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Dermatofibrosarcoma protuberans is a low-grade soft tissue sarcoma not often related to the head and neck area. Distant metastases are not often recorded. Wide surgical excision is considered the most appropriate treatment modality. In cases of insufficient or positive surgical margins, the role of adjuvant radiation therapy or targeted therapy might be beneficial. Dermatofibrosarcoma protuberans transformation to a neoplasm with fibrosarcomatous elements is extremely rare. The presence of fibrosarcomatous elements is associated with more aggressive behavior of the tumor and increases significantly its metastatic potential. We present a rare case of head and neck dermatofibrosarcoma protuberans with multiple local recurrences 13 years after the initial diagnosis.

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Introduction: Patients often suffer from an elongated styloid process. This clinical entity is well known and is described as Eagle syndrome. The presence of this anatomical variation is not always associated with symptoms. However, there is a strong correlation between the elongated styloid process and Eagle syndrome. Aim: This study aims to calculate the incidence of elongated styloid processes in the Greek population, to analyze the morphometric characteristics of styloid processes, and to compare these among sexes. Materials and methods: This is a single-center retrospective study. All skulls were donated to the Department of Anatomy, the Aristotle University of Thessaloniki from January 2013 to May 2019 for research purposes. A Styloid process longer than 30mm was considered elongated. We used Welch’s t-test for the statistical analysis of the data. Results: The prevalence of elongated styloid processes was 35%. The average diameter was 3.32 mm and the average total length was 25.02 mm. There was no statistically significant difference between male and female skulls, though the female styloid processes were slightly longer and the male slightly wider. Symmetry was recorded in 31% of skulls. The average axial angle was 650 but in 4% of cases, it was less than 200. Conclusions: The elongated styloid process is not a rare entity. Eagle syndrome should always be considered in the differential diagnosis when patients report chronic sore throat. Our anatomical findings add a new dimension to the etiopathogenesis of Eagle syndrome.