PMC5461560_01
(a) Lump in mid frontal region in male patient (before excision in 2012), mass size 12 x 10 x 6 cm. (b) Head CT scan showing soft tissue attenuation irregular mass single lesion lobulated in mid frontal region. (c) Lump in mid frontal region in same patient after operated 4 years ago with mass size 12 x 10 x 5 cm. (d) Head CT scan showing soft tissue attenuation irregular mass multiple lesion lobulated in mid frontal
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F1
We present a case of a 29-year-old adult male whose main complaint was a recurrent lump, a painless lesion, on his mid frontal region after tumor excision who was diagnosed with DFSP 4 years ago [Figure 1a and b]. History revealed that the DFSP recurred in the second year after the first tumor excision [Figure 1c]. On physical examination, there was a irregular, skin-colored, multiple lobulated mass, measuring 12 x 10 x 5 cm in diameter, with a fixated base; head computed tomography (CT) shown no intracranial mass [Figure 1d].
(a-c) A wide radical excision with 4 cm distance from neoplasm margin and translational skin flap line was drawn. (d) After wide excision was performed, calvarial defect was observed without involvement of duramater below; as frontal bone craniectomy was performed. (e) A bone defect 10 x 8cm was made and cranioplasty using titanium mesh was placed. (f) The skin defect was then reconstructed by translational skin flap and (g) split-thickness skin graft. (h) Mass with an irregular, skin colored, multiple lobulated mass, 12 x 10 x 5 cm in diameter was excised
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F2
A wide radical excision with 4 cm distance from neoplasm margin and translational skin flap line was drawn [Figure 2a-c]. After a wide radical excision was performed, calvarial defect was observed without involvement of duramater; frontal bone craniectomy was performed [Figure 2d]. A wide bone defect 10 x 8cm was made, and cranioplasty using titanium mesh was placed [Figure 2e]. The skin defect was then reconstructed by translational skin flap and split-thickness skin graft [Figure 2f and g]. An irregular, skin colored, multiple lobulated mass, measuring 12 x 10 x 5 cm in diameter, was excised along the surrounding skin in radius 4 cm from neoplasm edge [Figure 2h].
(a) Section showing spindle cells arranged in short fascicles, storiform pattern, oval nuclei, vesicular chromatin, inconspicuous nucleoli and scanty to moderate cytoplasm (HE, 100x). (b) Section showing tumor cell diffuse strong positive staining for CD-34 (100x). (c) Section showing tumor cell diffuse strong positive staining for vimentin (100x)
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F4
As in histopathological findings, using hematoxylin and eosin (HE) stained sections showed a densely cellular and poorly circumscribed tumor in the dermis layer, comprising interwoven bundles and fascicles of uniform spindle shaped cells arranged in a "storiform" or "cartwheel" pattern [Figure 4a]. Tumor cells were strongly positive for both CD-34 [Figure 4b] and vimentin expression [Figure 4c].
PMC5461560_02
(a, b) A wide radical excision with 4 cm distance from neoplasm margin and translational skin flap line was drawn. (c) After wide excision were performed, calvarial defect was observed without involvement of duramater below; as frontal bone craniectomy was performed. (d, e) The skin defect was then reconstructed by translational skin flap and (f). Mass with an irregular, skin colored, multiple lobulated mass, 8 x 6 x 4 cm in diameter was excised
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F3
On physical examination, there was an irregular, skin-colored, multiple lobulated mass, measuring 8 x 6 x 4 cm in diameter, with a fixated base; head CT showed no intracranial mass [Figure 3a]. A wide radical excision with 4 cm distance from neoplasm margin and translational skin flap line was drawn [Figure 3b]. After a wide excision was performed, calvarial defect was observed without involvement of duramater; parietooccipital bone craniectomy was performed [Figure 3c]. The skin defect was then reconstructed using translational skin flap and split-thickness skin graft [Figure 3d and e].