Huge undifferentiated fibroblastic sarcoma of the foot and lower leg: impact of diagnostic delay and discussion of an entity

Kutane Sarkome – nicht alle sind wirklich selten, die meisten „low risk“

Die biologische und morphologische Vielfalt der Weichteilmalignome, der Sarkome, ist enorm.

Diese Übersicht fokussiert deshalb auf die 5 am häufigsten vorkommenden Weichteilmalignome. Betrachtet werden soll dabei, was der Kliniker wissen muss, was neu ist und welche Fallstricke es gibt. Ziel dieses Artikels ist es dabei, eine Übersicht zu geben sowie die Konzeptbildung darüber, womit man es im Wesentlichen zu tun hat.

Clinical and radiological profile of posterior cortical atrophy and comparison with a group of typical Alzheimer disease and amnestic mild cognitive impairment

Posterior cortical atrophy (PCA) is a rare dementia affecting higher visual processing and other posterior cortical functions with atrophy and hypometabolism in occipito-parieto-temporal areas, more on right side. The objective of the study was to explore the clinical, neuropsychological, and radiological features of PCA patients and to compare them with typical multi-domain amnestic Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI) patients. Four out of 9 patients of PCA fulfilling the criteria of Tang-Wai et al. (2004), 10 patients each of AD and aMCI fulfilling NIA-AA criteria were chosen. Patients were assessed clinically by experienced neurologists. Neuropsychological assessment was performed with standardized validated tests. Each patient underwent an MRI. FDG-PET was done for all PCA and six AD patients. PCA patients were younger, cognitively more impaired with rapid progression showing predominant visuospatial deficits consistent with the damage to the upstream of visual processing. AD patients presented predominantly with amnestic symptoms, with visuospatial dysfunction in some and aMCI had mild memory loss. Marked atrophy and hypometabolism in occipital, parietal and temporal areas in PCA, atrophy and hypometabolism in medial temporal areas in AD and minimal non-localized atrophy in MRI in aMCI were seen. Two PCA patients showed hypometabolism extending to the medial temporal and one to the frontal cortex. The clinical and imaging features of PCA are consistent with the damage predominantly to the upstream of visual processing. The difference between PCA and typical AD suggests involvement of AD pathology at different sites within a common disease-relevant network of brain regions.

Dermatofibrosarcoma Protuberans Found Within Procedural Scars: A Retrospective Review at a Tertiary Referral Cancer Center

Background: Surgical scars are not a well-known risk factor for the development of dermatofibrosarcoma protuberans (DFSP). However, DFSP can arise within a surgical scar.

Objective: This study determined the number of DFSP found within scars from prior surgical procedures at a tertiary academic cancer center.

Methods: A retrospective data analysis was performed of all patients with biopsy-proven DFSP from January 2000 to April 2018 at MD Anderson Cancer Center (MDACC), a tertiary referral cancer center. Chart review was performed, and data were recorded for gender, race, and age of patients. We also recorded the site, location, and size of the DFSP and whether the patients had a history of prior surgery at the DFSP site. All patients had a pathologic diagnosis of DFSP at MDACC. Patients were selected from the pathology database at MDACC using the keywords “DFSP” or “dermatofibrosarcoma protuberans”. A total of 458 patients were identified; however, 94 patients were excluded from the study because they were only referred to MDACC with a confirmed diagnosis of DFSP and were not seen as patients by a MDACC physician.

Results: Of the remaining 364 patients, 37 patients (10.1%) had either a history of a benign neoplasm or an inflammatory disease that had been evaluated or treated by either punch biopsy, shave biopsy, or minor excision at the site of DFSP (8.5%, 31 patients) or a DFSP arising within a major surgical procedural scar (1.6%, six patients). The surgical sites identified were the abdomen (four patients) and the groin (two patients). Three of the patients with a major surgical scar DFSP had prior laparoscopic surgery at the site.

Conclusions: DFSPs occur at surgical scars. The development of surgical scar DFSP in 10% of our patients prompts us to postulate that the neoplasm may be associated with the malignant transformation of these scars.