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Mahmood MN. Histopathologic Evaluation of Atypical Fibroxanthoma or Pleomorphic Dermal Sarcoma Debulk Specimen from Mohs Surgery: A Requirement for Their Proper Distinction. Dermatopathology (Basel) 2024; 11:184-191. [PMID: 39051321 PMCID: PMC11270197 DOI: 10.3390/dermatopathology11030019] [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: 06/02/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024] Open
Abstract
Pleomorphic dermal sarcomas can be clinically aggressive, with a higher tendency to cause local recurrence, metastasis, and death. Atypical fibroxanthoma and pleomorphic dermal sarcoma are histopathologically similar, and their distinction requires a systematic examination of the entire excised tumor. Since Mohs micrographic surgery is commonly utilized to treat atypical fibroxanthoma, a histopathologic evaluation of debulk specimens by permanent pathology is prudent to avoid underdiagnosing pleomorphic dermal sarcoma. This approach can improve risk assessment and treatment decisions, ultimately enhancing patient outcomes. Also, the proper distinction will facilitate the future development of accurate staging criteria and additional treatment modalities.
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Affiliation(s)
- Muhammad N Mahmood
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, AB T6G 2B7, Canada
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2
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Saleh JS, Whittington CP, Bresler SC, Patel RM. Pleomorphic Dermal Sarcoma. Surg Pathol Clin 2024; 17:153-158. [PMID: 38278604 DOI: 10.1016/j.path.2023.06.007] [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] [Indexed: 01/28/2024]
Abstract
Pleomorphic dermal sarcoma (PDS) is a rare cutaneous/subcutaneous neoplasm of purported mesenchymal differentiation that exists along a clinicopathologic spectrum with atypical fibroxanthoma (AFX). While PDS and AFX share histopathologic and immunohistochemical features, PDS exhibits deeper tissue invasion and has a higher rate of metastasis and local recurrence than AFX. Given its aggressive clinical course, early recognition and clinical management of PDS are essential for optimizing patient outcomes. This review aims to provide a brief overview of the clinicopathologic and molecular features, prognosis, and treatment of PDS.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA; Department of Dermatology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Carli P Whittington
- Department of Pathology, University of Michigan, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA; Department of Dermatology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Scott C Bresler
- Department of Pathology, University of Michigan, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA; Department of Dermatology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Rajiv M Patel
- Department of Pathology, University of Michigan, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA; Department of Dermatology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA; Cutaneous Pathology, WCP Laboratories, Inc., Maryland Heights, MO, USA.
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Moody R, Darji K, Missall TA, Chow P, Behshad R. A Case of Pleomorphic Dermal Sarcoma: Giant Exophytic Tumor of the Medial Canthus. Dermatopathology (Basel) 2023; 11:13-18. [PMID: 38247725 PMCID: PMC10801471 DOI: 10.3390/dermatopathology11010003] [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: 09/06/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
We present the case of a 99-year-old Caucasian female who was referred for treatment of a painless, 8.0 cm × 7.8 cm exophytic, pedunculated, ulcerated tumor of the left medial canthus. Pathology showed spindled, oval, and polygonal cells with pleomorphic nuclei. Many multinuclear giant cells and mitotic figures were also noted. The tumor was highlighted with CD10, showed focal positivity with actin, desmin, and CD68, and had increased Ki67 immunohistochemical staining. The tumor was negative for pancytokeratin, CK5/6, p63, MART-1/MelanA, S100, Sox10, p40, CD34, and CD23. Based on clinicopathologic correlation, the diagnosis of pleomorphic dermal sarcoma (PDS) was made. Pleomorphic dermal sarcoma (PDS) refers to a deep, histologically high-grade tumor that often resembles other tumors clinically and histologically. As PDS is frequently aggressive and related to adverse outcomes, it is important to recognize its distinguishing features in comparison to other similar entities, including atypical fibroxanthoma (AFX) and pleomorphic leiomyosarcoma (PLMS). To our knowledge, there is only one other reported case in the literature of PDS occurring on the eye. By reviewing and understanding characteristic etiologies, locations of presentation, histopathological features, and management techniques, pathologists can make a more accurate diagnosis and dermatologists can provide more effective patient care in a timely manner.
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Affiliation(s)
- Rylee Moody
- School of Medicine, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
| | - Kavita Darji
- Department of Dermatology, SSMHealth SLUCare, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
| | - Tricia A. Missall
- Department of Dermatology, University of Florida, Gainesville, FL 32606, USA
| | - Peter Chow
- Department of Dermatology, SSMHealth SLUCare, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
| | - Ramona Behshad
- Department of Dermatology, SSMHealth SLUCare, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
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Seretis K, Klaroudas A, Galani V, Papathanakos G, Varouktsi A, Mitselou A, Batistatou A, Lampri E. Pleomorphic dermal sarcoma: it might be rare but it exists. J Surg Case Rep 2023; 2023:rjad374. [PMID: 37545789 PMCID: PMC10401320 DOI: 10.1093/jscr/rjad374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/11/2023] [Indexed: 08/08/2023] Open
Abstract
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal tissue tumor. Its differential diagnosis from similar tumors, such as low differentiated squamous cell carcinoma, fibrosarcoma, desmoplastic melanoma, atypical fibroxanthoma (AFX), may be difficult, as they have similar clinical and histological presentation. We present a case of an 83-year-old man exhibiting an exophytic scalp lesion. Excision of the lesion was performed, ensuring clear surgical margins and pathologic examination revealed an invasive pleomorphic dermal sarcoma. This case highlights a rare case of a large pleomorphic dermal sarcoma, and it discusses the histological, molecular features, its differential diagnosis and management of PDS.
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Affiliation(s)
| | - Antonios Klaroudas
- Department of Anatomy-Histology-Embryology, School of Medicine University of Ioannina, Greece
| | - Vasiliki Galani
- Correspondence address. Department of Anatomy-Histology-Embryology, School of Medicine University of Ioannina, Greece. E-mail:
| | | | - Anna Varouktsi
- Department of Internal Medicine, Ippokrateio Hospital, Thessalonνki, Greece
| | - Antigoni Mitselou
- Department of Forensic Pathology, Medical School University of Ioannina, Greece
| | - Anna Batistatou
- Department of Pathology, Medical School University of Ioannina, Greece
| | - Evangeli Lampri
- Department of Pathology, Medical School University of Ioannina, Greece
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Ripa V, Singh N, Star AE, Smith F. Progression of the atypical fibroxanthoma to pleomorphic dermal sarcoma in a heart transplant patient. BMJ Case Rep 2021; 14:14/7/e242359. [PMID: 34215640 DOI: 10.1136/bcr-2021-242359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 82-year-old man presented with a right scalp lesion which had been increasing in size. The patient's medical history was significant for a heart transplant 25 years before, and he was on chronic immunosuppression. Biopsy of the lesion showed atypical fibroxanthoma. The patient underwent an excision of the lesion with split thickness skin graft. Pathology showed fibroxanthoma with negative margins. Over the next 9 months, the patient developed new lesions, which were also excised to negative margins. However, with each new lesion, the histology demonstrated increasing dysplasia and ultimately pleomorphic sarcoma. The patient had a metastatic workup with CT of the chest, which was negative, and he underwent a radical scalpectomy, split thickness skin graft placement and adjuvant radiation therapy. The patient has not developed any new scalp lesions and no evidence of metastasis.
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Affiliation(s)
- Valeria Ripa
- General Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Natasha Singh
- Pathology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Allen E Star
- General Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Franz Smith
- Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
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Abstract
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal tissue tumor. Distinguishing PDS from similar conditions, such as atypical fibroxanthoma (AFX), its less aggressive tumor counterpart, is difficult, as they are clinically and histologically similar. We present a case of a 77-year-old man presenting with a large nodular scalp lesion of three weeks duration. Pathology revealed a 3.3 cm invasive pleomorphic dermal sarcoma. Surgical excision with 2 cm margins was performed with successful healing of the graft. This case highlights a rare case of a large pleomorphic dermal sarcoma and discusses the histological features and management of PDS.
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Affiliation(s)
| | - Mai P Hoang
- Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Bobby Y Reddy
- Dermatology, Massachusetts General Hospital, Boston, USA
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de Paiva ACG, de Abreu MAMM, de Souza MP. Undifferentiated pleomorphic sarcoma. An Bras Dermatol 2018; 93:154-155. [PMID: 29641724 PMCID: PMC5871389 DOI: 10.1590/abd1806-4841.20186613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 07/18/2017] [Indexed: 12/05/2022] Open
Affiliation(s)
- Ana Carolina Gonçalves de Paiva
- Dermatology Service, Hospital Regional de
Presidente Prudente - Presidente Prudente (SP), Brazil
- Discipline of Dermatology, Universidade do
Oeste Paulista (Unoeste) - Presidente Prudente (SP), Brazil
| | - Marilda Aparecida Milanez Morgado de Abreu
- Dermatology Service, Hospital Regional de
Presidente Prudente - Presidente Prudente (SP), Brazil
- Discipline of Dermatology, Universidade do
Oeste Paulista (Unoeste) - Presidente Prudente (SP), Brazil
| | - Marcela Pesce de Souza
- Dermatology Service, Hospital Regional de
Presidente Prudente - Presidente Prudente (SP), Brazil
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