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

Abstract

Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing mesenchymal neoplasm of the dermis and subcutaneous tissues that has a low-to intermediate-grade malignancy. DFSP commonly involves the trunk and extremities, and very rarely the breast skin, mimicking a primary breast neoplasm with few reported cases in the literature. We report a 35-year old female patient who was referred to the Royal Hospital, Muscat, Oman in 2017, with a two-year history of a slow growing left breast lump. Assessment of the breasts with mammography revealed a lobulated lesion in the left-upper-inner quadrant with neither microcalcification nor architectural distortion, mimicking a benign lesion. However, on ultrasound, the lesion had suspicious features with increased vascularity and hence, it was categorised as breast imaging reporting and data system (BIRAD) IV. The patient underwent left breast wide local excision and the histopathological diagnosis was dermatofibrosarcoma protuberans.

Keywords: Breast; Dermatofibrosarcoma Protuberans; Oman; Ultrasonography.

Figure 1

Photograph of the left breast of a 35-year-old female patient showing a nodular pinkish skin lesion over the upper-inner quadrant measuring 3 × 3 cm.

Figure 2

A mammogram of a 35-year-old female patient with dermatofibrosarcoma protuberans of left breast. Mediolateral oblique (A) and craniocaudal (B) showing a lobulated, smoothly marginated mass in the upper-inner quadrant of the left breast.

Figure 3

Colour Doppler ultrasound image of the left breast of a 35-year-old female patient showing a well-circumscribed lobulated subcutaneous mass measuring 3 × 1.4 cm with increased vascularity.

Figure 4

Histopathologic findings of the left breast lesion in a 35-year-old female patient. A: Hematoxylin and eosin (H&E) stain at ×40 magnification. The tumour was hypercellular and composed of spindle cells arranged in a storiform pattern. B: H&E stain at ×200 magnification showing that the tumour was infiltrating the subcutaneous tissue.

Figure 5

Histopathologic findings of the left breast lesion in a 35-year-old female patient. A: Hematoxylin and eosin stain at ×400 magnification demonstrating storiform arrangement of short spindle cells and mitotic figures. B: The tumor cells show positive immune histochemical reactivity for CD34.