Alexander S. Somwaru1*, Marco Ertreo2
Received Date: 17 September, 2018;
Accepted Date: 01 October, 2018; Published Date: 08 October, 2018
1. Keywords: CTA; MRI; Dermatofibrosarcoma protuberans
A 31-year-old woman presented to the emergency room for evaluation of a slow-growing, fumigating, and ulcerated mass in the left thigh (Figures 1 and 2). Computed Tomography (CT) (Figures 3 and 4) and Magnetic Resonance (MR) imaging (Figures 5 and 6) show a large, exophytic, heterogeneously enhancing mass with central necrosis. The mass originated from the skin and ulcerated through it. The mass closely approached the left gluteal musculature and fascia without invasion.
After oncological staging workup, which was negative for metastases, the patient underwent surgical resection and placement of a large tissue graft. Final pathology of the mass was a dermatofibrosarcoma protuberans, or a fibrosarcoma arising in a dermatofibroma. This neoplasm is a slow-growing spindle cell tumor, which arises from the dermis layer of the skin, is very rare; it occurs in one case per million per year . The most common anatomic sites of occurrence are the body wall, followed by the extremities and then the head and neck [1-3]. Because of its slow rate of growth, this tumor is commonly ignored and often left untreated for years .
CT and MR imaging are the best modalities to image dermatofibrosarcoma protuberans [1-3]. Both CT and MR depict the size and extent of the tumor as well as it its anatomic relationship to the regional soft tissues, muscles, and bones. 3-D reconstructed images are valuable for pre-operative surgical planning. CT and MR imaging typically show a solitary, well-defined mass arising from the subcutaneous soft tissues . This neoplasm will homogeneously enhance on both modalities; if larger than 5 cm, this tumor may have non-enhancing components due to necrosis and/or cystic degeneration [1-3].
The treatment of dermatofibrosarcoma protuberans is surgery; it has an excellent prognosis after complete resection may locally recur if adequate surgical resection margins are not obtained [1,2]. Prior to initiation of radiation therapy, the patient was lost to follow-up.
Figure 1: Ulcerated mass in the left thigh (Annotated).
Figure 2: Fumigating, and ulcerated mass in the left thigh (Non-annotated).
Figure 3: Magnetic resonance imaging (Annotated).
Figure 4: Magnetic resonance imaging (Non-annotated).
Figure 5: Large, exophytic, heterogeneously enhancing mass with central necrosis (Annotated).
Figure 6: Large, exophytic, heterogeneously enhancing mass with central necrosis (Non-annotated).