Fibrosarcomatous dermatofibrosarcoma protuberans from scar following trauma

Abstract

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue neoplasm of low metastatic potential notable for its progressive growth and high rate of local recurrence after surgical excision. Fibrosarcomatous transformation of DFSP (FS-DFSP) is a rare variant characterized by higher rates of local recurrence and metastasis. Trauma has been hypothesized as a potential risk factor for the development of DFSP, although clear evidence has been lacking. In this study, we report a case of FS-DFSP that was found arising from a previously stable scar following a traumatic injury. A 49-year-old male was diagnosed with keloid scars following a motor vehicle accident where he sustained trauma. 12 years later, a large tumor developed immediately after a second traumatic event to the primary scar. Pathology of the excisional biopsy specimen demonstrated FS-DFSP with focal areas consistent with keloid and hypertrophic scar. This observation demonstrates the development of DFSP from underlying scar following a clear history of trauma. Furthermore, it suggests trauma as a possible trigger for the fibrosarcomatous transformation of DFSP.

Clinical and histopathological analysis of 141 dermatofibrosarcoma protuberans in Korea: A comparative study according to trauma

“…Some suggested that trauma could serve as a trigger in stimulating the neoplasm development in a person predisposed by a desmoplastic diathesis 20 . Moreover, others insisted that trauma could play an important etiological role 3,7 . Constant irritation, infection, chronic ulceration, the release of toxins from the injury, poor lymphatic regeneration or exposure to harmful environmental agents may lead to the malignant degeneration in chronic burn scars 11,21,22 .…”

“…20 Moreover, others insisted that trauma could play an important etiological role. 3,7 Constant irritation, infection, chronic ulceration, the release of toxins from the injury, poor lymphatic regeneration or exposure to harmful environmental agents may lead to the malignant degeneration in chronic burn scars. 11,21,22 DFSPs developed at the various injection or insertion sites have been reported (e.g.…”

“…Suggestive factors related to DFSP development include local injection, therapeutic irradiation, surgical scars, burn scars and physical trauma. [3][4][5][6][7][8][9][10][11][12] In previous retrospective studies, approximately 10%-20% of DFSP cases were associated with prior trauma of any type. 2,12 However, the incidence rate varied according to studies, and previous reports were based on a small number of cases.…”

“…13 Moreover, the etiological relationship and underlying mechanism have not yet been established. 7 This study elucidated the clinicopathological characteristics of DFSP in Korean patients by anatomic mapping and evaluated correlations between DFSP and long-term trauma history to explore the differences in clinicopathological features and prognosis.…”

Tumor in the plantar region: dermatofibrosarcoma protuberans in an infrequent topography

“… 1 Local trauma has been described as a potential risk factor for tumor onset. 2 The most common sites of involvement are the trunk (40%–50%), the proximal limbs (30%–40%), and the head and cervical region (10%–15%). In the literature review, 11 reports of tumors located in the plantar region were retrieved.…”