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Zhang L, Chen H, Wang B. Dermatofibrosarcoma protuberans misdiagnosed as sebaceous adenoma and incompletely resected in a child: A case report. J Clin Lab Anal 2023; 37:e24500. [PMID: 35622689 PMCID: PMC10623525 DOI: 10.1002/jcla.24500] [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: 03/25/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dermatofibrosarcoma protuberans is extremely rare in children, making a correct diagnosis by clinicians is usually difficult due to its nonspecific manifestations, the recurrence of dermatofibrosarcoma protuberans after resection has always been a perplexing problem for clinicians. Ultrasound plays an irreplaceable role in the assessment of dermatofibrosarcoma protuberans, although there is a limitation in the diagnosis of the tumor. CASE REPORT A 10-year-old boy led by his parents sought for surgical treatment because of the growing mass. Physical examination and preoperative ultrasonography showed that the mass was clear, and the routine resection of mass was performed. Six days postoperatively, histopathological examination indicated that the mass was dermatofibrosarcoma protuberans, and the peripheral and deep resection margins were positive. The patient was informed that a second extended resection was required. The second postoperative pathology showed a negative margin, and the patient was discharged. Postoperative follow-up was assessed by ultrasound examination, and the patient had no abnormalities. CONCLUSIONS Dermatofibrosarcoma protuberans should be included in the differential diagnosis when the wide base subcutaneous lesion has suspicious features with high vascularity on ultrasound. If an ultrasound reveals a mass with abundant blood flow, clinicians should routinely perform the extended resection. Wide surgical excision may reduce the risk of reoperation and recurrence, and long-term follow-up is necessary to evaluate postoperative outcomes.
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Affiliation(s)
- Liang Zhang
- Department of Radiology, The Second Clinical Medicine FacultyInner Mongolia University for NationalitiesYakeshiChina
| | - Hana Chen
- Department of Radiology, The Second Clinical Medicine FacultyInner Mongolia University for NationalitiesYakeshiChina
| | - Bin Wang
- Department of Radiology, The Second Clinical Medicine FacultyInner Mongolia University for NationalitiesYakeshiChina
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2
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Li Y, Chen Z, Nie S, Wu Z. Atrophic dermatofibrosarcoma protuberans: Two case reports and literature review. Front Oncol 2023; 13:1100398. [PMID: 36845717 PMCID: PMC9948607 DOI: 10.3389/fonc.2023.1100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
Dermatofibrosarcoma protuberans is a rare, locally aggressive, slowly growing cutaneous fibroblastic sarcoma with a high recurrence rate and low metastatic potential. Atrophic dermatofibrosarcoma protuberans is a rare variant usually presents as atrophic plaques, easily neglected and misdiagnosed as benign lesions by patients and dermatologists. Here we report two cases of atrophic dermatofibrosarcoma protuberans, one of which was accompanied by pigment, and review other cases have been reported in the literature. Understanding the most up-to-date literature and early identification of these dermatofibrosarcoma protuberans variants can help clinicians avoid delayed diagnosis and improve prognosis.
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Affiliation(s)
| | | | - Shu Nie
- Department of Dermatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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3
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Shah SR, Regmee S, Maharjan DK, Thapa PB. Recurrent Dermatofibrosarcoma Protuberance: A Case Report. JNMA J Nepal Med Assoc 2021; 59:1192-1195. [PMID: 35199742 PMCID: PMC9124319 DOI: 10.31729/jnma.7187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022] Open
Abstract
Dermatofibrosarcoma protuberance represents less than 0.1% of all tumors, treatment of which requires wide local excision (≥5cm) but recurrence is not rare. Here we present a 32-year male presented with a swelling of 15 x 6cm over the left lumbar region for which he underwent excision three years ago, the histopathological examination of the swelling, showed a malignant mesenchymal tumor and Immunohistochemistry features were suggestive of Dermatofibrosarcoma protuberance. After three years of interval, he again presented with complaints of swelling in the previously operated site for nine months and underwent excision of the mass with Split Thickness Skin Graft. Although the tumor was confined to the skin and subcutaneous tissue in the present case, the patient didn't undergo any adjuvant radiotherapy to avoid a possible relapse that would infiltrate deeper structures for the first time. Being a recurrent tumor, long-term follow-up is strongly recommended.
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Affiliation(s)
- Shiv Raj Shah
- Department of Surgery, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Sujan Regmee
- Department of Surgery, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Dhiresh Kumar Maharjan
- Department of Surgery, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Prabin Bikram Thapa
- Department of Surgery, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Malan M, Xuejingzi W, Quan SJ. The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans. Pan Afr Med J 2019; 33:297. [PMID: 31692830 PMCID: PMC6815477 DOI: 10.11604/pamj.2019.33.297.17692] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Malumani Malan
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, Peoples Republic of China
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, Peoples Republic of China
| | - Wu Xuejingzi
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, Peoples Republic of China
| | - Song Ji Quan
- Head of Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, People's Republic of China
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Current Update on the Molecular Biology of Cutaneous Sarcoma: Dermatofibrosarcoma Protuberans. Curr Treat Options Oncol 2019; 20:29. [PMID: 30874910 DOI: 10.1007/s11864-019-0628-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT Cutaneous sarcoma is a group of malignant mesenchymal tumors primarily involving the dermis, and it is characterized by extreme clinicopathological heterogeneity. Although its occurrence rate is rare, dermatofibrosarcoma protuberans (DFSP) is one of the most common types of dermal sarcoma. DFSP grows slowly and tends to relapse locally after inadequate resection. There are various histological variants of DFSP tumors and it often mimics benign lesions such as dermatofibroma and scar, which make accurate diagnosis difficult and delayed, and some cases progress to the stage where the tumor is unresectable. Recent advancements in cancer genetics and molecular biology methods have elucidated the COL1A1-PDGFB fusion gene, some novel fusion gene variants and pathways related to DFSP pathogenesis that have resulted in the evolution of cutaneous sarcoma diagnosis and treatment. For example, some clinical studies have confirmed the efficacy of imatinib methylate, an αPDGFR-targeted therapy for unresectable or metastatic DFSP. The present review summarizes recent updates in DFSP research, diagnostics, and treatment.
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Aragão SSDC, Leite EJDS, Cardoso AEC, Houly RLS. An unusual variant of atrophic dermatofibrosarcoma protuberans. An Bras Dermatol 2018; 93:282-284. [PMID: 29723383 PMCID: PMC5916409 DOI: 10.1590/abd1806-4841.20187049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/19/2017] [Indexed: 11/22/2022] Open
Abstract
Dermatofibrosarcoma protuberans is an uncommon neoplasm that is most often seen in young adults. The most common clinical presentation is the protruding form; however, other subtypes are known, such as the atrophic. In 2012 there were only 33 reports of this variant in the literature. Many cases of Dermatofibrosarcoma protuberans in children are only discovered in adulthood because they were not diagnosed early. Due the high morbidity, we raise the need for attention from the dermatologist to recognize uncommon neoplasms in the clinical practice. We report a case of a 15-year-old patient diagnosed with atrophic Dermatofibrosarcoma protuberans on the back.
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Affiliation(s)
- Simone Silva da Costa Aragão
- Service of Dermatology, Hospital Universitário Prof. Alberto
Antunes. Universidade Federal de Alagoas (HUPAA-UFAL) - Maceió (AL),
Brazil
| | - Everson José dos Santos Leite
- Service of Dermatology, Hospital Universitário Prof. Alberto
Antunes. Universidade Federal de Alagoas (HUPAA-UFAL) - Maceió (AL),
Brazil
| | - Alberto Eduardo Cox Cardoso
- Service of Dermatology, Hospital Universitário Prof. Alberto
Antunes. Universidade Federal de Alagoas (HUPAA-UFAL) - Maceió (AL),
Brazil
| | - Ricardo Luiz Simões Houly
- Service of Pathology, Hospital Universitário Prof. Alberto
Antunes. Universidade Federal de Alagoas (HUPAA-UFAL) - Maceió (AL),
Brazil
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Jia J, Zheng Y, Dong X, Wang X, Yang J, Ying Z, Wang Y, Niu X, Xiao S. Dermatofibrosarcoma protuberans with pit-like lesions: A case report and literature review. Oncol Lett 2015; 10:3765-3768. [PMID: 26788205 DOI: 10.3892/ol.2015.3741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 07/07/2015] [Indexed: 01/23/2023] Open
Abstract
The present study describes a case of pit-like dermatofibrosarcoma protuberans (DFSP) with the clinical manifestations, histopathological features and criteria for diagnosis. The study also reviews the relevant literature in order to raise awareness among dermatologists with regard to the specific behavior of DFSP. A 27-year-old female presented with subcutaneous nodules on the left side of the neck that had been apparent for 5 years and which had gradually begun caving in during the last year. Histopathological examination revealed that the tumor was composed of a large number of spindle cells arranged in a whirlpool-like pattern. Immunohistochemical studies revealed positive staining for cluster of differentiation 34, vimentin and lysozyme, which could be used as diagnostic markers of DFSP. The patient was finally diagnosed with DFSP by pathological and immunohistochemical analyses. The DFSP was treated with an extended resection followed by adjacent skin repair. The patient responded well and no relapse occurred during the 8-month clinical follow-up. Thus, the current study describes a unique pit-like clinical manifestation of DFSP with typical immunohistochemical and pathological features. In addition, histopathological examination revealed a downward depression in the epidermis. Therefore, histopathological examination should be considered as an essential diagnostic tool for DFSP.
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Affiliation(s)
- Jinjing Jia
- Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Yan Zheng
- Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Xinyu Dong
- Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Xin Wang
- Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Jiao Yang
- Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Zhaoxia Ying
- Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Yongxian Wang
- Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Xinwu Niu
- Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Shengxiang Xiao
- Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
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Chan IL, Carneiro S, Menezes M, Ramos-E-Silva S, Magalhães T, Cuzzi T, Ramos-E-Silva M. Dermatofibrosarcoma protuberans: a case report. Case Rep Dermatol 2014; 6:134-9. [PMID: 24926255 PMCID: PMC4035680 DOI: 10.1159/000362900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We present a typical case of dermatofibrosarcoma protuberans with local recurrence 2 months after surgery and, motivated by this patient, make a review of the most important aspects. This is a rare tumor and we call special attention to the fact that its recurrence is extremely frequent, so there is absolute need to observe these patients periodically after surgery.
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Affiliation(s)
- I Lym Chan
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
| | - Sueli Carneiro
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil ; Sector of Dermatology, University of the State of Rio de Janeiro, Brazil
| | - Mariana Menezes
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
| | - Stella Ramos-E-Silva
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
| | - Taíssa Magalhães
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
| | - Tullia Cuzzi
- Department of Pathology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ramos-E-Silva
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
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Wollina U. Dermatofibrosarcoma protuberans in a 10-year-old child. J Dermatol Case Rep 2013; 7:121-4. [PMID: 24421865 DOI: 10.3315/jdcr.2013.1160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 04/10/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans is a rare mesenchymal malignancy in childhood and adolescence. The tumor is characterized by dermal spindle cell proliferation with infiltration of subcutaneous tissue, expression of CD34, and a specific fusion of the platelet-derived growth factor beta with the collagen type 1alpha1 gene. MAIN OBSERVATION We observed a 10-year-old girl with a medaillon-like, asymptomatic plaque on the chest that was diagnosed as DSFP. The tumor was completely removed by delayed Mohs surgery. Follow-up so far has shown a complete response. CONCLUSIONS The prognosis of dermatofibrosarcoma protuberans in children is excellent as long as early diagnosis is followed by complete excision with Mohs surgery as a golden standard.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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Barreiros HM, Serrano PN, Parreira JC, Bártolo E. Photoletter to the editor: Atrophic dermatofibrosarcoma protuberans with minimal clinical manifestation. J Dermatol Case Rep 2013; 7:27-8. [PMID: 23580914 DOI: 10.3315/jdcr.2013.1133] [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: 12/03/2012] [Accepted: 01/21/2013] [Indexed: 11/11/2022]
Abstract
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.
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