Dermatofibrosarcoma Protuberans and Adjuvant Radiotherapy: A Case Report with Uncertain Surgical Margins in The Breast
Abstract
Background: Dermatofibrosarcoma Protuberans (DFSP) is a rare, locally aggressive superficial soft tissue tumor that can occur in many parts of the body. Surgical resection with a wide margin of safety is the main treatment modality of this rare tumor of the breast. According to the postoperative pathology report, the patient can be followed up or adjuvant radiotherapy (RT) can be added.
Case presentation: A 22-year-old woman presented with a mass filling the lower inner quadrant of her right breast. Tru-cut biopsy revealed a mesenchymal tumor, but excision was recommended for definitive diagnosis. A right breast quadrantectomy was performed. The result came as DFSP. Tumor diameter was 10x9x6.5 cm and the tumor was positive in most of the surgical margins. The patient underwent re-resection and a residual tumor with a diameter of 0.2 cm was detected at a distance of 3.3 cm from the surgical margin. Although the surgical margins were negative, the distance of the posterior surgical margin, in particular, could not be assured. Because of the uncertainty of surgical margins, 60 Gy RT was planned.
Conclusion: The localization of DFSP in the breast is extremely rare and surgery is the primary treatment. RT should be added as an adjuvant when safe surgical margins cannot be obtained.
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References
Weiss SW, Goldblum JR. Enzinger and Weiss's soft tissue tumors. Mosby-Elsevier. 2008:303-24.
Prabhu VV, Shivani A, Kulkarni S, Pawar VR. Dermatofibrosarcoma protuberans: male breast. Med J Dr DY Patil Univ. 2014;7(1):85.
Cottier O, Fiche M, Meuwly JY, Delaloye JF. Dermatofibrosarcoma presenting as a nodule in the breast of a 75-year-old woman: a case report. J Med Case Rep. 2011;5:503.
Guillou L, Folpe A. Bone and Soft tissue Pathology; in the Series: Foundations in Diagnostic Pathology. JR Goldblum editor. 2010:79-83.
Snow SN, Gordon EM, Larson PO, Bagheri MM, Bentz ML, et al. Dermatofibrosarcoma protuberans: a report on 29 patients treated by Mohs micrographic surgery with long-term follow-up and review of the literature. Cancer. 2004;101(1):28-38.
Garcia C, Clark RE, Buchanan M. Dermatofibrosarcoma protuberans. Int J Dermatol. 1996;35(12):867-71.
Zhou X, Sun D, Liu Y, Sun Q, Yuan Z, et al. Dermatofibrosarcoma protuberans: our 10-year experience on 80 patients. J Dermatolog Treat. 2020;31(6):554-8.
Ruiz-Tovar J, Fernandez Guarino M, Reguero Callejas ME, Aguilera Velardo A, Arano Bermejo J, et al. Dermatofibrosarcoma protuberans: review of 20-years experience. Clin Transl Oncol. 2006;8(8):606-10.
Kimmel Z, Ratner D, Kim JY, Wayne JD, Rademaker AW, et al. Peripheral excision margins for dermatofibrosarcoma protuberans: a meta-analysis of spatial data. Ann Surg Oncol. 2007;14(7):2113-20.
Chan T-C, Wu C-J, Jeng S-F. Dermatofibrosarcoma protuberans: A 10-year experience. Formos J Surg. 2015;48(1):10-6.
Park TH, Seo SW, Kim JK, Chang CH. Reconstructive challenge of dermatofibrosarcoma protuberans in the female breast. World J Surg Oncol. 2011;9:1.
Swan MC, Banwell PE, Hollowood K, Goodacre TE. Late recurrence of dermatofibrosarcoma protuberans in the female breast: a case report. Br J Plast Surg. 2005;58(1):84-7.
Mirza TI, Akhtar K, Abbas HB, Sameena M, Tahir F, et al. Dermatofibrosarcoma Protuberans Male Breast: A Case report. Oman Med J. 2011;26(5):e023.
Castle KO, Guadagnolo BA, Tsai CJ, Feig BW, Zagars GK. Dermatofibrosarcoma protuberans: long-term outcomes of 53 patients treated with conservative surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 2013;86(3):585-90.
Williams N, Morris CG, Kirwan JM, Dagan R, Mendenhall WM. Radiotherapy for dermatofibrosarcoma protuberans. Am J Clin Oncol. 2014;37(5):430-2.
Chen YT, Tu WT, Lee WR, Huang YC. The efficacy of adjuvant radiotherapy in dermatofibrosarcoma protuberans: a systemic review and meta-analysis. J Eur Acad Dermatol Venereol. 2016;30(7):1107-14.
Wang Y, Wang Y, Chen R, Tang Z, Liu S. A Rare Malignant Disease, Dermatofibrosarcoma Protuberans of the Breast: A Retrospective Analysis and Review of Literature. Biomed Res Int. 2020;2020:8852182.
Al-Rahbi S, Al-Lawati T, Al-Kharusi S, Thomas S, Al-Harrasi K. Dermatofibrosarcoma Protuberans: A Rare Malignancy of the Breast. Oman Med J. 2015;30(5):378-81.
Muhammed A, Elnakib E, Nady M. Dermatofibrosarcoma of The Breast - Case Report and Review of Literature. Eur J Breast Health. 2018;14(4):234-7.
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