| Myxoid
dermato-fibrosarcoma protuberans: a rare variant analyzed in a series
of 23 cases.
Am J Surg Pathol. 2007 Sep;31(9):1371-7.
The myxoid
variant of dermatofibrosarcoma protuberans (DFSPs) is uncommon. It
often presents a diagnostic challenge and is important to recognize to
prevent both undertreatment and overtreatment. To better characterize
this unusual variant of DFSP, 23 myxoid DFSPs (DFSP with greater than
50% myxoid stroma) were retrieved from the authors' consult files. 13
patients were male and 10 were female (median age 40 years; range 9
months to 72 years of age). Tumor size ranged from 1.5 to 11 cm
(median 2.8 cm). The most frequent sites were the extremities (9) and
head and neck (7), followed by the trunk (4) and anogenital region
(3). Grossly, the tumors were white/tan/gray to yellow, firm to
gelatinous soft tissue masses. Histologically, tumor stroma ranged
from 50 to 100% myxoid (median 80%). The majority of cases displayed
an infiltrative sheet-like proliferation of bland spindle cells with
palely eosinophilic cytoplasm and stellate nuclei without pleomorphism.
The stroma was myxoid with prominent thin-walled vessels. All cases
displayed honeycomb infiltration of fat and 16 cases showed cellular
areas of more typical DFSP. Four tumors contained pigmented dendritic
cells (Bednar variant), 1 showed areas of giant cell fibroblastoma and
1 showed progression to fibrosarcomatous DFSP. Mitoses ranged from 0
to 5 per 10 high power fields. 95% of cases (21 out of 22) were
positive for CD34 and all cases were negative for S100 and muscle
markers. Clinical follow-up in 8 cases, ranging from 3-21 years,
(median follow-up 6 years), revealed local recurrence in 2 cases and
no evidence of metastasis. All patients were free of disease following
wide excision or excision followed by radiotherapy. In summary, these
low-grade lesions are clinically similar to typical DFSP, but their
unusual morphology is easily confused with a variety of other tumor
types. |
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Dermatofibrosarcoma Protuberans
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Dermpath-India
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D-Histological evaluation of surgery in dermatofibrosarcoma
protuberans and malignant fibrous histiocytoma: Differences in
growth patterns and outcome.Eur J Surg Oncol.
2007 Aug 21.
AIMS: To
evaluate the microscopic growth pattern of dermatofibrosarcoma
protuberans (DFSP) and malignant fibrous histiocytoma (MFH) and the
long-term outcome using 3D-histologic surgery with paraffin sections
to cover complete margins and to detect subclinical spreads very
sensitively. METHODS: One hundred and one patients have been
included comprising 70 DFSP, 31 MFH. Data from 87 patients treated
since 1992 were collected prospectively. RESULTS: Mean clinical
tumor-size was 45mm, mean histological tumor size 65mm. A mean
excision margin of 19mm achieved negative margins. The histological
infiltration shows an asymmetrical pattern with horizontal or
vertical extension either cord-, sector- or multiple-like up to 70mm
in length, detectable by 3D-histology. Age and localization differed
significantly between DFSP and MFH lesions. MFH tumors had a
significantly deeper infiltration than DFSP. The mean follow up was
60months. In 70 patients with DFSP one local recurrence after
62months occurred, but no metastasis. 31 patients with MFH developed
8 local recurrences, and 4 metastases (lymph nodes and/ or lungs); 3
of them died of the disease, all 3 had a postoperative status of R1
(p=0.001). CONCLUSIONS: There are significant differences in growth
pattern and clinical outcome between DFSP and MFH. DFSP can be cured
by surgery following 3D-histology with paraffin sections. MFH is
significantly more malignant. After local R0-resection proofed by
3D-histology higher cure rates can be achieved. |
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June 2009
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