A male case of dermatofibrosarcoma protuberans in the breast presenting as gynecomastia

Abstract

Introduction. Dermatofibrosarcoma protuberans (DFSP) is a very rare mesenchymal tumor that accounts for approximately 0.1% of all malignancies. It is a locally aggressive fibrous tumor, with a high recurrence rate, which sometimes gives rise to distant metastases, usually to the bones and lungs. DFSP usually occurs on the trunk and extremities with only a small number of cases in the breast, especially in men. Case report. This paper analyzes a rare case of DFSP in the male breast. A 66-year-old man presented with gynecomastia of the left breast. The diagnostic work-up comprised of clinical examination, ultrasonography, core biopsy, and mammography. Immunohistochemistry revealed diffuse and strong positivity for vimentin, CD99, and CD34, while the tumor cells were completely negative for keratin, S100 protein, STAT6, CD31, and factor VIII, highly suggestive for DFSP. Subsequently, a radical mastectomy was performed and preoperative diagnosis of dermatofibrosarcoma protuberans was confirmed by pathological examination and immunohistochemistry. The patient was still disease-free six months after the surgical treatment. Conclusion. DFSP is a soft tissue sarcoma that rarely occurs in the breast, especially in men. The most common clinical presentation in the breast is a mass, but it can also present as gynecomastia, as in our case.The diagnosis of DFPS is based on anatomopathology with immunohistochemistry analysis since there are no specific imaging features for this rare entity. Surgical excision with wide and negative margins is optimal for reducing the risk of recurrence. Keywords: dermatofibrosarcoma protuberans; male breast; rare; CD34; STAT6; immunohistochemistry Apstrakt Uvod. Dermatofibrosarkom protuberans (DFSP) je veoma redak mezenhimalni tumor koji čini otprilike 0,1% svih maligniteta. To je lokalno agresivni fibrozni tumor, sa velikom stopom recidiva, koji ponekad može dati udaljene metastaze, obično u kosti i pluća. DFSP se obično javlja na trupu i ekstremitetima, dok se samo mali broj slučajeva javlja u dojci, posebno kod muškaraca. Prikaz bolesnika. Ovaj rad analizira retki slučaj DFSP u muškoj dojci. 66-godišnji muškarac je javio sa ginekomastijom leve dojke. Dijagnostička obrada sastojala se od kliničkog pregleda, ultrazvuka, kor biopsije i mamografije. Imunohistohemija je pokazala difuznu i jaku pozitivnost za vimentin, CD99 i CD34, dok su tumorske ćelije bile potpuno negativne na keratin, S100 protein, STAT6, CD31 i faktor VIII, što je sugerisalo da 4 se radi o DFSP. Nakon toga izvršena je radikalna mastektomija i patološkim pregledom i imunohistohemijom dokazana je preoperativna dijagnoza dermatofibrosarkoma protuberans. Pacijent je šest meseci nakon hirurškog lečenja i dalje bio bez bolesti. Zaključak. DFSP je sarkom mekog tkiva koji se izuzetno retko razvija u dojkama muškaraca. Uobičajena klinička prezentacija na dojci jeste masa sa širokim krvžicama na površini, mada se može prezentovati i samo kao ginekomastija, kao u našem slučaju. Dijagnoza DFPS se zasniva na patološkoj anatomiji sa imunoh...