Italian Sarcoma Group, but no difference in the RFS or overall survival rate in the most recent European Organization for Research and Treatment of Cancer trial. We conclude that adjuvant chemotherapy has not been proven to improve the outcome of an unselected population of patients. Several hypotheses are proposed to account for this observation.