Dermatofibrosarcoma protuberans (DFSP) is a rare type of soft tissue sarcoma that originates in the dermis, commonly appearing on the trunk and proximal extremities. Often manifesting as a slowly progressing plaque with pink or violet hues, DFSP presents diagnostic challenges due to its subtle initial appearance. The pathogenesis of DFSP is linked to the chromosomal translocation t(17;22)(q22;q13), resulting in the COL1A1-PDGFB fusion protein. Surgical removal, using Mohs micrographic surgery or wide local excision, is the primary treatment. However, the risk of local recurrence necessitates careful post-treatment surveillance, and radiation therapy may be used to mitigate this risk. For advanced or metastatic cases, tyrosine kinase inhibitors represent a promising avenue of treatment, reflecting the evolving strategies in DFSP management.
This in-depth guide on DFSP is designed for healthcare professionals, offering critical insights into its pathophysiology, clinical presentation, diagnosis, and treatment. A thorough understanding of DFSP’s molecular mechanisms and clinical behavior is crucial for enhancing diagnostic accuracy, enabling earlier recognition, and prompt biopsy. This resource aims to equip clinicians with the knowledge to effectively utilize various treatment modalities, including advanced surgical techniques like Mohs micrographic surgery and wide local excision. The importance of an interprofessional team approach is also emphasized, highlighting how collaborative expertise improves patient care through informed decision-making and comprehensive treatment planning. By adopting multidisciplinary strategies, healthcare providers can optimize patient outcomes, minimize local recurrence risks, and effectively manage advanced or metastatic DFSP. Crucially, this guide will delve into the Dermatofibrosarcoma Protuberans Differential Diagnosis, enabling clinicians to confidently distinguish DFSP from similar skin lesions and ensure accurate patient management.
Objectives:
- Distinguish dermatofibrosarcoma protuberans from its differential diagnoses, such as dermatofibromas and other soft tissue sarcomas, based on distinctive clinical and histopathological features, including immunohistochemical staining patterns.
- Select and interpret appropriate diagnostic modalities, including various biopsy techniques and molecular testing, in the diagnostic evaluation of patients suspected of having dermatofibrosarcoma protuberans.
- Implement evidence-based treatment strategies, such as surgical excision with wide margins, Mohs micrographic surgery, radiation therapy, and targeted therapies, in the effective management of dermatofibrosarcoma protuberans.
- Foster collaboration within interdisciplinary teams to enhance care coordination and communication, ultimately improving outcomes for patients affected by dermatofibrosarcoma protuberans.
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Introduction
Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue sarcoma that predominantly occurs on the trunk and proximal extremities. It typically manifests as a slowly progressing, firm plaque, exhibiting colors ranging from violet-red to blue. The insidious growth of DFSP often leads to delayed diagnosis, sometimes spanning months or even years. A significant majority of DFSP cases are associated with the t(17;22)(q22;q13) translocation, which results in the formation of the COL1A1-PDGFB fusion protein.
DFSP is characterized by extensive local infiltration that extends far beyond the visible lesion. Distant metastasis is infrequent, primarily occurring after fibrosarcomatous transformation. Surgical excision with clear margins is the gold standard treatment, employing techniques such as Mohs micrographic surgery or wide local excision. Radiation therapy can be beneficial in reducing local recurrence, particularly when achieving wide surgical margins is challenging. More recently, tyrosine kinase inhibitors have demonstrated promising response rates in patients with advanced or metastatic disease.[1] Post-treatment, diligent monitoring for local recurrence is essential for patients who have undergone curative treatment. Accurate diagnosis is paramount, and understanding the dermatofibrosarcoma protuberans differential diagnosis is crucial to avoid misdiagnosis and ensure appropriate management.
Etiology
The t(17;22)(q22;q13) translocation is present in approximately 90% of DFSP cases, including the fibrosarcomatous variant (DFSP-FS).[2] In cases lacking this translocation, alternative translocations involving the platelet-derived growth factor subunit B (PDGFB) gene on chromosome 22 may be observed. The progression from DFSP to DFSP-FS is sometimes associated with genomic gain affecting the PDGFB/COL1A1 fusion gene, although this is not a consistent finding.
Microsatellite instability, characterized by changes in the number of repeated DNA bases within microsatellites compared to the inherited state, has also been observed in DFSP. These instances are often accompanied by the acquisition of tumor protein p53 (TP53) mutations, especially in high-grade sarcoma transformations. Understanding the genetic underpinnings of DFSP is crucial not only for pathogenesis but also for exploring targeted therapies and distinguishing DFSP from other lesions in the dermatofibrosarcoma protuberans differential diagnosis.
Epidemiology
DFSP is a rare tumor, with an annual incidence of 0.8 to 4.5 cases per million people. It accounts for 1% to 6% of all soft tissue sarcomas and 18% of cutaneous soft tissue sarcomas, affecting both sexes equally. Some studies indicate a slight male predominance. While DFSP is most commonly diagnosed in adults between the third and fifth decades of life, it can occur across all age groups, with children representing about 6% of cases. Accelerated tumor growth may be observed during pregnancy.[3] DFSP-FS constitutes 5% to 15% of all DFSPs, and the Bednar or pigmented variant is even rarer, accounting for less than 5% of cases. DFSP, including the pigmented variant, is more prevalent in Black individuals compared to White individuals.[4] Considering these epidemiological factors is important when evaluating skin lesions and formulating a dermatofibrosarcoma protuberans differential diagnosis.
Pathophysiology
The t(17;22)(q22;q13) translocation leads to the formation of supernumerary ring chromosomes derived from chromosome 22. These rings contain amplified sequences from 17q22-qter and 22q10-q13.1.[4], [5] Less frequently, a linear derivative of chromosome 22 may be involved.[6] Both the ring chromosomes and the translocated linear derivative of chromosome 22 harbor a fusion gene where PDGFB is merged with the collagen type 1A1 (COL1A1) gene. This rearrangement places PDGFB under the control of the COL1A1 promoter, resulting in the normally suppressed PDGFB becoming activated. This genetic alteration induces PDGFB upregulation, leading to excessive production of platelet-derived growth factor (PDGF). The overproduction of PDGF results in continuous activation of the tyrosine kinase PDGFRB receptor, driving cellular proliferation and tumor development.[7] Understanding this pathway is crucial for targeted therapy and for differentiating DFSP from other proliferative skin conditions in the dermatofibrosarcoma protuberans differential diagnosis.
Histopathology
DFSP is characterized by its ill-defined borders and typically involves the dermis and subcutis, although rare cases may be confined to the dermis (see Image. Dermatofibrosarcoma Protruberans, Low-Power Field). It is considered an intermediate tumor, falling between benign dermatofibroma and frank fibrosarcoma, due to its potential for aggressive local invasion and rare distant metastasis. Transformation to a high-grade sarcoma is extremely rare. The overlying epidermis typically shows no atypical histological features.[8]
The tumor cells in DFSP are spindle-shaped and arranged in a storiform or woven pattern, often parallel to the epidermal surface. They exhibit minimal pleomorphism and scant cytoplasm (see Image. Hematoxylin and Eosin Stain Dermatofibrosarcoma Protuberans). These cells are embedded in a collagenous stroma, sometimes with hyaline or myxoid changes. A characteristic honeycomb appearance arises from tentacle-like projections that infiltrate the subcutaneous tissue, traversing septa and fat, leading to fat entrapment. DFSP usually extends into subcutaneous fat but rarely involves fascia, muscle, or bone unless it is recurrent or long-standing. Necrosis is uncommon, and while mitoses are present, significant mitotic activity or atypical mitoses are rare. A mitotic count reaching 10 mitoses per 10 high power fields (HPF) and tumor size correlate with metastatic spread. Fibrosarcomatous transformation occurs in about one-fifth of DFSPs, presenting as an expansive tumor with fascicular and herringbone patterns and atypical cytological features.[9], [10] Histopathological examination is essential for confirming DFSP and distinguishing it from other spindle cell lesions in the dermatofibrosarcoma protuberans differential diagnosis.
History and Physical
DFSP typically presents as an asymptomatic, skin-colored to red-brown firm plaque, which may progress to multiple raised nodules with a violaceous to red-brown hue (see Image. Dermatofibrosarcoma Protuberans). The pigmented variant often exhibits irregular brown pigmentation, and the atrophic variant appears as a violaceous plaque resembling morphea or scar tissue. Lesions grow slowly over months to years and can initially mimic keloids or dermatofibromas, frequently leading to misdiagnosis, especially in early stages. As the tumor progresses, it can reach several centimeters in diameter and may be accompanied by telangiectasia in the surrounding or overlying skin. The tumor is typically fixed to the dermis but mobile over deeper structures in early stages, becoming fixed to underlying structures later in the disease progression. Rarely, DFSP can develop within preexisting scars or tattoos. Ulceration and pain may occur as lesions enlarge. Approximately 50% of lesions are found on the trunk, 35% on the extremities, and 15% on the head and neck.[11] A thorough history and physical exam, considering the slow growth and varied presentations, is vital in raising suspicion for DFSP and considering the dermatofibrosarcoma protuberans differential diagnosis.
Evaluation
DFSP should be considered in the differential diagnosis of any individual presenting with a slow-growing cutaneous nodule. Dermoscopy is an initial, non-conclusive assessment tool that may provide suggestive evidence. A definitive diagnosis requires a core needle or excisional biopsy. A comprehensive patient history and physical examination, including lymph node assessment and a complete skin examination, are essential. Fine needle aspiration may be considered in cases with a history of prior treatment.
Light microscopy of hematoxylin and eosin-stained specimens is typically sufficient for diagnosing DFSP. However, differentiating DFSP from other neoplasms such as dermatofibroma, fibrosarcoma, leiomyosarcoma, undifferentiated soft tissue sarcoma, atypical fibroxanthoma, and others can be challenging. Immunohistochemistry testing is crucial for confirmation in all suspected DFSP cases. DFSP characteristically stains positive for CD34 in 80% to 100% of cases (see Image. Cellular Dermatofibroma). Vimentin and hyaluronate are also typically positive. DFSP is negative for factor XIIIa, smooth muscle actin, desmin, S100 proteins, and keratins, which aids in the dermatofibrosarcoma protuberans differential diagnosis.
Molecular testing, using reverse transcription polymerase chain reaction (RT-PCR) or fluorescence in situ hybridization (FISH) to detect the t(17;22)(q22;q13) translocation, is available. Both methods exhibit 100% specificity, but FISH is more sensitive than RT-PCR for detecting the PDGFB/COL1A1 transcript (90% vs. 72%, respectively). Molecular testing is particularly useful when the diagnosis is uncertain or to predict response to tyrosine kinase inhibitor treatment.
Imaging is not routinely performed in the diagnostic process for DFSP, as most cases are superficial. However, imaging may be helpful for large or recurrent tumors, suspicion of bone invasion, or when defining the extent of the disease is necessary. Magnetic resonance imaging (MRI) is the preferred imaging modality.[12], [13], [14], [15] Computed tomography (CT) is useful if underlying bone involvement or lung metastases are suspected. Lung metastasis, via hematogenous spread, is the most common site, while regional lymph node involvement is rare. Extensive staging workup is generally not necessary due to the low likelihood of lymphatic and hematogenous dissemination. Some recommend a chest radiograph or CT scan before treatment, although the National Comprehensive Cancer Network (NCCN) guidelines do not specifically recommend routine staging evaluation.[16], [17] A comprehensive evaluation, including clinical, histopathological, immunohistochemical, and potentially molecular and imaging studies, is crucial for accurate diagnosis and for ruling out conditions in the dermatofibrosarcoma protuberans differential diagnosis.
Treatment / Management
The primary treatment for localized DFSP is surgical resection with negative margins.[18] The optimal surgical approach depends on the tumor size and location. Regional lymph node dissection is not typically necessary due to the low risk of metastasis. Inadequate initial resection is a significant risk because of delayed diagnosis and the tumor’s infiltrative nature. Simple excision leads to local recurrence in nearly 50% of patients. Recurrent tumors are more likely to invade fascia, muscle, or bone and may result in distant metastases.[19], [20] Pathologically negative margins are therefore essential.
Wide Local Excision
Wide local excision (WLE) is a viable surgical option. The resection margins are critical determinants of local recurrence risk. DFSP tumor projections can extend beyond 3 cm from the primary tumor. Studies indicate a local recurrence rate of 47% with resection margins less than 3 cm, compared to 7% with 3 to 5 cm margins.[20], [21], [22] NCCN guidelines recommend 2 to 4 cm margins with clear pathologic margins when clinically feasible.
Mohs Micrographic Surgery
Mohs micrographic surgery (MMS) involves progressive horizontal tissue slicing during resection, combined with immediate microscopic evaluation using frozen section analysis. This includes prompt immunostaining for CD34 until clear margins are achieved. Real-time margin examination reduces the likelihood of positive margins. Some studies suggest MMS may result in lower local recurrence rates than WLE for DFSP. DFSP treated with WLE has a recurrence rate of about 7.3%, compared to approximately 1% with MMS.[23], [24] However, randomized trials and long-term data are needed to confirm these findings. MMS offers the advantage of smaller lateral margins, resulting in smaller wounds and less complex reconstruction, making it a particularly good option for cosmetically sensitive areas where margin minimization is desirable.
Radiation Therapy
DFSP is a radiosensitive tumor. Radiation therapy is rarely used as a standalone treatment for DFSP.
Current NCCN guidelines recommend adjuvant radiation in the following scenarios:
- Positive margins following surgical resection.
- Negative margins, but with the closest margin less than 1 cm in patients who did not undergo MMS.
- For recurrent or metastatic disease when surgical excision is not feasible.[25]
Radiation doses typically range from 50 to 70 Gy, extending 3 to 5 cm beyond the surgical margin when possible.[26]
Molecularly Targeted Therapy
Imatinib, a tyrosine kinase inhibitor, targets the PDGF receptor and other receptor tyrosine kinases such as c-KIT. It is FDA-approved for unresectable, recurrent, or metastatic DFSP.[27] Imatinib competitively inhibits ATP binding to the PDGFB receptor, reducing kinase activity, limiting tumor growth, and promoting apoptosis. Patients with the t(17;22)(q22;q13) translocation show a better response to imatinib, making translocation screening important before initiating therapy. Further research is needed to determine if patients without this translocation might also benefit.
Imatinib’s adverse effects include gastrointestinal upset, edema, fatigue, anemia, and rash. Most DFSP patients with the translocation respond favorably to imatinib, with studies reporting response rates around 65%. The duration of therapy varies, with some sources suggesting 6 months or longer.[28], [29] Ongoing research is exploring the potential integration of imatinib with surgical approaches for localized DFSP.
Posttreatment Surveillance
Regular self-examination and clinical examinations of the primary site every 6 months for 3 to 5 years, followed by annual lifelong examinations, are recommended for posttreatment surveillance. Radiographic surveillance, blood counts, and liver function tests are indicated only if symptoms warrant. Metastatic lesions are more likely with recurrent lesions that have progressed for many years or when a fibrosarcomatous component is present. Some experts advise limiting follow-up imaging to patients with recurrent DFSP or DFSP-FS. Effective treatment and surveillance strategies are crucial to manage DFSP and prevent recurrence, and accurate diagnosis is the first step in this process, emphasizing the importance of understanding the dermatofibrosarcoma protuberans differential diagnosis.
Differential Diagnosis
The dermatofibrosarcoma protuberans differential diagnosis includes a range of benign and malignant conditions that can mimic DFSP clinically or histopathologically. Distinguishing DFSP from these conditions is essential for appropriate patient management. Key differential diagnoses include:
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Cellular fibrous histiocytoma (dermatofibroma): Dermatofibroma is a benign lesion that can clinically resemble early DFSP. Histopathologically, dermatofibromas are typically smaller, more circumscribed, and lack the extensive subcutaneous infiltration seen in DFSP. Immunohistochemistry is crucial as dermatofibromas show limited or absent CD34 staining, unlike the diffuse CD34 positivity in DFSP (see Image. Cellular Dermatofibroma). Factor XIIIa positivity in dermatofibroma, which is negative in DFSP, can further aid in differentiation.
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Solitary fibrous tumor: Solitary fibrous tumors can also present as spindle cell neoplasms. However, they often exhibit a more prominent patternless architecture and “hemangiopericytoma-like” vasculature histologically. Immunohistochemically, solitary fibrous tumors are typically CD34 positive, similar to DFSP, but are also positive for STAT6 (nuclear), which is negative in DFSP.
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Spindle cell lipoma: Spindle cell lipomas are benign adipose tumors that can occur subcutaneously. They are characterized by a mixture of mature adipocytes and spindle cells. S-100 protein positivity in spindle cell lipoma helps differentiate it from DFSP, which is S-100 negative.
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Angiosarcoma: Cutaneous angiosarcoma, a malignant vascular tumor, can mimic DFSP clinically. Histologically, angiosarcoma shows vasoformative features and is positive for vascular markers like CD31 and ERG, which are negative in DFSP.
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Peripheral nerve sheath tumors (PNST): PNSTs, including schwannoma and neurofibroma, are derived from nerve sheath cells. Benign PNSTs are typically well-circumscribed. Malignant PNSTs are more aggressive. S-100 protein is positive in PNSTs, which is helpful in differentiating them from DFSP.
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Spindle cell melanoma: Amelanotic or spindle cell melanoma can be challenging to differentiate from DFSP. Immunohistochemical stains for melanocytic markers (S-100, Melan-A, SOX10, HMB-45) are essential. Melanoma will be positive for these markers, while DFSP is negative.
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Angiomyxoma: Angiomyxoma is a benign myxoid tumor of soft tissue. Its prominent myxoid stroma and distinctive vasculature are histopathological features that distinguish it from DFSP.
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Myxoid sarcoma: Myxoid sarcomas, such as myxofibrosarcoma and myxoid liposarcoma, are malignant tumors with a prominent myxoid matrix. Clinical and histological context, along with specific immunohistochemical markers, are used for differentiation.
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Synovial sarcoma: Synovial sarcoma is a high-grade sarcoma that can rarely occur in the skin. It typically shows a biphasic or monophasic spindle cell morphology. T-SYT translocation detection by molecular testing is diagnostic for synovial sarcoma and distinguishes it from DFSP.
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Sarcomatoid carcinoma: Sarcomatoid carcinoma is a poorly differentiated carcinoma with spindle cell features. Cytokeratin positivity in sarcomatoid carcinoma, absent in DFSP, is a key differentiating factor.
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Cutaneous melanoma: While typically pigmented, amelanotic melanoma can be in the differential diagnosis of DFSP. Melanocytic markers will be positive in melanoma.
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Dermatofibroma: As mentioned earlier, dermatofibroma is a benign fibrohistiocytic lesion. Its clinical and histological features, along with immunohistochemistry, help differentiate it from DFSP.
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Dermatologic metastatic carcinoma: Metastatic carcinomas to the skin can rarely present as spindle cell lesions. Clinical history and cytokeratin positivity are important in diagnosis.
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Epidermal inclusion cyst: These benign cysts are common skin lesions. Clinical presentation and the presence of squamous epithelium lining the cyst on histology differentiate them from DFSP.
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Keloid: Keloids are benign proliferations of scar tissue. Clinical history of trauma or surgery and the dense, hyalinized collagen on histology distinguish them from DFSP.
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Morphea (localized scleroderma): Morphea is a skin condition characterized by localized skin thickening. The sclerotic appearance and lack of spindle cells on histology differentiate it from DFSP. [17]
A careful clinicopathological correlation, including immunohistochemistry and sometimes molecular testing, is essential for accurate dermatofibrosarcoma protuberans differential diagnosis and to ensure appropriate patient management.
Prognosis
The prognosis for DFSP is generally favorable, with a 10-year survival rate of 99.1%. However, patients with metastatic disease have a significantly poorer prognosis, with a typical survival of around 2 years post-diagnosis. The overall risk of metastasis is approximately 5%, with 1% involving regional lymph nodes and 4% distant metastasis. While metastasis is uncommon, local recurrence is a more significant concern for morbidity. Factors associated with a poorer prognosis include age over 50, DFSP-FS variant, high mitotic index, and increased cellularity.[30] Wider surgical excision improves the overall prognosis by reducing local recurrence rates. Accurate diagnosis, distinguishing DFSP from its differential diagnoses, is crucial for appropriate treatment and ultimately, patient prognosis.
Complications
Complications of DFSP primarily arise from the surgical treatment and local recurrence. Wound-related issues such as infections, difficulties in defect closure requiring skin grafting or complex plastic surgery, contractures, keloid formation, and suboptimal cosmetic outcomes are common. Mohs micrographic surgery can help minimize these complications. Death is a rare but possible complication in patients who develop metastatic disease. Early and accurate diagnosis, facilitated by a thorough understanding of the dermatofibrosarcoma protuberans differential diagnosis, can lead to less extensive surgery and fewer complications.
Deterrence and Patient Education
DFSP is a relatively rare soft tissue neoplasm that is locally aggressive but rarely metastasizes. Healthcare professionals should emphasize the importance of regular skin examinations and prompt medical evaluation for any suspicious lesions to facilitate early detection and improve outcomes. Patients should be educated about the appearance of DFSP, understanding it may initially present as a small, asymptomatic papule or patch that slowly enlarges over months to years. The slow progression often delays diagnosis, highlighting the need for patients to report any skin lesion changes promptly.
Before treatment, patients should understand that surgical excision is the preferred treatment and be aware of potential risks, such as cosmetic outcomes. They should also be informed about the low likelihood of metastasis but the higher potential for local recurrence after resection. Clinicians should encourage adherence to scheduled follow-up appointments for continuous monitoring, ensuring timely intervention and optimal DFSP management. Comprehensive patient education and proactive deterrence strategies empower individuals to take an active role in their skin health, facilitating early detection and treatment. Accurate initial diagnosis, crucial for effective management, relies on the clinician’s ability to differentiate DFSP from its dermatofibrosarcoma protuberans differential diagnosis.
Enhancing Healthcare Team Outcomes
DFSP is an uncommon soft tissue sarcoma predominantly found on the trunk and proximal extremities, typically presenting as a slow-growing, firm plaque with violet-red, brown, or blue hues. Diagnosis requires a high index of suspicion due to its slow growth and potential for being unrecognized for extended periods. Healthcare professionals managing DFSP patients must be proficient in recognizing its characteristics and accurately interpreting diagnostic tests, including biopsies and imaging studies.
DFSP is characterized by extensive local infiltration, potentially extending well beyond visible lesions, although distant metastasis is rare unless fibrosarcomatous transformation occurs. Surgical excision with clear margins, using techniques like WLE and MMS, is the preferred treatment. Adjunctive radiation therapy can reduce local recurrence, particularly when wide margins are impractical. Emerging treatments such as tyrosine kinase inhibitors show promise for advanced or metastatic DFSP. Developing a patient-centered, comprehensive care plan is essential, involving surgical excision, radiation therapy, or pharmacotherapy based on the stage, location, and extent of the DFSP lesion. Vigilant post-treatment monitoring for local recurrence is crucial. Awareness of DFSP’s varied presentations, treatment modalities, and differential diagnoses is essential for timely and effective management.
To enhance patient-centered care, outcomes, patient safety, and team performance in DFSP management, physicians, advanced practice practitioners, nurses, pharmacists, and other healthcare professionals must collaborate effectively using a multidisciplinary approach. Effective communication is critical for care coordination and seamless transitions between treatment phases. Team members should regularly communicate patient status updates, treatment plans, and any care plan changes. Clear and concise communication helps prevent errors, reduces complications, and promotes patient safety. By leveraging collective skills, implementing effective strategies, communicating openly, coordinating care seamlessly, and fostering a collaborative culture, healthcare professionals can enhance patient-centered care, improve outcomes, ensure patient safety, and optimize team performance in DFSP management, starting with accurate diagnosis and dermatofibrosarcoma protuberans differential diagnosis.
Review Questions
Figure
Image Alt Text: Clinical presentation of Dermatofibrosarcoma Protuberans showing a raised, nodular skin lesion, important for dermatofibrosarcoma protuberans differential diagnosis against benign skin growths.
Dermatofibrosarcoma Protuberans Contributed by S Verma, MBBS, DVD, FRCP, FAAD
Figure
Image Alt Text: Cellular Dermatofibroma histology showing limited CD34 staining, a key immunohistochemical feature in the dermatofibrosarcoma protuberans differential diagnosis from dermatofibroma.
Cellular Dermatofibroma. The image depicts a dermatofibroma confirmed by the absence or limited CD34 staining in contrast to dermatofibrosarcoma protuberans that stains diffusely positive. Contributed by F Farci, MD
Figure
Image Alt Text: Low-power microscopic view of Dermatofibrosarcoma Protuberans, illustrating its infiltrative growth pattern, important for dermatofibrosarcoma protuberans differential diagnosis with localized skin lesions.
Dermatofibrosarcoma Protruberans, Low-Power Field Contributed by D Anand, MD
Figure
Image Alt Text: Hematoxylin and Eosin stain of Dermatofibrosarcoma Protuberans showing spindle cells in a storiform pattern, a histological characteristic for dermatofibrosarcoma protuberans differential diagnosis against other spindle cell tumors.
Hematoxylin and Eosin Stain Dermatofibrosarcoma Protuberans. The image depicts a spindle cell neoplasm with a storiform pattern involving the entire thickness of the dermis, consistent with dermatofibrosarcoma protuberans. Contributed by M Abdel-Halim (more…)
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Disclosure: Gopal Menon declares no relevant financial relationships with ineligible companies.
Disclosure: Jennifer Brooks declares no relevant financial relationships with ineligible companies.
Disclosure: Michael Ramsey declares no relevant financial relationships with ineligible companies.
