Autopsy and Case Reports
http://autopsyandcasereports.org/article/doi/10.4322/acr.2018.039
Autopsy and Case Reports
Article / Clinical Case Report

Fibrosarcomatous dermatofibrosarcoma protuberans from scar following trauma

Sang Wook Lee; Araya Zaesim; Amanda Jackson; Michael Borkat

Abstract

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue neoplasm of low metastatic potential notable for its progressive growth and high rate of local recurrence after surgical excision. Fibrosarcomatous transformation of DFSP (FS-DFSP) is a rare variant characterized by higher rates of local recurrence and metastasis. Trauma has been hypothesized as a potential risk factor for the development of DFSP, although clear evidence has been lacking. In this study, we report a case of FS-DFSP that was found arising from a previously stable scar following a traumatic injury. A 49-year-old male was diagnosed with keloid scars following a motor vehicle accident where he sustained trauma. 12 years later, a large tumor developed immediately after a second traumatic event to the primary scar. Pathology of the excisional biopsy specimen demonstrated FS-DFSP with focal areas consistent with keloid and hypertrophic scar. This observation demonstrates the development of DFSP from underlying scar following a clear history of trauma. Furthermore, it suggests trauma as a possible trigger for the fibrosarcomatous transformation of DFSP.

Keywords

Dermatofibrosarcoma, Wounds and Injuries, Cicatrix

References

Kreicher KL, Kurlander DE, Gittleman HR, Barnholtz-Sloan JS, Bordeaux JS. Incidence and survival of primary dermatofibrosarcoma protuberans in the United States. Dermatol Surg. 2016;42(Suppl 1):S24-31. 10.1097/DSS.0000000000000300.26730971

Gloster HM Jr. Dermatofibrosarcoma protuberans. J Am Acad Dermatol. 1996;35(3):355-74. 10.1016/S0190-9622(96)90597-6.8784271

Hirano SA, Torosky CM. Dermatofibrosarcoma protuberans arising at a Rho(D) immune globulin injection site. Cutis. 2012;90(5):233-4.23270191

Green JJ, Heymann WR. Dermatofibrosarcoma protuberans occurring in a smallpox vaccination scar. J Am Acad Dermatol. 2003;48(5, Suppl):S54-5. 10.1067/mjd.2003.168.12734474

Tanaka A, Hatoko M, Tada H, Kuwahara M, Iioka H, Niitsuma K. Dermatofibrosarcoma protuberans arising from a burn scar of the axilla. Ann Plast Surg. 2004;52(4):423-5. 10.1097/01.sap.0000100421.95683.9b.15084891

Saeki H, Kadono T, Le Pavoux A, Mori E, Tamaki K. Dermatofibrosarcoma protuberans with COL1A1-PDGFB fusion transcript arising on a scar due to a previous drainage tube insertion. J Dermatol. 2008;35(10):686-8. 10.1111/j.1346-8138.2008.00545.x.19017053

Reha J, Katz SC. Dermatofibrosarcoma protuberans. Surg Clin North Am. 2016;96(5):1031-46. 10.1016/j.suc.2016.05.006.27542641

Laskin WB. Dermatofibrosarcoma protuberans. CA Cancer J Clin. 1992;42(2):116-25. 10.3322/canjclin.42.2.116.1540852

Reifs CM, Salido-Vallejo R. Dermatofibrosarcoma protuberans with fibrosarcomatous transformation. An Bras Dermatol. 2016;91(5):700-1. 10.1590/abd1806-4841.20164886.27828659

Mentzel T, Beham A, Katenkamp D, Dei Tos AP, Fletcher CD. Fibrosarcomatous (“high-grade”) dermatofibrosarcoma protuberans: clinicopathologic and immunohistochemical study of a series of 41 cases with emphasis on prognostic significance. Am J Surg Pathol. 1998;22(5):576-87. 10.1097/00000478-199805000-00009.9591728

Monteagudo C, Llombart B, Burgues O, et al. Biphasic dermatofibrosarcoma protuberans with a labyrinthine plexiform high-grade fibrosarcomatous transformation. J Cutan Pathol. 2015;42(3):206-12. 10.1111/cup.12456.25410704

Segura S, Salgado R, Toll A, et al. Identification of t(17;22)(q22;q13) (COL1A1/PDGFB) in dermatofibrosarcoma protuberans by fluorescence in situ hybridization in paraffin-embedded tissue microarrays. Hum Pathol. 2011;42(2):176-84. 10.1016/j.humpath.2010.07.015.21111450

Dawes KW, Hanke WC. Dermatofibrosarcoma protuberans treated with Mohs micrographic surgery: cure rates and surgical margins. Dermatol Surg. 1996;22(6):530-4. 10.1111/j.1524-4725.1996.tb00369.x.8646467

Rutkowski P, Debiec-Rychter M. Current treatment options for dermatofibrosarcoma protuberans. Expert Rev Anticancer Ther. 2015;15(8):901-9. 10.1586/14737140.2015.1052799.26027711

Stojadinovic A, Karpoff HM, Antonescu CR, et al. Dermatofibrosarcoma protuberans of the head and neck. Ann Surg Oncol. 2000;7(9):696-704. 10.1007/s10434-000-0696-3.11034249

Stacchiotti S, Pantaleo MA, Negri T, et al. Efficacy and biological activity of imatinib in metastatic Dermatofibrosaroma Protuberans (DFSP). Clin Cancer Res. 2016;22(4):837-46. 10.1158/1078-0432.CCR-15-1243.26261104

Hoesly PM, Lowe GC, Lohse CM, Brewer JD, Lehman JS. Prognostic impact of fibrosarcomatous transformation in dermatofibrosarcoma protuberans: a cohort study. J Am Acad Dermatol. 2015;72(3):419-25. 10.1016/j.jaad.2014.11.020.25582537

Rutgers EJ, Kroon BB, Albus-Lutter CE, Gortzak E. Dermatofibrosarcoma protuberans: treatment and prognosis. Eur J Surg Oncol. 1992;18(3):241-8.1607035

 

 

 

5bab7c0f0e8825a10bffacb9 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections