Dermatofibrosarcoma Protuberans Presenting as a Primary Breast Mass

Abstract

Dermatofibrosarcoma protuberans (DFSP) is an atypical soft tissue malignancy that affects the dermis and subcutaneous tissue. The cause of DFSP is not clearly understood. This report highlights a rare case of DFSP of the left breast. We report a case of an 18-year-old female with past medical history of type 1 diabetes mellitus, who presented to the breast imaging clinic with a six-month history of left breast lump and associated skin discoloration. The patient had a dedicated left breast ultrasound which showed an indistinct, oval, hyperechoic mass in the superficial breast, measuring 1.4 x 1.0 x 2.5 cm with mild internal vascularity. An ultrasound-guided biopsy of this left breast mass was recommended and performed approximately three weeks later, demonstrating DFSP. The patient was then advised for consultation with Oncology, Surgical Oncology, and Radiation Oncology, to which surgical excision was the final recommendation. The patient had a wide local surgical excision procedure for her left breast mass with surgical pathology confirming negative margins shortly thereafter. This case highlights a great index of suspicion that should be taken when evaluating palpable breast masses with associated skin discoloration in young patients.

Keywords: benign breast condition; benign skin tumor; breast ultrasonography; dermatofibroma sarcoma; diagnostic mammography.

Figure 1. Gray-scale ultrasound image of the left breast upper outer quadrant palpable lump at the 2:00 axis, 8 cm from the nipple, demonstrates an indistinct, oval, parallel, hyperechoic mass.

cm - centimeters Four (4) white measurements which highlight the axial and transverse measurements of the lesion.

Figure 2. Color Doppler ultrasound image of the left breast palpable mass demonstrates mild internal vascularity.

Figure 3. Left image CC and right image ML mammographic views demonstrates a heart-shaped titanium biopsy clip within a focal asymmetry in the upper outer quadrant of the left breast, confirming appropriate sampling.

Red Arrows - Indicate heart-shaped biopsy clip within the focal asymmetry. CC - Craniocaudal view ML - Mediolateral view