Breast and pleuropulmonary metastasis of multirecurrent scalp dermatofibrosarcoma protuberans: a case report

Background

Dermatofibrosarcoma protuberans is a rare tumor, representing about 0.1% of skin malignant tumors. It is characterized by local aggressiveness with significant potential for recurrence. Although metastasis is rare, it does occur. We report a case of a Burkinabe woman with dermatofibrosarcoma protuberans.

Case presentation

A 27-year-old Burkinabe woman consulted our institution for a recurrent scalp nodule that had been evolving for 13 years. At clinical examination, she was in good condition with a dry cough. An atrophic scarring alopecic plaque of 15-cm diameter in the right parietal region of the scalp, topped by an erythematous firm nodule measuring 3 × 2 × 2 cm, was noted, as well as a mobile nodule located in the axillary tail of the right breast. Cerebral computed tomodensitometry had not objectified the reach of the vault or the brain. A thoracic scan revealed four intrathoracic tissue masses straight to pleural touch. There were no evolutionary lesions in the abdominopelvic region. Histopathologic examination of the biopsy of the scalp nodule showed a proliferation of fibrous background, with fusiform cells carrying a storiform appearance. These cells had dark, elongated nuclei and showed some mitosis without atypia. The cells expressed CD34 intensely and diffusely. The test results were negative for PS100 and smooth muscle actin. The breast nodule showed the same profile as the scalp nodule.

Conclusions

We concluded on the diagnosis of scalp dermatofibrosarcoma protuberans with breast metastasis and probable pleuropulmonary metastasis.

[Ecthyma gangrenosum of the eyelid after chickenpox]

BACKGROUND

Ecthyma gangrenosum is an acute ulcer necrotic skin infection frequently caused by Pseudomonas aeruginosa. It is characterised by necrotic ulcerations circumscribed by an inflammatory halo. Lesions are normally found in the anal, genital and axillary regions. Ecthyma gangrenosum is most commonly seen in immunodepressed patients (cytotoxic chemotherapy, HIV infection, neutropenia or functional neutrophil deficiency, agammaglobulinemia). It is a rarely described complication in chicken pox.

PATIENTS AND METHODS

Herein we report the case of a girl aged 2 ½ years presenting in our dermatology department with ecthyma gangrenosum on the right upper eyelid secondary to varicella. The disease course was marked by fibrous scarring of the inner canthus with ptosis of the right upper eyelid. The retractile scarring caused disability.

DISCUSSION

There have been previous reports of the contribution of non-steroidal anti- inflammatory drugs (NSAIDs) to the appearance of necrotic cutaneous super infections during the course of chickenpox. The occurrence of such complications on an eyelid may be harmful not only for the function of the eye but it can also cause extensive aesthetic impairment. Subsequent aesthetic and functional impairment may be improved by corrective surgery.

[Ichthyosis and social stigma in Burkina Faso]

BACKGROUND

Through the story of two families presenting ichthyosis, we report the support and social integration difficulties inherent in these genetic diseases.

PATIENTS AND METHODS

Family No. 1: a 38-year-old shepherd and his wife of 25 years both had lamellar ichthyosis that had been present continually since childhood. They had had 2 stillborn infants as well as a live newborn that were all presenting lamellar ichthyosis. Family No. 2: a 45-year-old housewife was seen at our consultation with her 3 youngest children aged 8 years, 6 years and 18 months. According to the mother, at birth, all 3 children were covered with a membrane resembling plastic that crackled during movement, and they had red eyes. Examination of the 3 children revealed a clinical picture of lamellar ichthyosis with ectropion, malformed ears and brachydactyly. Although they presented delayed growth and weight development, psychomotor development was normal. There was no consanguinity between the parents.

DISCUSSION

In both families, the visible nature of the dermatosis resulted in discrimination and ostracism. The precarious living conditions of the parents and the high cost of treatment in an African setting resulted in degradation of quality of life with exacerbation of the difficulties of social integration, resulting in a lack of schooling and a bleak future for these children.

[Preliminary data on dermatomycoses in Ouagadougou (Burkina Faso)]

This study is a contribution to a best knowledge of mycosis in Burkina Faso where the data concerning these diseases are very old. It has been focused on the clinical and mycological features of the dermoskeloton mycosis through the consultations at the two offices of dermatology in the city of Ouagadougou. From April to October, 1990, 216 patients have been taken census of, and they have shown 265 lesions among which 143 mycosis of the skinfolds (54 p. cent), 45 onychomycosis (17 p. cent), 29 palmoplantar mycosis (11 p. cent), 24 mycosis of the glabrous skin (9 p. cent) and 24 mycosis of the scalp (9 p. cent). From these 265 lesions we have isolated 156 strains of dermatophytes and 108 strains of candida. The species which have been seen more frequently are Candida albicans (30 p. cent), Trichophyton rubrum (19 p. cent), Trichophyton soudanense (13 p. cent) and Trichophyton tonsurans (8 p. cent). This study has enabled the identification of some clinical features and some responsible agents of the dermatoskeloton mycosis in Ouagadougou. It will lay the foundation for further specific studies in the country.