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Zhang Z, Lu Y, Shi C, Chen M, He X, Zhang H. Pediatric dermatofibrosarcoma protuberans: A clinicopathologic and genetic analysis of 66 cases in the largest institution in Southwest China. Front Oncol 2023; 13:1017154. [PMID: 36776313 PMCID: PMC9916051 DOI: 10.3389/fonc.2023.1017154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
Background Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous tumor in children. Most published articles are sporadic or small series and lack systematically molecular analyses. The aim of our study is to better understand the clinicopathologic and genetic features of these rare lesions. Methods All patients diagnosed with DFSP aged ≤ 18 years were retrospectively reviewed from January 2006 to May 2022. Results A total of 66 cases (32 male and 34 female patients) were identified, with ages ranging from 0.3 to 18 years (median, 13 years). Tumor locations predominantly occurred on the trunk (38/66, 57.6%), followed by the extremities (20/66, 30.3%) and head/neck (8/66, 12.1%). Histological findings revealed classic (41/66, 62.1%), myxoid (4/66, 6.1%), pigmented (6/66, 9.1%), plaque-like (3/66, 4.5%), giant cell fibroblastoma (GCF; 6/66, 9.1%), and fibrosarcomatous (6/66, 9.1%) variants of DFSP. Immunochemistry revealed minority tumors (9/66, 13.6%) showing patchy or negative staining for CD34. Fluorescence in situ hybridization (FISH) indicated that 49 of 53 tested cases including all detected biopsy specimens (11/11) contained COL1A1-PDGFB fusion, in which the average copy number gain of COL1A1-PDGFB was 0.68. There were four cases negative for COL1A1-PDGFB rearrangement, one of which was found to harbor a novel COL3A1-PDGFB fusion by next-generation sequencing (NGS). Treatment for 63 patients comprised 40 marginal excisions and 23 wide local excisions (WLEs), including 1 with imatinib therapy. Follow-up information was available on 49 patients with a duration of 12-161 months (median, 60 months). Fourteen patients developed tumor recurrence, all with initial marginal excisions. The others survived with no evidence of disease. Conclusions This study of pediatric DFSP indicates certain discrepancies in clinicopathologic characteristics between children and adults. The majority of pediatric DFSPs contain COL1A1-PDGFB fusion, the same as their adult counterparts. The COL3A1-PDGFB chimerism might be associated with the special morphology of GCF, which needs further investigation. FISH is valuable in biopsy tissues and cases with atypical CD34 immunostaining, while supplementary NGS could be helpful to identify the cytogenetically cryptic DFSP. Overall, an urgent accurate diagnosis is needed to formulate an optimal therapeutic strategy in the pediatric population.
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Affiliation(s)
- Zhang Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Lu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Changle Shi
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
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Houdek MT, Tsoi KM, Mallett KE, Claxton RM, Ferguson PC, Griffin AM, Baum CL, Brewer JD, Rose PS, Wunder JS. Surgical Outcomes of Primary Dermatofibrosarcoma Protuberans: A Retrospective, Multicenter Study. Ann Surg Oncol 2022; 29:8632-8638. [PMID: 35933538 DOI: 10.1245/s10434-022-12351-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive tumor with a low rate of metastatic disease. Previous series have shown a superiority of Mohs micrographic surgery (MMS) compared with wide local excision (WLE). Likewise, there is paucity of data examining the long-term follow-up of patients. OBJECTIVE The purpose of the current study was to examine the outcome of surgical treatment of primary DFSP of the trunk and extremities. METHODS We reviewed 236 patients (115 females, 121 males, mean age 41 ± 15 years) undergoing MMS (n = 81, 34%) or WLE (n = 155, 66%) to treat a primary DFSP. Mean tumor size and follow-up was 4 ± 2 cm and 7 years, respectively. Final margins were negative in 230 (97%) patients. RESULTS There was no difference (p > 0.05) in patient age, sex, tumor size, negative margin excision, or history of a previous inadvertent excision between patients who underwent WLE and those undergoing MMS. There were two cases of local recurrence and two cases of metastasis, with no difference in the 5-year local recurrence-free survival (98% vs. 99%, p = 0.69) or metastatic-free survival (98% vs. 100%, p= 0.27) between WLE and MMS. CONCLUSION There was no difference in oncologic outcome comparing MMS with WLE for DFSP outside the head and neck. The goal of treatment for DFSP is to achieve a negative margin, regardless of surgical treatment modalities. A 'less is more' approach to follow-up can likely be taken for patients with completely resected DFSP in easy-to-examine anatomical areas. In these patients, no formal follow-up should be required.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Kim M Tsoi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | | | | | - Peter C Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | - Anthony M Griffin
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jay S Wunder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada
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Nakamura T, Kawai A, Asanuma K, Hagi T, Sudo A. Clinical Outcome of Dermatofibrosarcoma Protuberance. Report From the Bone and Soft Tissue Tumor (BSTT) Registry in Japan. In Vivo 2021; 35:611-615. [PMID: 33402516 DOI: 10.21873/invivo.12298] [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: 11/02/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Owing to its rarity, dermatofibrosarcoma protuberance (DFSP) is often inappropriately excised. After unplanned excision (UE), additional excision is commonly performed. We aimed to elucidate the effect of additional excision after UE. PATIENTS AND METHODS We examined 306 patients with primary DFSP. We analyzed surgical outcomes in 291 patients who received planned excision (PE) or additional excision after UE. RESULTS Of 306 patients, 194 received PE and the remaining 112 received UE. Of 112 patients, 97 received additional excision after UE. Additional surgery due to complications was more frequent in patients with UE than in those with PE. The 5-year local recurrence-free rate in patients without additional excision after UE was significantly worse than that in those with additional excision after UE. CONCLUSION If UE is performed, we recommend additional excision for preventing local recurrence; however, the surgical wound should be carefully observed.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan;
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tomohito Hagi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
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Adem D, Yazici S, Ozsen M, Cetintas SK, Yalcinkaya U, Şahin AB, Tanrıverdi O, Orhan SO, Ocak B, Cubukcu E, Kahveci R, Evrensel T. The Ki-67 proliferation index predicts recurrence-free survival in patients with dermatofibrosarcoma protuberans. Bosn J Basic Med Sci 2021; 21:174-178. [PMID: 33091330 PMCID: PMC7982062 DOI: 10.17305/bjbms.2020.5088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/17/2020] [Indexed: 11/16/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue sarcoma that originates from the dermis or subcutaneous tissue in the skin. While its prognosis is generally favorable, disease recurrence is relatively frequent. Since morbidity after repeated surgery may be significant, an optimized prediction of recurrence-free survival (RFS) has the potential to improve current management strategies. The purpose of this study was to investigate the prognostic value of the Ki-67 proliferation index with respect to RFS in patients with DFSP. We retrospectively analyzed data from 45 patients with DFSP. We calculated the Ki-67 proliferation index as the percentage of immunostained nuclei among the total number of tumor cell nuclei regardless of the intensity of immunostaining. We constructed univariate and multivariate Cox proportional hazards regression models to identify predictors of RFS. Among the 45 patients included in the study, 8 developed local recurrences and 2 had lung metastases (median follow-up: 95.0 months; range: 5.2-412.4 months). The RFS rates at 60, 120, and 240 months of follow-up were 83.8%, 76.2%, and 65.3%, respectively. The median Ki-67 proliferation index was 14%. Notably, we identified the Ki-67 proliferation index as the only independent predictor for RFS in multivariate Cox proportional hazards regression analysis (hazard ratio = 1.106, 95% confidence interval = 1.019-1.200, p = 0.016). In summary, our results highlight the potential usefulness of the Ki-67 proliferation index for facilitating the identification of patients with DFSP at a higher risk of developing disease recurrences.
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Affiliation(s)
- Deligonul Adem
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Serkan Yazici
- Department of Dermatology and Venereology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Mine Ozsen
- Department of Surgical Pathology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | | | - Ulviye Yalcinkaya
- Department of Surgical Pathology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ahmet Bilgehan Şahin
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ozgur Tanrıverdi
- Department of Medical Oncology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Sibel Oyucu Orhan
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Birol Ocak
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Erdem Cubukcu
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ramazan Kahveci
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Turkkan Evrensel
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
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van den Bos RR. Dermatofibrosarcoma protuberans: slowly gathering evidence for optimal treatment of a slow-growing tumour. Br J Dermatol 2020; 184:595. [PMID: 33140441 PMCID: PMC8246961 DOI: 10.1111/bjd.19567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Affiliation(s)
- R R van den Bos
- Department of Dermatology, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, the Netherlands
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