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Winer LK, Akumuo R, Fredette JD, Deng M, Hasler JS, Greco SH, von Mehren M, Bartholomew AJ, Blazer DG, Gabrielova L, Adamkova D, Bernard-Bedard E, Nessim C, Kollár A, Olariu R, Cencelj-Arnez R, Hompes D, Ford SJ, Cardona K, Sato K, Iwata S, Farma JM, Villano AM. Current patterns of care and outcomes for dermatofibrosarcoma protuberans: An international multi-institutional collaborative. Cancer 2024. [PMID: 38985726 DOI: 10.1002/cncr.35468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/26/2024] [Accepted: 05/31/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a cutaneous sarcoma with an infiltrative growth pattern that makes it challenging to clear margins. High quality data regarding DFSP natural history, management, and outcomes are limited. METHODS Data were retrospectively collected for adult DFSP patients who underwent resection at 10 institutions in eight countries. Demographics, tumor characteristics, treatment strategies, and outcomes were analyzed. RESULTS Analysis included 347 patients consisting of young (median, 42 years), White (76.2%), males (54.2%) with truncal lesions (57.3%). The majority (76.8%) were symptomatic at presentation. Preoperative imaging was used in 55.9% of cases. Diagnosis was established with excisional biopsy in 50.9% versus incisional biopsy in 25.0% of cases. Despite planned margins of >1.0 cm in 67.4% of cases, only 69.0% of patients achieved R0 resection. Twenty-two percent of patients underwent at least one re-excision. R0 resection was achieved at a second procedure in 80.2% and a third procedure in 86.2%. Ultimately, R0 resection was feasible in 89.5% of all patients. Fibrosarcomatous transformation (FST) was observed in 12.6%. In total, 6.6% (N = 23) recurred (17 local, six distant). Of the six distant recurrences, 50.0% had FST. With a median follow-up of 47.0 months, disease-specific survival rate was 98.8%. In multivariable analysis, R0 margins at index resection were associated with wider circumferential margins and non-FST histology. CONCLUSIONS In this international, multicenter collaborative, DFSP practice patterns were heterogeneous but achieved favorable recurrence rates and survival. Multiple excisions to clear margins remain commonplace and can inform future efforts to optimize margin selection.
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Affiliation(s)
- Leah K Winer
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Rita Akumuo
- Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Jordan D Fredette
- Division of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Mengying Deng
- Division of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jill S Hasler
- Division of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Stephanie H Greco
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Margaret von Mehren
- Division of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Alex J Bartholomew
- Department of Surgery, Duke University Hospital, Durham, North Carolina, USA
| | - Dan G Blazer
- Department of Surgery, Duke University Hospital, Durham, North Carolina, USA
| | - Lucie Gabrielova
- Department of Surgery, Masaryk Memorial Cancer Institute, Brno, Zluty kopec, Czech Republic
| | - Dagmar Adamkova
- Department of Surgery, Masaryk Memorial Cancer Institute, Brno, Zluty kopec, Czech Republic
| | | | - Carolyn Nessim
- Division of Surgical Oncology, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Attila Kollár
- Department of Medical Oncology, Inselspital, Bern University Hospital, Univesity of Bern, Bern, Switzerland
| | - Radu Olariu
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, Freiburgstrasse, Switzerland
| | - Romi Cencelj-Arnez
- Division of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Daphne Hompes
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Samuel J Ford
- Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Kenneth Cardona
- Division of Surgical Oncology, Emory University Hospital, Atlanta, Georgia, USA
| | - Kenji Sato
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jeffrey M Farma
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Anthony M Villano
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Matias M, Verissimo M, Barbosa R, Casal D. Case report: Dermatofibrosarcoma protuberans of the foot: What steps can we take? Int J Surg Case Rep 2023; 111:108667. [PMID: 37716054 PMCID: PMC10514428 DOI: 10.1016/j.ijscr.2023.108667] [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: 07/24/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 09/18/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma affects mainly the trunk and proximal limbs. Clinically, it typically presents as an asymptomatic plaque or nodular-like lesion that progresses slowly before entering a rapid growth phase. DFSP exhibits a low potential for metastasis, mainly in cases where fibrosarcomatous transformation occurs, but it has a high rate of local recurrence. Diagnosis of DFSP is often delayed, and it is challenging to establish without performing a biopsy and histologic analysis. The mainstay treatment for DFSP is surgical wide excision with free margins, although this can be challenging depending on the location of the tumor. CASE PRESENTATION We report a rare presentantion of dermatofibrosarcoma protuberans according to the SCARE guidelines. The patients main concern was the slow evolving mass on the dorsum of the foot that at presentation was 1x1cm. The biopsy showed a dermatofibrosarcoma protuberans. A radical excision involving ray amputation of the 2nd and 3rd finger provided a 1 cm clear margin. CLíNICAL DISCUSSION AND CONCLUSION: This case shows how an inconspicuous nodule in an uncommon area can be the primary manifestation of a serious condition.
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Affiliation(s)
- Miguel Matias
- Plastic Reconstructive Surgery Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
| | - Miguel Verissimo
- Plastic Reconstructive Surgery Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Raquel Barbosa
- Plastic Reconstructive Surgery Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Diogo Casal
- Plastic Reconstructive Surgery Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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Chen S, Xiong L, Zhao L, Li Y, Li L. Survival Outcomes and Prognostic Factors of Dermatofibrosarcoma Protuberans: A Population-Based Retrospective Cohort Analysis. Dermatol Surg 2023; 49:825-831. [PMID: 37384896 PMCID: PMC10461715 DOI: 10.1097/dss.0000000000003853] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Limited information is available regarding survival outcomes and risk factors of dermatofibrosarcoma protuberans (DFSP). OBJECTIVE To investigate the clinicopathologic characteristics and survival outcomes of DFSP. MATERIALS AND METHODS The study cohort (7,567 patients) was selected from the Surveillance, Epidemiology, and End Results Program (2000-2018). Demographic and clinicopathologic variables, survival outcomes, and prognostic factors were analyzed. RESULTS A total of 5,640 (74.53%) and 1,927 (25.47%) tumors were located in the skin and soft tissue, respectively. The median follow-up duration was 92 months. Median follow-up times were similar between patients with lymph node (107 months) and distant (102 months) metastases; the median survival time of the 89 patients (1.18%) who died of DFSP was significantly short (41 months, p < .001). Independent risk factors for cancer-specific mortality included age at diagnosis, histologic grade, and tumor size. Patients with tumors ≥10 cm in size or histologic grade III had significantly higher DFSP-specific mortality (7.07% and 10.08%, respectively, p < .001). Tumor locations and surgical procedures did not significantly influence survival. CONCLUSION Dermatofibrosarcoma protuberans has a favorable survival prognosis, even in patients with node-positive or distant metastases. Dermatofibrosarcoma protuberans-specific mortality is significantly higher in patients with grade III or large (≥10 cm) tumors.
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Affiliation(s)
- Shijing Chen
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Lidan Xiong
- Center of Cosmetic Safety and Efficacy Evaluation of West China Hospital, Sichuan University, Chengdu, China
| | - Lingyun Zhao
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Yiming Li
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Li
- Department of Dermatology and Venereology, West China Hospital, Sichuan University, Chengdu, China
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Lerttiendamrong B, Annoppornchai P, Promniyom P. Fibrosarcomatous dermatofibrosarcoma protuberans: a rapidly growing 30 cm mass on the posterior scalp. ASIAN BIOMED 2023; 17:200-205. [PMID: 37860677 PMCID: PMC10584390 DOI: 10.2478/abm-2023-0060] [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] [Indexed: 10/21/2023]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing sarcoma of the skin and subcutaneous tissue, accounting for around 5 cases per million per year. Fibrosarcomatous transformation of DFSP occurs in 10%-15% of DFSP cases, with a higher risk of local recurrence, metastasis, and death. We present a case of a male in his 30s with a complaint of rapidly progressive mass in the occipital region of the head. Within 1 year, the mass enlarged by >30 cm. Physical examination revealed a skin-colored 40×30 cm mass with an overlying skin necrosis at the posterior scalp. Brain, neck, and chest computed tomography (CT) scans were performed. The mass was surgically excised by wide excision with a 2 cm margin. Pathological report confirmed fibrosarcomatous DFSP Grade 3 with decreased CD34 expression. Delayed reconstruction of free flap and split-thickness skin graft were subsequently performed. No recurrence was detected 3 months postoperatively.
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Affiliation(s)
- Bhoowit Lerttiendamrong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Pavinee Annoppornchai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Pasu Promniyom
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
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Espinoza AF, Onwuka E, Hicks MJ, Masand P, Monson L, Okcu MF, Pinglay N, Vidimos A, Vasudevan SA. Dermatofibrosarcoma protuberans case report: Aggressive tumor in a preadolescent child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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6
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Burke CJ, Fritz J, Samim M. Musculoskeletal Soft-tissue Masses. Magn Reson Imaging Clin N Am 2023; 31:285-308. [PMID: 37019551 DOI: 10.1016/j.mric.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Evaluation of soft-tissue masses has become a common clinical practice indication for imaging with both ultrasound and MR imaging. We illustrate the ultrasonography and MR imaging appearances of soft-tissue masses based on the various categories, updates, and reclassifications of the 2020 World Health Organization classification.
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Affiliation(s)
- Christopher J Burke
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, USA.
| | - Jan Fritz
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, USA
| | - Mohammad Samim
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, USA
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Porrino J, Al-Dasuqi K, Irshaid L, Wang A, Kani K, Haims A, Maloney E. Update of pediatric soft tissue tumors with review of conventional MRI appearance-part 1: tumor-like lesions, adipocytic tumors, fibroblastic and myofibroblastic tumors, and perivascular tumors. Skeletal Radiol 2022; 51:477-504. [PMID: 34191084 DOI: 10.1007/s00256-021-03836-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
There are numerous soft tissue tumors and tumor-like conditions in the pediatric population. Magnetic resonance imaging is the most useful modality for imaging these lesions. Although certain soft tissue lesions exhibit magnetic resonance features characteristic of a specific diagnosis, most lesions are indeterminate, and a biopsy is necessary for diagnosis. We provide a detailed update of soft tissue tumors and tumor-like conditions that occur in the pediatric population, emphasizing each lesion's conventional magnetic resonance imaging appearance, using the recently released 5th edition of the World Health Organization Classification of Soft Tissue and Bone Tumors as a guide. In part one of this review, pediatric tumor-like lesions, adipocytic tumors, fibroblastic and myofibroblastic tumors, and perivascular tumors are discussed. In part two, vascular lesions, fibrohistiocytic tumors, muscle tumors, peripheral nerve sheath tumors, tumors of uncertain differentiation, and undifferentiated small round cell sarcomas are reviewed. Per the convention of the WHO, these lesions involve the connective, subcutaneous, and other non-parenchymatous-organ soft tissues, as well as the peripheral and autonomic nervous system.
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Affiliation(s)
- Jack Porrino
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA.
| | - Khalid Al-Dasuqi
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA
| | - Lina Irshaid
- Yale School of Medicine Department of Pathology, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Annie Wang
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA
| | - Kimia Kani
- Department of Radiology, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Andrew Haims
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA
| | - Ezekiel Maloney
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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Al-Qassab S, Lalam R, Botchu R, Bazzocchi A. Imaging of Pediatric Soft Tissue Tumors and Tumor-like Conditions. Semin Musculoskelet Radiol 2021; 25:39-56. [PMID: 34020467 DOI: 10.1055/s-0041-1723966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Lumps and bumps are frequently seen in children, and the vast majority are a result of trauma, infection, or inflammation. True soft tissue neoplastic lesions are rare; however, their wide and complex classifications make these lesions challenging to manage. Imaging features are usually nonspecific, and a reasonable list of differential diagnoses can be generated following consideration of the clinical presentation, age, and anatomical location of the lesion. In this article, we offer a practical approach to diagnosing such lesions by discussing the most common three benign and malignant lesions in different anatomical regions stratified by age with emphasis on certain features that might aid in the diagnosis such as depth, multiplicity, calcification, or other specific imaging feature.
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Affiliation(s)
- Sinan Al-Qassab
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Radhesh Lalam
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Rajesh Botchu
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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Abduljawad H, Mansour E, Abdulkader M, Tawab MA. Case report: Dermatofibrosarcoma of the breast. Radiol Case Rep 2021; 16:1524-1529. [PMID: 33948128 PMCID: PMC8081876 DOI: 10.1016/j.radcr.2021.03.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 01/03/2023] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon neoplasm of the skin and soft tissue, commonly appearing on the trunk and extremities. The occurrence of DFSP in the breast is extremely rare. It has low to intermediate malignant potential with a high rate of local recurrence and invasion. We present a case of a 28-year- old female with a skin lesion on the breast associated with an underlying breast lump. We aim to discuss the sonographic and magnetic resonance findings of breast dermatofibrosarcoma.
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Affiliation(s)
- Hiba Abduljawad
- Medical Imaging Department, King Hamad University Hospital, Busaiteen, Kingdom of Baharin,Corresponding author.
| | - Eman Mansour
- Medical Imaging Department, King Hamad University Hospital, Busaiteen, Kingdom of Baharin
| | - Marwah Abdulkader
- Medical Imaging Department, King Hamad University Hospital, Busaiteen, Kingdom of Baharin,Department of Pathology, King Hamad University Hospital, Busaiteen, Kingdom of Baharin
| | - Mohamed A. Tawab
- Medical Imaging Department, King Hamad University Hospital, Busaiteen, Kingdom of Baharin
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Choong P, Lindsay D, Khoo M, Saifuddin A. Dermatofibrosarcoma protuberans: the diagnosis of high-grade fibrosarcomatous transformation. Skeletal Radiol 2021; 50:789-799. [PMID: 33001221 DOI: 10.1007/s00256-020-03617-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Dermatofibrosarcoma protuberans (DFSP) is an intermediate-grade tumour which may undergo fibrosarcomatous transformation to a high-grade sarcoma (DFSP-FST). DFSP-FST requires wide local resection, and therefore, pre-operative identification is important. The aims of this study are to see if DFSP and DFSP-FST can be differentiated based on MRI appearances, and to determine the ability of ultrasound-guided core needle biopsy (US-CNB) to identify DFSP-FST. MATERIALS AND METHODS Retrospective review of patients with a histological diagnosis of DFSP with/without transformation to DFSP-FST. Patient age, gender, lesion location and maximal size were recorded, as were several MRI features. MRI studies were reviewed independently by 2 musculoskeletal radiologists and the assessed features were then compared with final surgical resection histology. Histological results of US-CNB were also compared with final surgical pathology. RESULTS A total of 42 patients were included, 26 males and 16 females with a mean age of 41.3 years (range 3-78 years). The upper limb was involved in 12 cases, the lower limb in 17 and the trunk in 13. Final surgical histological diagnosis was DFSP in 21 (50%) cases and DFSP-FST in 21 (50%) cases. Mean tumour dimension for DFSP was 32 mm and DFSP-FST 68 mm (p < 0.001). MRI features indicative of DFSP-FST included multi-lobular morphology (p = 0.03), T2W hypointensity compared with fat (p = 0.03), internal flow voids (p = 0.03) and peri-tumoral oedema (p < 0.001). Only 3 cases of DFSP-FST were correctly diagnosed on US-CNB. CONCLUSIONS Various MRI findings can suggest a diagnosis of DFSP-FST, but US-CNB is unreliable at identifying high-grade fibrosarcomatous transformation.
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Affiliation(s)
- Paul Choong
- Spinal Cord Injuries Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Daniel Lindsay
- Department of Histopathology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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Kim H. Dermatofibrosarcoma protuberans in the breast: Case report. Int J Surg Case Rep 2021; 81:105773. [PMID: 33773373 PMCID: PMC8024653 DOI: 10.1016/j.ijscr.2021.105773] [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: 12/24/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 11/30/2022] Open
Abstract
The occurrence of dermatofibrosarcoma protuberans in the breasts is rare. Histological examination is helpful for identifying dermatofibrosarcoma protuberans. Treatment of dermatofibrosarcoma protuberans; surgical resection.
Introduction and importance Dermatofibrosarcoma protuberans (DFSP) represents about 1% of soft tissue sarcomas with an estimated incidence of 0.8–5.0 cases per million per year. The involvement of DFSP in breast is very rare and very few cases have been reported in the literature. DFSP was recurred in situ, not spread to distant site. The complete surgical excision with wide, pathologically negative margins of 3 cms is the optimal treatment for primary or recurrent tumor. Presentation of case A 46-year-old woman presented with palpable lump in the in the right breast. On ultrasonography, a lesion appeared as hypoechoic, circumscribed mass of approximately 37 mm × 30 mm in diameter in the upper central part of the right breast. The mass of right breast was demonstrated DFPS by pathologic examination. Chest computerized tomography (CT) scan and 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography (PET) showed only primary lesion in subcutaneous layer and no enlarged lymph node. The patient underwent excision of the tumor widely. There was no evidence of DFSP local recurrence after five years of follow-up of the patient. Discussion DFSP is a rare tumor arising from dermis and subcutaneous mesenchymal tissue. Whereas, characteristic imaging feature of DFSP in the breast are not well-defined. The primary treatment for DFSP is considered to be surgical excision. Conclusion DFSP in breast is extremely uncommon and can mimic a primary breast tumor. Surgical excision with adequate resection margins is recommended to ensure local control of the disease.
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Affiliation(s)
- Hwansoo Kim
- Department of Surgery, Kangwon National University Hospital, Republic of Korea
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12
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Mujtaba B, Wang F, Taher A, Aslam R, Madewell JE, Spear R, Nassar S. Dermatofibrosarcoma Protuberans: Pathological and Imaging Review. Curr Probl Diagn Radiol 2021; 50:236-240. [DOI: 10.1067/j.cpradiol.2020.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/26/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022]
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13
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Saifuddin A, Ali S, Sabahuddin A, Malhotra K, Khoo M. The differential diagnosis of trunk and extremity dermal and sub-dermal lesions referred to a musculoskeletal oncology service. Clin Imaging 2021; 78:51-59. [PMID: 33765643 DOI: 10.1016/j.clinimag.2021.02.030] [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: 12/15/2020] [Revised: 02/08/2021] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the differential diagnosis of dermal and sub-dermal soft tissue masses which do not extend to the deep fascia that are referred to a specialist musculoskeletal oncology service. MATERIALS AND METHODS Review of all patients referred to a specialist musculoskeletal oncology service over a 13-month period with a dermal or sub-dermal soft tissue mass which did not extend to the deep fascia based on MRI appearances. Data collected included age, gender, site and maximal lesion size, and final histological diagnosis for biopsied and/or excised lesions. RESULTS 56 patients were included, 21 (37.5%) males and 35 (62.5%) females with mean age 49.75 years (range 5-86 years). 3 patients had 2 lesions making a total of 59 lesions, 11 (18.6%) dermal and 48 (81.4%) sub-dermal. Histological diagnosis was available in 44 (74.6%) cases, of which 11 (25%) were non-neoplastic, 23 (52.3%) were benign neoplasms, and 10 (22.7%) were malignant neoplasms. Although older age at presentation and greater mean maximal tumour dimension were seen with malignant lesions, these did not reach statistical significance (p = 0.154 and 0.102 respectively). There was also no relationship between skin involvement from sub-dermal lesions and malignancy, but 5 of 6 dermal lesions which showed an exophytic growth pattern were malignant. CONCLUSIONS The differential diagnosis of dermal and sub-dermal lesions which do not reach the deep fascia is wide with a malignant lesion being the cause in almost one-quarter of cases.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Sania Ali
- Department of Plastic Surgery, Wexham Park Hospital, UK
| | | | - Karan Malhotra
- Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.
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14
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Aoki T, Fujisaki A, Terasawa T, Hayashida Y, Todoroki Y, Hirano N, Hisaoka M, Sakai A, Korogi Y. Primary Site Identification of Soft-Tissue Mass: Things to Know in MRI Assessment. J Magn Reson Imaging 2020; 55:37-47. [PMID: 32949073 DOI: 10.1002/jmri.27368] [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: 07/06/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/09/2022] Open
Abstract
The spectrum of soft-tissue mass is varied, including neoplastic and nonneoplastic/inflammatory lesions. However, soft-tissue tumors have similar imaging findings and, therefore, the diagnosis of soft-tissue mass is challenging. Although careful assessment of the internal characteristics on imaging can often narrow the differential diagnoses, the differential diagnosis may be out of the question if identification of the soft-tissue mass origin is missed. The purpose of this article is to review the imaging findings and the essential anatomy to identify the primary site of the soft-tissue mass, and discuss the associated potential pitfalls. In order not to fall into a pitfall, recognition of characteristic imaging findings indicating the origin of the soft-tissue mass and anatomical knowledge of the normal tissue distribution are necessary. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Akitaka Fujisaki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Takashi Terasawa
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yoshiko Hayashida
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yo Todoroki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Natsumi Hirano
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yukunori Korogi
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
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Sedaghat S, Schmitz F, Sedaghat M, Nicolas V. Appearance of recurrent dermatofibrosarcoma protuberans in postoperative MRI follow-up. J Plast Reconstr Aesthet Surg 2020; 73:1960-1965. [PMID: 32952057 DOI: 10.1016/j.bjps.2020.08.089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/01/2020] [Accepted: 08/18/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the appearance of recurrent dermatofibrosarcoma protuberans (DFSP) in postoperative MRI follow-up and to assess the occurrence of postoperative soft tissue changes detected in MRI. METHODS A total of 464 MRI follow-up scans of 32 patients with histologically proven diagnosis of DFSP were analyzed. MR imaging was performed using a 1.5T MRI system. Recurrent DFSP was examined for signal intensity, contrast behavior, appearance, and extent in MRI. RESULTS The mean age of the patients was 44,5±17,1 years. Recurrences of DFSP occurred 26±23.3 months after primary tumor resection in the mean (Min.: 9, Max.: 60). In 25% of the patients (n = 8), recurrences of DFSP were detected. Recurrent DFSP most often showed a nodular and homogeneous configuration with well-defined borders and marked contrast enhancement, and a hyperintense signal in PD-weighted and turbo inversion recovery magnitude sequences. All recurrences were well detected in the follow-up MRIs regardless of the performed plastic surgery procedure. Lateral and depth margins had no significant impact on the local recurrence rate. In all, 88% of the patients developed subcutaneous tissue edema (p < 0.01), followed by muscle edema (34%, p = 0.02), and postoperative seroma (22%). CONCLUSION Recurrent DFSP mainly appear uniform and clearly delimitable on MRI as nodular, homogeneous, and well-defined lesions with marked contrast enhancement. Therefore, MRI is a valuable tool for postsurgical follow-up. Nearly all patients develop subcutaneous edema after the resection of DFSP.
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Affiliation(s)
- Sam Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany.
| | - Frederick Schmitz
- Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany
| | - Maya Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany
| | - Volkmar Nicolas
- Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany
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Hao X, Billings SD, Wu F, Stultz TW, Procop GW, Mirkin G, Vidimos AT. Dermatofibrosarcoma Protuberans: Update on the Diagnosis and Treatment. J Clin Med 2020; 9:E1752. [PMID: 32516921 PMCID: PMC7355835 DOI: 10.3390/jcm9061752] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 12/23/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a slow growing, low- to intermediate-grade dermal soft-tissue tumor. It has a high local recurrence rate but low metastatic potential. It is characterized by a uniform spindle cell arrangement, classically with a storiform pattern and CD34 immunoreactivity. The histomorphology and immunophenotype overlap with a broad range of other neoplasms. The standard treatment is complete surgical excision. The surgical procedures include wide local excision (WLE) with tumor free margins, Mohs micrographic surgery (MMS) and amputation. Unresectable DFSPs are treated with radiation therapy and/or targeted therapy. DFSP has characteristic t(17; 22) (q22; q13), resulting in a COL1A1- PDGFB fusion transcripts in more than 90% of DFSPs. Molecular detection of the gene rearrangement or fusion transcripts is helpful for the diagnosis of patients with atypical morphology and for screening candidates for targeted therapy with tyrosine kinase inhibitors. The aims of the present review are to update the clinical presentation, tumorigenesis and histopathology of DFSP and its variants for diagnosis and differential diagnosis from other benign and malignant tumors, to compare the advantages and drawbacks of WLE and MMS, to propose the baseline for selecting surgical procedure based on tumor's location, size, stage and relationship with surrounding soft tissue and bone structures, and to provide a biologic rationale for the systemic therapy. We further propose a modified clinical staging system of DFSP and a surveillance program for the patients after surgical excision.
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Affiliation(s)
- Xingpei Hao
- Foot and Ankle Specialists of the Mid-Atlantic, Rockville, MD 20850, USA
| | - Steven D. Billings
- Department of Pathology, Cleveland Clinic, Cleveland, OH 44195, USA; (S.D.B.); (G.W.P.)
| | - Fangbai Wu
- Department of Radiology, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Todd W. Stultz
- Imaging Institute, Section of Neuroradiology, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Gary W. Procop
- Department of Pathology, Cleveland Clinic, Cleveland, OH 44195, USA; (S.D.B.); (G.W.P.)
| | - Gene Mirkin
- Foot and Ankle Specialists of the Mid-Atlantic, Rockville, MD 20850, USA
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Bouhani M, Fertani Y, Zemni I, Adouni O, Bouida A, Chargui R, Khaled R. Dermatofibrosarcoma Protuberans of the Breast in Man: An Extremely Rare Entity With a Review of the Literature. J Investig Med High Impact Case Rep 2020; 7:2324709619875634. [PMID: 31522558 PMCID: PMC6747849 DOI: 10.1177/2324709619875634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare sarcoma of soft tissue representing about 1% of all tumors. In addition, DFSP occurs commonly on the trunk and extremities, and only a few cases of DFSP have been observed on the breast. In men, only 11 cases, including this case, have been reported. In this article, we present a case of left breast DFSP that occurred in a 44-year-old man. The physical examination revealed a left breast tender mass, which invaded the skin. The tumor was staged as T4b N0 M0. Mammography and sonography showed a suspect mass of the left breast. The biopsy and immunochemistry permitted the diagnosis of DFSP of the left breast. The patient had a left mammectomy, with free margins. He presents no evident sign of recurrence 7 months later.
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19
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Li M, Zhang L, Xu XJ, Shi Z, Zhao XM. CT and MRI features of tumors and tumor-like lesions in the abdominal wall. Quant Imaging Med Surg 2019; 9:1820-1839. [PMID: 31867236 DOI: 10.21037/qims.2019.09.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Masses involving the abdominal wall are common in clinical practice and have many etiologies, including tumors and tumor-like lesions. Abdominal wall tumors include primary and secondary tumors, the former of which constitute a heterogeneous group of soft tissue tumors with their own unique spectrum. Tumor-like lesions, such as hernias, are more common and must be distinguished from true tumors. Medical imaging is valuable for discovering, diagnosing, and evaluating the extent of abdominal wall masses. With the increasing application of computed tomography (CT) and magnetic resonance imaging (MRI), determining a diagnosis or narrowing the differential diagnosis is often possible, thus facilitating effective management. In this article, we comprehensively review the spectrum of common abdominal wall masses and present the CT and MRI features of typical cases in our hospital. A systematic stepwise diagnostic approach is also proposed for clinical practice.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao-Juan Xu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhuo Shi
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xin-Ming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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20
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Eshraghi B, Jahanbani-Ardakani HR, Abtahi SM, Abtahi SH. Ophthalmologic aspects of Dermatofibrosarcoma Protuberans: A systematic review in the context of a rare case of primary orbital involvement. J Fr Ophtalmol 2019; 42:913-924. [PMID: 30981544 DOI: 10.1016/j.jfo.2018.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To provide a systematic review on ophthalmologic presentations of dermatofibrosarcoma protuberans (DFSP) in conjunction with a case report of primary orbital involvement by this tumor. METHODS A thorough electronic search on PubMed, Medline, Scopus, EMBASE and web of science databases was performed. All available data from reported cases along with our described case were extracted and analyzed. RESULTS We describe a 66-year-old male with primary orbital DFSP who was managed by total excision of the tumor without recurrence after 18 months of follow-up. In the literature, 14 studies reporting 15 cases were identified and reviewed. Our review topics included epidemiology, clinical presentations, pathologic features, differential diagnosis, imaging, treatment and prognosis. CONCLUSION Rarely, but crucially, ophthalmologists may encounter DFSP in the orbital or periorbital area. They should be familiar with the pathologic nature and treatment options for this tumor. This diagnosis should be kept in mind when approaching a case with a non-tender, nodular, firm, mass or more rarely an indenting orbital mass.
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Affiliation(s)
- B Eshraghi
- Department of ophthalmology, Feiz hospital, Isfahan university of medical sciences, Isfahan, Iran; Isfahan eye research center (IERC), Feiz hospital, Isfahan university of medical sciences, Isfahan, Iran
| | - H R Jahanbani-Ardakani
- Isfahan medical students research center (IMSRC), Isfahan university of medical sciences, Isfahan, Iran; School of medicine, Isfahan university of medical sciences, Isfahan, Iran
| | - S-M Abtahi
- Department of otolaryngology, head and neck surgery, school of medicine, Isfahan university of medical sciences, Isfahan, Iran
| | - S-H Abtahi
- Department of ophthalmology, Feiz hospital, Isfahan university of medical sciences, Isfahan, Iran; Isfahan eye research center (IERC), Feiz hospital, Isfahan university of medical sciences, Isfahan, Iran; Isfahan medical students research center (IMSRC), Isfahan university of medical sciences, Isfahan, Iran.
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21
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Becker-Weidman D, Mhuircheartaigh JN, Mortele KJ. The skinny on skin: MRI features of cutaneous and subcutaneous lesions detected on body MRI studies. Abdom Radiol (NY) 2018. [PMID: 29525881 DOI: 10.1007/s00261-018-1543-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The skin and subcutaneous tissues are inevitably imaged as part of most body MRI studies. Incidental or even symptomatic skin lesions may, therefore, be detected and present a diagnostic challenge for the radiologist. We aim to provide a comprehensive review, with illustrative examples, of the skin abnormalities encountered on body MRI studies in our busy academic radiology department.
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Affiliation(s)
- David Becker-Weidman
- Great Lakes Medical Imaging, 199 Park Club Lane #300, Williamsville, NY, 14221, USA.
| | | | - Koenraad J Mortele
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
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22
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Trofymenko O, Bordeaux JS, Zeitouni NC. Survival in patients with primary dermatofibrosarcoma protuberans: National Cancer Database analysis. J Am Acad Dermatol 2018; 78:1125-1134. [DOI: 10.1016/j.jaad.2017.11.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 12/20/2022]
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Abstract
Superficial solid masses are common conditions in clinical practice, however, some of which can be easily diagnosed and others would be difficult. Although imaging of superficial masses is not always characteristic, it would be helpful to give a definitive diagnosis or narrow a differential diagnosis. Crossing-section imaging can depicture the masses directly, find some pathognomonic signs and demonstrate their relationship with adjacent structures, which can provide decision support for clinician's reference. Computed tomography (CT) can be used to detect calcifications and bone erosion which could not be seen on radiographs. Magnetic resonance imaging (MRI) is the preferred way for evaluating soft tissue lesions and provides information on hemorrhage, necrosis, edema, cystic and myxoid degeneration, and fibrosis. Other advantages of MRI are its superior soft tissue resolution and any profile imaging, which can aid the assessment of extension and adjacent infiltration. Positron emission tomography (PET)/CT and PET/MRI have been increasingly used in bone and soft tissue sarcomas and provides advantages in the initial tumor staging, tumor grading, therapy assessment, and recurrence detection. Therefore, imaging examination can play an important role in treatment decision making for superficial solid tumors. Here we review the important conditions presenting as superficial mass and show the imaging of typical cases diagnosed in our hospital.
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Affiliation(s)
- Jingfeng Zhang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yanyuan Li
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yilei Zhao
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jianjun Qiao
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
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24
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Sharma D, Singh G, Kakkar N, Jha V. Orbital dermatofibrosarcoma protuberans with frontal and ethmoid sinus involvement: A case report and brief review of literature. Indian J Ophthalmol 2017; 65:892-894. [PMID: 28905843 PMCID: PMC5621282 DOI: 10.4103/ijo.ijo_770_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Dermatofibrosarcoma protuberans is a soft tissue sarcoma that is dermal in origin. The incidence is <0.1% of all malignancies and 1% of soft tissue sarcoma. Most commonly, it involves trunk (62%) followed by extremities (25%) and head and neck (13%). It is a slow growing tumor with locally aggressive behavior. Here, a 50-year-old female diagnosed with orbital dermatofibrosarcoma developed extra-axial component in right frontal region even on chemotherapy. Hence, the bad prognostic factors are yet to be established in dermatofibrosarcoma protuberans.
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Affiliation(s)
- Deepti Sharma
- Department of Radiation Oncology, Safdarjung Hospital, New Delhi, India
| | - Garima Singh
- Department of Radiation Oncology, Safdarjung Hospital, New Delhi, India
| | - Neha Kakkar
- Department of Radiation Oncology, Safdarjung Hospital, New Delhi, India
| | - Vidya Jha
- Department of Radiation Oncology, Safdarjung Hospital, New Delhi, India
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25
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Levy AD, Manning MA, Miettinen MM. Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 2-Uncommon Sarcomas. Radiographics 2017; 37:797-812. [PMID: 28493803 DOI: 10.1148/rg.2017160201] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Soft-tissue sarcomas occurring in the abdomen and pelvis are an uncommon but important group of malignancies. Recent changes to the World Health Organization classification of soft-tissue tumors include the movement of gastrointestinal stromal tumors (GISTs) into the soft-tissue tumor classification. GIST is the most common intraperitoneal sarcoma. Liposarcoma is the most common retroperitoneal sarcoma, and leiomyosarcoma is the second most common. GIST, liposarcoma, and leiomyosarcoma account for the majority of sarcomas encountered in the abdomen and pelvis and are discussed in part 1 of this article. Undifferentiated pleomorphic sarcoma (previously called malignant fibrous histiocytoma), dermatofibrosarcoma protuberans, solitary fibrous tumor, malignant peripheral nerve sheath tumor, rhabdomyosarcoma, extraskeletal chondro-osseous sarcomas, vascular sarcomas, and sarcomas of uncertain differentiation uncommonly arise in the abdomen and pelvis and the abdominal wall. Although these lesions are rare sarcomas and their imaging features overlap, familiarity with the locations where they occur and their imaging features is important so they can be diagnosed accurately. The anatomic location and clinical history are important factors in the differential diagnosis of these lesions because metastasis, more-common sarcomas, borderline fibroblastic proliferations (such as desmoid tumors), and endometriosis have imaging findings that overlap with those of these uncommon sarcomas. In this article, the clinical, pathologic, and imaging findings of uncommon soft-tissue sarcomas of the abdomen and pelvis and the abdominal wall are reviewed, with an emphasis on their differential diagnosis.
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Affiliation(s)
- Angela D Levy
- From the Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (A.D.L., M.A.M.); the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.); and the Center of Cancer Research, National Cancer Institute, Bethesda, Md (M.M.M.)
| | - Maria A Manning
- From the Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (A.D.L., M.A.M.); the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.); and the Center of Cancer Research, National Cancer Institute, Bethesda, Md (M.M.M.)
| | - Markku M Miettinen
- From the Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (A.D.L., M.A.M.); the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.); and the Center of Cancer Research, National Cancer Institute, Bethesda, Md (M.M.M.)
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26
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Sun C, Zou J, Wang Q, Wang Q, Han L, Batchu N, Ulain Q, Du J, Lv S, Song Q, Li Q. Review of the pathophysiology, diagnosis, and therapy of vulvar leiomyoma, a rare gynecological tumor. J Int Med Res 2017; 46:663-674. [PMID: 28875758 PMCID: PMC5971502 DOI: 10.1177/0300060517721796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this article is to discuss the pathophysiology, diagnosis, differential diagnosis, and therapy of vulvar leiomyoma. We performed a review of all English-language reports of vulvar leiomyoma published in PubMed from 1978 to 2015 using the following search terms: “vulval leiomyoma,” “vulvar leiomyoma,” “vulval smooth muscle tumor,” and “external genitalia smooth muscle tumor.” Vulvar leiomyomas, which are rare benign monoclonal tumors, most commonly occur in the fourth and fifth decades of life. The genetics of vulvar leiomyoma remain undefined. Three principal histological patterns have been identified: spindled, epithelioid, and myxoid. Imaging tests such as ultrasound, endoscopic ultrasound, and magnetic resonance imaging are used in diagnosis. Surgical excision is the only curative treatment for vulvar leiomyomas. Establishment of a full differential diagnosis list and correct final diagnosis before surgery are essential for optimal clinical management. Although recurrence of vulvar leiomyoma is extremely rare, long-term follow-up of all cases is advisable.
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Affiliation(s)
- Chao Sun
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Junkai Zou
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qing Wang
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qi Wang
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Lu Han
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Nasra Batchu
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qurat Ulain
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Jiang Du
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Shulan Lv
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
| | - Qing Song
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China.,2 Center of Big Data and Bioinformatics, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China.,3 Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Qiling Li
- 1 Department of Obstetrics and Gynecology, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China.,2 Center of Big Data and Bioinformatics, the First Affiliated Hospital of 12480 Xi'an Jiaotong University , Xi'an, Shaanxi, China
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Raj SD, Sweetwood K, Kapoor MM, Raj KM, Nagi C, Sepulveda KA, Sedgwick EL. Spindle cell lesions of the breast: Multimodality imaging and clinical differentiation of pathologically similar neoplasms. Eur J Radiol 2017; 90:60-72. [DOI: 10.1016/j.ejrad.2017.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 01/11/2017] [Accepted: 02/13/2017] [Indexed: 01/13/2023]
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28
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Humphreys TR, Shah K, Wysong A, Lexa F, MacFarlane D. The role of imaging in the management of patients with nonmelanoma skin cancer. J Am Acad Dermatol 2017; 76:591-607. [DOI: 10.1016/j.jaad.2015.10.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 10/12/2015] [Accepted: 10/17/2015] [Indexed: 11/17/2022]
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29
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Carter BW, Benveniste MF, Betancourt SL, de Groot PM, Lichtenberger JP, Amini B, Abbott GF. Imaging Evaluation of Malignant Chest Wall Neoplasms. Radiographics 2016; 36:1285-306. [PMID: 27494286 DOI: 10.1148/rg.2016150208] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Neoplasms of the chest wall are uncommon lesions that represent approximately 5% of all thoracic malignancies. These tumors comprise a heterogeneous group of neoplasms that may arise from osseous structures or soft tissues, and they may be malignant or benign. More than 50% of chest wall neoplasms are malignancies and include tumors that may arise as primary malignancies or secondarily involve the chest wall by way of direct invasion or metastasis from intrathoracic or extrathoracic neoplasms. Although 20% of chest wall tumors may be detected at chest radiography, chest wall malignancies are best evaluated with cross-sectional imaging, principally multidetector computed tomography (CT) and magnetic resonance (MR) imaging, each of which has distinct strengths and limitations. Multidetector CT is optimal for depicting bone, muscle, and vascular structures, whereas MR imaging renders superior soft-tissue contrast and spatial resolution and is better for delineating the full extent of disease. Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is not routinely performed to evaluate chest wall malignancies. The primary functions of PET/CT in this setting include staging of disease, evaluation of treatment response, and detection of recurrent disease. Ultrasonography has a limited role in the evaluation and characterization of superficial chest wall lesions; however, it can be used to guide biopsy and has been shown to depict chest wall invasion by lung cancer more accurately than CT. It is important that radiologists be able to identify the key multidetector CT and MR imaging features that can be used to differentiate malignant from benign chest lesions, suggest specific histologic tumor types, and ultimately guide patient treatment. (©)RSNA, 2016.
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Affiliation(s)
- Brett W Carter
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Marcelo F Benveniste
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Sonia L Betancourt
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Patricia M de Groot
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - John P Lichtenberger
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Behrang Amini
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Gerald F Abbott
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
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Gupta B, Verma N, Khurana N, Kumar Jain S. Dermatofibrosarcoma protuberans of the scalp, with fibrosarcomatous areas masquerading as epidermal inclusion cyst. BMJ Case Rep 2016; 2016:bcr-2016-215427. [PMID: 27389726 DOI: 10.1136/bcr-2016-215427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Lesions on the scalp are frequently encountered in clinical practice. Commonly diagnosed lesions include epidermal inclusion cysts (EICs), dermoid cysts and lipomas. Dermatofibrosarcoma protuberans (DFSP) is a low-grade malignant skin tumour occurring mostly in the extremities. However, its occurrence on the scalp is unusual, with an incidence of <5%. This lesion is rarely known to undergo fibrosarcomatous transformation. We present two such rare cases of DFSP of the scalp, with fibrosarcomatous transformation, masquerading clinically as EIC.
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Affiliation(s)
- Barkha Gupta
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nidhi Verma
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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Wales C, Caravaglio JV, Radi M, Woo R, Bancroft L. A rare case of dermatofibrosarcoma protuberans of the forefoot. Radiol Case Rep 2016; 11:102-5. [PMID: 27257461 PMCID: PMC4878958 DOI: 10.1016/j.radcr.2016.02.013] [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: 01/10/2016] [Accepted: 02/28/2016] [Indexed: 11/26/2022] Open
Abstract
Dermatofibrosarcoma protuberans is an extremely rare, potentially malignant tumor type that usually presents on the trunk or proximal extremities. The clinical presentation includes a gradually enlarging painless plaque-like or nodular lesion of the skin with surrounding red to blue discoloration. The diagnosis is based on clinical presentation, computed tomography or magnetic resonance imaging, and biopsy with histologic analysis. An early and timely diagnosis improves chances of complete surgical resection thus improving prognosis. Herein, we present a rare case of dermatofibrosarcoma protuberans with the hopes that its addition to the literature will aid in the earlier recognition of future patients and help prevent this potentially curable disease from becoming deadly.
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Affiliation(s)
- Cameron Wales
- College of Medicine, University of Central Florida, Florida Hospital, 601 East Rollins Street, Orlando, FL 32803, USA
| | - Joseph V Caravaglio
- College of Medicine, University of Central Florida, Florida Hospital, 601 East Rollins Street, Orlando, FL 32803, USA
| | - Michael Radi
- Department of Pathology, Florida Hospital, 601 East Rollins Street, Orlando, FL 32803, USA
| | - Raymund Woo
- Pediatric Orthopedic Surgery, Florida Hospital, 601 East Rollins Street, Orlando, FL 32803, USA
| | - Laura Bancroft
- Department of Radiology Florida Hospital, 601 East Rollins Street, Orlando, FL 32803, USA
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Al-Naami AQ, Khan LA, Amin K, Al-Naami ARM, Sun Z. Dermatofibrosarcoma protuberans-a rare neoplasm. Quant Imaging Med Surg 2016; 6:229-30. [PMID: 27190778 DOI: 10.21037/qims.2015.11.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Awaji Qasim Al-Naami
- 1 Department of General and Laparoscopic Surgery, Sabya General Hospital, Jazan, Kingdom of Saudi Arabia ; 2 Department of Medical Radiation Sciences, Curtin University, Perth, Australia
| | - Liaqat Ali Khan
- 1 Department of General and Laparoscopic Surgery, Sabya General Hospital, Jazan, Kingdom of Saudi Arabia ; 2 Department of Medical Radiation Sciences, Curtin University, Perth, Australia
| | - Khadija Amin
- 1 Department of General and Laparoscopic Surgery, Sabya General Hospital, Jazan, Kingdom of Saudi Arabia ; 2 Department of Medical Radiation Sciences, Curtin University, Perth, Australia
| | - Abdu-Rahman Mohammad Al-Naami
- 1 Department of General and Laparoscopic Surgery, Sabya General Hospital, Jazan, Kingdom of Saudi Arabia ; 2 Department of Medical Radiation Sciences, Curtin University, Perth, Australia
| | - Zhonghua Sun
- 1 Department of General and Laparoscopic Surgery, Sabya General Hospital, Jazan, Kingdom of Saudi Arabia ; 2 Department of Medical Radiation Sciences, Curtin University, Perth, Australia
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Al Barwani AS, Taif S, Al Mazrouai RA, Al Muzahmi KS, Alrawi A. Dermatofibrosarcoma Protuberans: Insights into a Rare Soft Tissue Tumor. J Clin Imaging Sci 2016; 6:16. [PMID: 27195182 PMCID: PMC4863404 DOI: 10.4103/2156-7514.181492] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/14/2016] [Indexed: 11/04/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare soft tumor which originally represents a cutaneous sarcoma. It grows slowly and presents usually as nodular superficial lesion on the trunk or the extremities. Although these tumors are locally aggressive with high rate of recurrence following surgery; the prognosis is considered excellent when it is effectively treated. The radiological appearance of this tumor has rarely been studied and findings infrequently discussed in the literature probably because many lesions underwent resection before imaging. Although imaging is infrequently performed for this lesion; it can show characteristic features and demonstrate the full extent. Imaging may also play a role in the differentiation of this tumor from more serious soft tissue lesions such as more aggressive sarcomas and hemangioma. In this article, we discuss the imaging findings of DFSP that can aid in its diagnosis and its variable appearances. In addition; the clinical presentation and treatment options are also described with review of the previous literature.
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Affiliation(s)
| | - Sawsan Taif
- Department of Radiology, Khoula Hospital, Muscat, Sultanate of Oman
| | | | | | - Asif Alrawi
- The James Cook University Hospital, South Tees Hospitals NHS, UK
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A Case of Dermatofibrosarcoma Protuberans of the Trunk. Indian J Surg 2016; 77:740-1. [PMID: 26730105 DOI: 10.1007/s12262-013-0903-7] [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: 02/24/2013] [Accepted: 03/15/2013] [Indexed: 10/27/2022] Open
Abstract
Dermatofibrosarcoma protuberans is a rare, usually superficial soft tissue sarcoma, which is diagnosed by its typical clinical manifestations. We report a case of histopathologically proved dermatofibrosarcoma protuberans of the left upper posterior trunk in a 35-year-old female for whom complete surgical resection was done.
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Van Steenkiste E, Van Laethem A, Biesemans G, Pans S. Role of diffusion-weighted magnetic resonance imaging in the evaluation of scalp dermatofibrosarcoma protuberans. Int J Dermatol 2015; 55:226-31. [DOI: 10.1111/ijd.13050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/18/2015] [Accepted: 04/01/2015] [Indexed: 11/25/2022]
Affiliation(s)
| | - An Van Laethem
- Department of Dermatology; University Hospitals Leuven; Leuven Belgium
| | - Geert Biesemans
- Department of Dermatology; University Hospitals Leuven; Leuven Belgium
| | - Steven Pans
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
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Thomas KL, Henderson-Jackson E, Caracciolo JT. Test yourself: answer - deep benign fibrous histiocytoma. Skeletal Radiol 2015; 44:1151-2, 1209-10. [PMID: 25680331 DOI: 10.1007/s00256-015-2113-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Kerry L Thomas
- Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, FL, USA
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Zhang L, Liu QY, Cao Y, Zhong JS, Zhang WD. Dermatofibrosarcoma Protuberans: Computed Tomography and Magnetic Resonance Imaging Findings. Medicine (Baltimore) 2015; 94:e1001. [PMID: 26091446 PMCID: PMC4616540 DOI: 10.1097/md.0000000000001001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The aim of this study was to analyze the computed tomography (CT) and magnetic resonance imaging (MRI) findings of dermatofibrosarcoma protuberans (DFSP), with a view to improving the diagnosis of this kind of tumor. A total of 27 cases of histopathologically confirmed DFSP were analyzed retrospectively. Of these, 18 patients underwent a CT scan and 9 patients underwent an MRI. All patients underwent unenhanced and contrast-enhanced examinations; 1 patient underwent multiphrase CT enhancement examination. Imaging characteristics, including location, shape, size, number, edge, and attenuation or intensity of each lesion, both unenhanced and contrast enhanced, were analyzed. Of the 27 cases, 24 were solitary, 2 had 2 nodules, and 1 had multiple confluent tumors. The lesion with multiple confluent tumors was ill defined and irregular; the other lesions were oval or round, well-defined nodules or masses. The unenhanced CT images showed 19 homogenous isodense lesions. There was no calcification in any of the patients. The contrast-enhanced CT images showed intermediate and marked nonhomogeneous enhancement in 13 lesions, intermediate homogeneous enhancement in 4 lesions, and a mild heterogeneous enhancement in 2 lesions. MR T1-weighted images revealed 1 ill-defined and 9 well-defined homogeneous isointense lesions. T2-weighted images showed homogeneous hyperintensity to the muscles in 6 lesions, 3 mild hyperintense lesions with hypointense lesions, and 1 mixed, mild hyperintense and isointense lesion. Contrast-enhanced T1-weighted images demonstrated intermediate and marked nonhomogeneous enhancement in 9 lesions and intermediate homogeneous enhancement in 1 lesion. DFSP is characterized by a subcutaneous well-defined soft tissue nodule or mass on plain CT/MR scans, and shows intermediate-to-marked enhancement on contrast-enhanced CT/MR scans. The imaging findings for DFSP are nonspecific, but may help to define the diagnosis in an appropriate clinical setting.
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Affiliation(s)
- Liang Zhang
- From the Department of Radiology (LZ, JZ, WZ), Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center; Department of Radiology (QL), The Second Affiliated Hospital, Sun Yat-sen University; and Department of Pathology (YC), Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
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Bashir S, Tariq M, Aslam HM, Hashmi ASM, Malik B, Amin A, Mumtaz S. Orbital dermatofibrosarcoma protuberans with intracranial extension preceded by recurrent leiomyoma of the orbit: a case report. J Med Case Rep 2015; 9:96. [PMID: 25924890 PMCID: PMC4423146 DOI: 10.1186/s13256-015-0561-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/03/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Dermatofibrosarcoma protuberans is a rare, locally aggressive cutaneous tumor of intermediate to low-grade malignancy. COL1A1-PDGFβ translocation is specific to dermatofibrosarcoma protuberans, where the abnormally fused COL1A1-PDGFβ gene directs formation of an abnormal combined (fusion) protein that researchers believe to ultimately function like the platelet-derived growth factor-beta protein. CASE PRESENTATION In this report, we present a case of a 63-year-old Asian man with dermatofibrosarcoma protuberans of the right orbit with intracranial extension. He had a prior history of recurrent leiomyomas at the identical site. He underwent near-total en bloc resection of the tumor through a wide craniectomy with a 6 cm rim of the frontal scalp, allowing the tumor to be resected en bloc, leaving negative margins. Microscopically, the tumor comprised spindle cells with mild nuclear atypia and a low mitotic index embedded in a spiraling pattern of decussating fascicles consistent with dermatofibrosarcoma protuberans. The lesion was positive for CD34 and BCL2. Following resection, the patient was started on imatinib mesylate therapy (800 mg/day). CONCLUSIONS We propose that platelet-derived growth factor, which has been implicated in the progression of leiomyomas by augmenting mitogenesis, may have acted in an autocrine manner to cause cell division, which may have led to the development of dermatofibrosarcoma protuberans in our patient. Further research is imperative to find certain molecular associations between the discussed soft tissue tumors. Also important is the effective utilization of platelet-derived growth factor receptor kinase inhibitors to prevent transformation to any platelet-derived growth factor-driven tumor, which in our patient was a dermatofibrosarcoma protuberans.
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Affiliation(s)
- Sanaullah Bashir
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Maryam Tariq
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | | | - Baber Malik
- Department of Molecular Diagnostic and Immunology Laboratory, Sindh Institute of Urology and Transplantation, Aga Khan University, Karachi, Pakistan.
| | - Akhtar Amin
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Sidra Mumtaz
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
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Al Tarakji M, Toro A, Di Carlo I, Junejo K. Unusual presentation of dermatofibrosarcoma protuberans in a male patient's breast: a case report and review of the literature. World J Surg Oncol 2015; 13:158. [PMID: 25896773 PMCID: PMC4411938 DOI: 10.1186/s12957-015-0562-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/26/2015] [Indexed: 11/10/2022] Open
Abstract
We herein present a case report and literature review of dermatofibrosarcoma protuberans in the breast of a male patient. A 27-year-old man presented with a painless lump in his right breast with areas of bluish skin discoloration. The diagnostic work-up comprised clinical examination, ultrasonography, core biopsy, mammography, and magnetic resonance imaging. After surgical excision, the preoperative diagnosis of dermatofibrosarcoma protuberans was proven by pathological examination and immunohistochemistry. The patient was still free of recurrence 1 year after surgical excision. This extremely rare case is, to the best of our knowledge, the fifth such case reported in the literature.
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Affiliation(s)
- Mohannad Al Tarakji
- Department of Surgery, Hamad General Hospital, Al Rayyan Rd, 3050, Doha, Qatar.
| | - Adriana Toro
- Department of Surgery, Taormina Hospital, Contrada Sirina, 98039, Messina, Italy.
| | - Isidoro Di Carlo
- Department of Surgery, Hamad General Hospital, Al Rayyan Rd, 3050, Doha, Qatar.
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Via S. Sofia 78, 95100, Catania, Italy.
| | - Kulsoon Junejo
- Department of Surgery, Hamad General Hospital, Al Rayyan Rd, 3050, Doha, Qatar.
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Fibroblastic and myofibroblastic tumors of the head and neck: Comprehensive imaging-based review with pathologic correlation. Eur J Radiol 2015; 84:250-60. [DOI: 10.1016/j.ejrad.2014.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 09/28/2014] [Accepted: 10/22/2014] [Indexed: 01/01/2023]
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Prognostic impact of fibrosarcomatous transformation in dermatofibrosarcoma protuberans: a cohort study. J Am Acad Dermatol 2015; 72:419-25. [PMID: 25582537 DOI: 10.1016/j.jaad.2014.11.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade cutaneous malignancy that sometimes transforms into a high-grade fibrosarcomatous variant (DFSP-FS). Limited data compare clinical features and biological behavior of these 2 entities. OBJECTIVE We sought to compare clinical features and biological behavior of DFSP and DFSP-FS. METHODS This was a retrospective cohort study of ambulatory patients with DFSP or DFSP-FS treated between January 1955 and March 2012 in the dermatology department of a tertiary care academic medical center. RESULTS Of 188 patients, 171 (91%) had DFSP and 17 (9%) had DFSP-FS. Recurrence-free survival differed significantly between the groups over time (P = .002). The 1-year and 5-year recurrence-free survival was 94% and 86%, respectively, for DFSP, vs 86% and 42%, respectively, for DFSP-FS. Metastatic disease occurred in no patients with DFSP and in 18% (3 of 17) with DFSP-FS (P < .001). There were no statistically significant differences in age at diagnosis, sex, race, symptomatology, maximum tumor size, muscle/bone invasion, or duration of tumor before diagnosis. LIMITATIONS The retrospective nature of study was a limitation. CONCLUSIONS DFSP-FS exhibits more aggressive behavior than DFSP, with lower recurrence-free survival and greater metastatic potential. Their similar clinical presentation mandates histopathological differentiation for prognosis.
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Soft-tissue masses in the abdominal wall. Clin Radiol 2014; 69:e422-31. [DOI: 10.1016/j.crad.2014.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/05/2014] [Accepted: 06/06/2014] [Indexed: 02/07/2023]
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Malignant Skin and Subcutaneous Neoplasms in Adults: Multimodality Imaging With CT, MRI, and18F-FDG PET/CT. AJR Am J Roentgenol 2014; 202:W422-38. [DOI: 10.2214/ajr.13.11424] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Millare GG, Guha-Thakurta N, Sturgis EM, El-Naggar AK, Debnam JM. Imaging findings of head and neck dermatofibrosarcoma protuberans. AJNR Am J Neuroradiol 2014; 35:373-8. [PMID: 23907249 DOI: 10.3174/ajnr.a3650] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dermatofibrosarcoma protuberans is a rare, locally aggressive sarcoma of the skin in children and adults, usually involving the trunk and extremities and less commonly the head and neck. Despite clinical reports in the literature on the management of dermatofibrosarcoma protuberans, there are limited articles describing its imaging features. MATERIALS AND METHODS We retrospectively reviewed the demographics and imaging findings in all 24 patients with pathologically proven dermatofibrosarcoma protuberans of the head and neck seen at a tertiary cancer center between 2001 and 2010. RESULTS Twenty-two of the 24 lesions were nodular and well circumscribed; 19 of the 24 were located on the scalp. On imaging, all 24 lesions involved subcutaneous tissues. The lesions ranged in size from 0.6-9.5 cm (mean, 3.7 cm; standard deviation, 2.3 cm). Twelve lesions involved the soft tissues either at or extending directly to the midline. Thirteen lesions were associated with bulging of the skin surface. Fourteen lesions were imaged with CT and 14 with MR imaging. Whereas variable enhancement patterns were noted on CT and MR imaging, dermatofibrosarcoma protuberans was usually T2-hyperintense and demonstrated marked enhancement. None of the lesions was associated with bone invasion, perineural spread, or nodal/distant metastasis. CONCLUSIONS Knowledge of the imaging characteristics of dermatofibrosarcoma protuberans may alert neuroradiologists to include dermatofibrosarcoma protuberans in the differential diagnosis of lesions about the head and neck with similar imaging characteristics.
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Affiliation(s)
- G G Millare
- From the Department of Diagnostic Radiology (G.G.M.), Baylor College of Medicine, Houston, Texas
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46
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Hamid R, Hafeez A, Darzi AM, Zaroo I, Owais H, Akhter A. Dermatofibrosarcoma protuberans: Role of wide local excision. South Asian J Cancer 2014; 2:232-8. [PMID: 24455646 PMCID: PMC3889049 DOI: 10.4103/2278-330x.119926] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objectives: The main objective of the present study was to study the outcome of surgical treatment of dermatofibrosarcoma protuberans. Materials and Methods: This study included 45 patients both retrospective and prospective from December 1995 to December 2010. Results: Out of 45 patients, 30 were males and 15 females with the male to female ratio of 2:1. Mean age of presentation was 38.4 + 13.2 years. Commonest mode of presentation was raised firm multinodular lesion with fixity to overlying skin. Site distribution was 42.22% trunk, 57.88% extremities and head and neck. None of the patients had lymph node involvement All patients underwent wide local excision. On histological examination, 8 patients had positive margins. Overall recurrence rate was 22.22%. (please clarify what is the difference between the rate of recurrence following surgery and the overall recurrence rate) Only 2 patients developed metastasis to lungs in the course of their follow-up. Out of 45 patients, 35 remained recurrence free over a varying period of 5 months to 13 years (mean 68 months). Ten patients developed one or more local recurrences. Average time from initial treatment to recurrence was 32 months. All patients with recurrent tumors were subjected to salvage treatment, i.e., re-excision. Average recurrence-free period was 36 + 44 months within a mean follow-up of 68 months. Conclusion: Because of the potential of local recurrence, therapy for DFSP should be directed toward adequate local excision of the primary lesion. Minimal resection should include a surrounding margin, comprising 3-cm margin of normal skin and removal of underlying deep fascia. Compromising on margins invites higher chances of local recurrence.
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Affiliation(s)
- Raashid Hamid
- Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Aadil Hafeez
- Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Ashraf M Darzi
- Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Inam Zaroo
- Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Habib Owais
- Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Afrozah Akhter
- Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Magnetic resonance imaging of vulvar dermatofibrosarcoma protuberans - report of a case. Radiol Oncol 2013; 47:244-6. [PMID: 24133389 PMCID: PMC3794880 DOI: 10.2478/raon-2013-0039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 09/30/2012] [Indexed: 12/03/2022] Open
Abstract
Background Dermatofibrosarcoma protuberans (DFSP) of the vulva is a rare low-grade soft tissue sarcoma. Magnetic resonance imaging (MRI) findings of vulvar DFSP were essentially unreported in the literature. Case report We report a DFSP of vulva with its clinical, histological and MRI features. As far we know this is the first case of histologically confirmed vulvar DFSP presenting with MR images. The diagnosis of DFSP is usually made by histopathologic and clinical findings. Conclusions MRI is useful both for the diagnosis of DFSP and following up the patients since it has high soft tissue resolution and no risk of radiation exposure. With MRI the relation to the adjacent anatomical structures, extension and depth of the tumour and possible lymph node involvement can also be demonstrated.
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Abstract
A 45-year-old, otherwise healthy woman presented with mild epiphora and a palpable mass in the lacrimal sac area. After transcutaneus orbitotomy and complete excision histopathology revealed a primary Dermatofibrosarcoma protuberans invading the orbit. During the 24-months follow-up, no recurrence occurred. To the best of our knowledge this is the first report of a primary DFSP with the orbit involved.
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Affiliation(s)
- Michael P Schittkowski
- University Eye Department, University Medicine Goettingen, Goettingen, D 37075, Germany.
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Lee RK, Griffith JF, Ng AW, Lai FMM. Ultrasound Appearances of Dermatofibrosarcoma Protuberans. J Med Ultrasound 2013. [DOI: 10.1016/j.jmu.2013.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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50
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Computed tomographic and pathological findings of dermatofibrosarcoma protuberans. J Comput Assist Tomogr 2012; 36:462-8. [PMID: 22805678 DOI: 10.1097/rct.0b013e31825d5a24] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the computed tomographic (CT) and pathological findings of dermatofibrosarcoma protuberans to improve the awareness and understanding of the tumors from aspect of CT images. METHODS The CT findings of 16 cases (17 tumors) with dermatofibrosarcoma protuberans confirmed by pathological findings were retrospectively selected. Fourteen cases were primary dermatofibrosarcoma protuberans, 2 cases were recurrent tumors. Thirteen patients had CT plain and enhanced scans, 1 patient had direct enhanced CT scan, 2 patients had only unenhanced scan. Images of the tumors were analyzed and compared with pathological results. RESULTS Of the 16 cases (17 tumors total), 9 cases were on the trunk, 7 cases were on the head and the neck; 15 cases appeared as solitary isohypodense, ovoid, or round mass at the cutaneous and subcutaneous tissue, 1 case demonstrated 2 isodense masses on unenhanced CT images. The mean diameter of tumors was 4.0 cm, and the depth was 1.7 cm. The margin was well defined (n = 15 [88.2%]) or ill defined (n = 2 [11.8%]). Fifteen tumors revealed moderate or marked homogeneous (n = 12 [80%], smaller lesion, diameter <5 cm) or heterogeneous (n = 3 [20%], larger lesion, diameter ≥5 cm) enhancement on enhanced CT with intratumoral nonenhancement areas, which indicated intratumoral necrotic and cystic degeneration areas. No calcifications and metastasis were found. The histological examinations revealed large amounts of uniform spindle cells, which were arranged in "storiform" pattern. Immunohistochemical analysis revealed samples positive for CD34 and vimentin. CONCLUSION The common imaging findings of dermatofibrosarcoma protuberans include a solitary, superficial, subcutaneous solid mass, various homogenous or heterogeneous enhancements due to degenerative areas. Computed tomographic scan is helpful to detect the size, location, depth and range of this tumor.
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