Trauma-induced recurrent of scalp dermatofibrosarcoma protuberans: a case report with a 6-year follow-up and literature review

Abstract

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare mesenchymal cell-derived soft tissue tumor, especially on the scalp. As a result, there is a lack of insight into the etiology of its occurrence and the triggers of its recurrence, which makes diagnosis difficult. This paper reports a case with a long follow-up period in an attempt to provide some valuable evidence-based medicine to assist in the clinical work-up of diagnostic.

Case description: We selected a young male who underwent surgical treatment in our hospital in 2013, and his pathological result at that time was "suspected dermatofibrosarcoma protuberans". At the same time, we followed the patient for 6 years and performed a literature review on the current management of DFSP. Six years later, the patient's scalp mass recurred after a head trauma. Based on the patient's medical history and pathogenesis of the disease, we believe that the patient's disease may be related to trauma.

Conclusions: DFSP is rare in clinic, and it is easy to be misdiagnosed because of its atypical clinical symptoms and long diagnosis time. This article analyzed the case which has a long-time follow-up and reviewed the literature on DFSP. Therefore, this paper finds that trauma may be a causative factor in the development and recurrence, and provides a basis for evidence-based medicine for the diagnosis and treatment of this disease.

Keywords: Dermatofibrosarcoma protuberans (DFSP); case report; pathogenesis; recurrence; trauma.

Figure 1

Radiological and pathological examinations. (A) The brain window of head CT shows the size of tumor. (B) The bone window of head CT shows the size of tumor. (C) H&E staining shows that tumor cells were fusiform and disordered in arrangement, with abundant cells and sparse cells in a few areas, accompanied by collagen fibers. Dilated or branching blood vessels could be seen. The magnification of the image is 10×. (D) H&E staining shows that fusiform, ovoid nucleus, fine chromatin, part of the nuclear membrane slightly irregular, little cytoplasm, eosinophilic, and visible nuclear division. The magnification of the image is 40×. (E) Immunohistochemistry of CD34 shows that the tumor cells tested diffusely and strongly positive for CD34. The magnification of the image is 20×. CT, computed tomography; H&E, hematoxylin and eosin.