Dermatofibrosarcoma protuberans
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| Dermatofibrosarcoma protuberans | |
|---|---|
| Diagnosis in short | |
 DFSP. H&E stain. | |
|
| |
| LM | dermal spindle cell lesion with storiform pattern, typically contains adipose tissue within the tumour -- described as "honeycomb pattern" and "Swiss cheese pattern" |
| LM DDx | dermatofibroma, dermatomyofibroma, nodular fasciitis |
| IHC | CD34 +ve, Factor XIIIa -ve |
| Molecular | t(17;22)(q22;q15) |
| Gross | firm plaque +/-ulceration |
| Site | skin - usually trunk or proximal extremities |
|
| |
| Clinical history | second to fifth decade |
| Prevalence | uncommon |
| Prognosis | moderate, locally aggressive, rarely metastases |
| Treatment | wide excision |
Dermatofibrosarcoma protuberans, abbreviated DFSP, is a rare locally aggressive tumour of the skin.
General
- Destroys adnexal structures - somewhat unusual for a mostly benign tumour.
- Occasionally transforms to a (more aggressive) fibrosarcoma.[1]
- Typically slow growing.[2]
- Usually second to fifth decade.[2]
Treatment:[3]
- Wide excision.
- May include imatinib (Gleevec).
Gross
Features:[4]
- Firm plaque, often bosselated, usually on the trunk.
- +/-Ulceration.
Images:
- Protuberant DFSP (dermatlas.med.jhmi.edu).
- Huge DFSP on back (dermatlas.med.jhmi.edu).
- Protuberant DFSP - gross and histology (dermatlas.med.jhmi.edu).
Microscopic
Features:[3]
- Dermal spindle cell lesion with storiform pattern.
- Spokes of the wheel-pattern.
- Contains adipose tissue within the tumour -- key feature.
- Described as "honeycomb pattern" and "Swiss cheese pattern".
Notes:
- Adnexal structure within tumour are preserved -- this is unusual for a malignant tumour -- important.
DDx:
- Dermatofibroma - main DDx - has entrapment of collagen bundles at the edge of the lesion.
- Dermatomyofibroma.[5]
- Nodular fasciitis.
DDx of storiform pattern:
- DFSP.
- Dermatofibroma.
- Solitary fibrous tumour.
- Undifferentiated pleomorphic sarcoma.
Subtypes
Numerous variants/subtypes are described:[2]
- Pigmented DFSP (Bednar tumour).
- Myxoid DFSP.
- Myoid DFSP.
- Granular cell DFSP.
- Sclerotic DFSP.
- Atrophic DFSP,
- Giant cell fibroblastoma.
- DFSP with fibrosarcomatous areas.
Images
DFSP with fat entrapped. (WC)
DFSP - high mag. (WC)
DFSP - storiform pattern - intermed. mag. (WC/Nephron)
DFSP - storiform pattern - very high mag. (WC/Nephron)
www:
IHC
Panel:[6]
- CD34 +ve.
- Factor XIIIa -ve.
- S-100 -ve (screen for melanoma).
- Caldesmin -ve (screen for muscle differentiation).
- Beta-catenin. (???)
- MIB1 (proliferation marker).
- Should not be confused with MIB-1 a gene that regulates apoptosis.
Molecular
A characteristic translocation is seen:[9] t(17;22)(q22;q15) COLA1/PDGFB.
See also
References
- ↑ Stacchiotti, S.; Pedeutour, F.; Negri, T.; Conca, E.; Marrari, A.; Palassini, E.; Collini, P.; Keslair, F. et al. (Oct 2011). "Dermatofibrosarcoma protuberans-derived fibrosarcoma: clinical history, biological profile and sensitivity to imatinib.". Int J Cancer 129 (7): 1761-72. doi:10.1002/ijc.25826. PMID 21128251.
- ↑ 2.0 2.1 2.2 Llombart, B.; Serra-Guillén, C.; Monteagudo, C.; López Guerrero, JA.; Sanmartín, O. (Feb 2013). "Dermatofibrosarcoma protuberans: a comprehensive review and update on diagnosis and management.". Semin Diagn Pathol 30 (1): 13-28. doi:10.1053/j.semdp.2012.01.002. PMID 23327727.
- ↑ 3.0 3.1 Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1183. ISBN 978-1416031215.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 600. ISBN 978-1416054542.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 504. ISBN 978-0443066542.
- ↑ AP. May 2009.
- ↑ 7.0 7.1 Abenoza P, Lillemoe T (October 1993). "CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans". Am J Dermatopathol 15 (5): 429–34. PMID 7694515.
- ↑ 8.0 8.1 Goldblum JR, Tuthill RJ (April 1997). "CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma". Am J Dermatopathol 19 (2): 147–53. PMID 9129699.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1249. ISBN 978-1416031215.