Dermatofibrosarkom protuberans muške dojke prezentovan kao ginekomastija

  • Viktorija Vučaj Ćirilović University of Novi Sad, Faculty of Medicine, Department of Radiology, Novi Sad, Serbia
  • Miloš Vuković University of Novi Sad, Faculty of Medicine, Department of Radiology Novi Sad, Serbia
  • Jasmina Boban University of Novi Sad, Faculty of Medicine, Department of Radiology Novi Sad, Serbia
  • Nenad Šolajić University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia
  • Milan Ranisavljević University of Novi Sad, Faculty of Medicine, Department of Surgery, Novi Sad, Serbia
  • Nataša Prvulović Bunović University of Novi Sad, Faculty of Medicine, Department of Radiology, Novi Sad, Serbia
DOI: https://doi.org/10.2298/VSP191124042V
Ključne reči: dojka, neoplazme, muškarci, dermatofibrosarkom; dijagnoza, diferencijalna, imunohistohemija, bolesti, retke

Sažetak


Uvod. Dermatofibrosarkom protuberans (DFSP) je veoma redak mezenhimalni tumor koji čini otprilike 0,1% svih maligniteta. To je lokalno agresivni fibrozni tumor, sa velikom stopom recidiva, koji ponekad može dati udaljene metastaze, obično u kostima i plućima. DFSP se obično javlja na trupu i ekstremitetima, a samo kod malog broja obolelih u dojci, posebno kod muškaraca. Prikaz bolesnika. Prikazan je redak slučaj DFSP u levoj dojci 66-godišnjeg muškarca koji se manifestovao kao ginekomastija. Dijagnostička obrada obuhvatila je klinički pregled, ultrazvučni pregled, “core” biopsiju i mamografiju. Imunohistohemija je pokazala difuznu i jaku pozitivnost za vimentin, CD99 i CD34, dok su tumorske ćelije bile potpuno negativne na keratin, S100 protein, STAT6, CD31 i faktor VIII, što je sugerisalo da se radi o DFSP. Nakon toga, izvršena je radikalna mastektomija i pregledom patologa i imunohistohemijskim metodama potvrđena je preoperativna dijagnoza DFSP. Bolesnik je šest meseci posle hirurškog lečenja i dalje bio bez bolesti. Zaključak. DFSP je sarkom mekog tkiva koji se izuzetno retko razvija u dojkama muškaraca. Uobičajena klinička prezentacija na dojci jeste masa sa širokim krvžicama na površini, mada se može prezentovati i samo kao ginekomastija, kao u opisanom slučaju. Dijagnoza DFPS se zasniva na patoanatomskoj i imunohistohemijskoj analizi jer ne postoje specifični znaci za ovaj retki entitet, vidljivi primenom različitih tehnika snimanja. Hirurška ekscizija sa širokim i negativnim marginama je optimalna za smanjenje rizika od recidiva.

Reference

Murase Y, Takeichi T, Matsumoto T, Sakakibara A, Akiyama M. A juvenile male case of dermatofibrosarcoma protuberans on the breast. Clin Exp Dermatol 2020; 45(1): 111−3.

Al Tarakji M, Toro A, Di Carlo I, Junejo K. Unusual presentation of dermatofibrosarcoma protuberans in a male patient’s breast: a case report and review of the literature. World J Surg Oncol 2015; 13: 158.

Lattin GE Jr, Jesinger RA, Mattu R, Glassman LM. From the Radiologic Pathology Archives: Diseases of the Male Breast: Radiologic-Pathologic Correlation. Radiographics 2013; 33(2): 461−89.

Llombart B, Serra-Guillén C, Rubio L, Nagore E, Requena C, Traves V et al. Subcutaneous dermatofibrosarcoma protuberans, a rare subtype with predilection for the head: A retrospective series of 18 cases. J Am Acad Dermatol 2017; 77(3): 503−11.e1.

Iyengar R, Kiwanuka E, Mangray S, Cruz AP, Katarincic J, Bhatt R. Diagnosis and Management of Dermatofibrosarcoma Protuberans in a 3-Year-Old Patient. J Hand Surg Am 2017; 42(9): 756.e1−756.e5.

Achouri L, Triki A, Bouzaiene H, Chemleli M, Laamouri B, Slimen M, et al. Transformed dermatofibrosarcoma protuberans: A series of nine cases and literature review. J Dermatol Dermatol Surg 2016; 20(1): 1−4.

Bouhani M, Fertani Y, Zemni I, Adouni O, Bouida A, Chargui R, et al. Dermatofibrosarcoma Protuberans of the Breast in Man: An Extremely Rare Entity With a Review of the Literature. J Investig Med High Impact Case Rep 2019; 7: 2324709619875634.

Dickson BC, Hornick JL, Fletcher CDM, Demicco EG, Howarth DJ, Swanson D, et al. Dermatofibrosarcoma protuberans with a novel COL6A3-PDGFD fusion gene and apparent predilection for breast. Genes Chromosomes Cancer 2018; 57(9): 437−45.

Chen X, Chen YH, Zhang YL, Guo YM, Bai ZL, Zhao X. Magnetic resonance imaging and mammographic appearance of dermatofibrosarcoma protuberans in a male breast: a case report and literature review. J Med Case Rep 2009; 3: 8246.

Lyu A, Wang Q. Dermatofibrosarcoma protuberans: a clinical analysis. Oncol Lett 2018; 16(2): 1855−62.

Diwakar DK, Wadhwani N, Paruthi S. Recurrent dermatofibrosarcoma protuberans: challenging a surgeon’s dexterity for the ‘tricky’ margins. Ecancermedicalscience 2018; 12: 858.

Akhtar K, Sherwani RK, Ray PS. Dermatofibrosarcoma Protuberans of Male Breast: An Unusual Presentation. Oman Med J 2012; 27(4): e038.

Mirza TI, Akhtar K, Abbas HB, Sameena M, Tahir F, Khan S, et al. Dermatofibrosarcoma protuberans male breast: a case report. Oman Med J 2011; 26(5): e023.

Saikia BK, Das I, Mandal GK. Fibrosarcomatous change in the background of dermatofibrosarcoma protuberans in male breast: Study of a rare case and review of the entity. J Midlife Health 2016; 7(1): 45−8.

Criscione VD, Weinstock MA. Descriptive epidemiology of dermatofibrosarcoma protuberans in the United States, 1973 to 2002. J Am Acad Dermatol. 2007; 56(6): 968−73.

Bowne WB, Antonescu CR, Leung DH, Katz SC, Hawkins WG, Woodruff JM, et al. Dermatofibrosarcoma protuberans: A clinicopathologic analysis of patients treated and followed at a single institution. Cancer 2000; 88(12): 2711−20.

Kreicher KL, Honda KS, Kurlander DE, Bordeaux JS. Hormone receptor expression in patients with dermatofibrosarcoma protuberans. J Am Acad Dermatol 2016; 75(6): 1205−9.

Djilas-Ivanovic D, Prvulovic N, Bogdanovic-Stojanovic D, Vicko F, Sveljo O, Ivkovic-Kapicl T. Dermatofibrosarcoma protuberans of the breast: mammographic, ultrasound, MRI and MRS features. Arch Gynecol Obstet 2009; 280(5): 827−30.

Trofymenko O, Bordeaux J, Zeitouni N. Survival in patients with primary dermatofibrosarcoma protuberans: National Cancer Database analysis. J Am Acad Dermatol 2018; 78(6): 1125−34.

Williams N, Morris CG, Kirwan JM, Dagan R, Mendenhall WM. Radiotherapy for dermatofibrosarcoma protuberans. Am J Clin Oncol 2014; 37(5): 430−2.

Criscito MC, Martires KJ, Stein JA. Prognostic Factors of Survival in Dermatofibrosarcoma Protuberans-Reply. JAMA Dermatol 2016; 152(12): 1398−9.

Objavljeno
2021/12/08
Broj časopisa
Vol. 78 Br. 10 (2021): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika