Imaging Features of Breast Dermatofibrosarcoma Protuberans in Various Modalities Including FDG-PET CT

Abstract

Dermatofibrosarcoma protuberans is an uncommon malignant mesenchymal tumor of the dermis, which most commonly appears on the body and extremities. A preoperative diagnosis of dermatofibrosarcoma protuberans is extremely difficult, because it is a very rare entity and its appearance is often similar to that of benign breast lesion. Here, we presented a case of breast dermatofibrosarcoma protuberans with associated radiological mammography, ultrasound, magnetic resonance imaging and fludeoxyglucose-positron emission tomography computerized tomography (FDG-PET CT) features. To our knowledge, our case is the first report of PET-CT findings of breast dermatofibrosarcoma protuberans. Furthermore, we reviewed characteristic radiologic features of this rare entity, which are helpful for differentiating it from other primary benign breast lesions.

Dermatofibrosarcoma Protuberans Mimicking Primary Breast Neoplasm: A case report and literature review

“…Involvement of the breast by DFSP is extremely rare, with only a few cases reported in the literature. 6,9 Clinically, DFSP usually appears as an irregular reddish-brown to bluish superficial nodule and the diagnosis might be suggested from the appearance. 6,8,10 However, DFSP can present as a subcutaneous nodule known as subcutaneous DFSP and when it involves the breast it can be confused with a primary breast lesion.…”

“…Another useful ultrasonographic finding that can help to distinguish DFSP is the presence of a peripheral hyperechoic rim in the subcutaneous tissue that represents a mixture of tumour cells and fibrous tissue infiltrating the subcutaneous fat. 1,2,4,5,9,11 On magnetic resonance imaging (MRI), DSFP has no specific features and appears as a well-defined nodule or mass that is T1 isointense to the muscle and shows homogenous or heterogenous enhancement on post-contrast examination. However, owing to its high spatial resolution and high tissue characterisation, MRI is very helpful in delineation of tumour extent and evaluating the anatomical relation of the tumour to adjacent structures.…”

“…However, owing to its high spatial resolution and high tissue characterisation, MRI is very helpful in delineation of tumour extent and evaluating the anatomical relation of the tumour to adjacent structures. 2,3,9 Due to its infiltrative behaviour, DFSP tends to extend beyond the clinical margin. This explains the high local recurrence rate of 20-50% following local excision and justifies the current recommendation of a wide local excision with a 2-3 cm resection margin.…”

“…Moreover, poorly treated lesions can lead to differentiation into highergrade sarcoma with a higher recurrence rate. 9 DFSP commonly occurs on the trunk (50–60%), followed by the limbs (25%) and the head and neck area (10–15%). Involvement of the breast by DFSP is extremely rare, with only a few cases reported in the literature.…”

Dermatofibrosarcoma protuberance: a recrudescent dermal malignancy

“…FDG-PET can be done to look for distant metastases, and its local uptake indicates an aggressive disease. 11 FNAC can diagnose soft tissue sarcomas to an accuracy of 95% in the hands of an expert pathologist, but due to the possibility of misdiagnosis, it isn't routinely done. 12 However, it can aid in giving preoperative radiotherapy and decrease the chances of local recurrence.…”