PMC6689845_01
(A) a 6cm erythematous nodular tumor on the left major labia of the vulva; (B,C) wide excision with margins of 5cm and reconstruction by a lotus petal flap
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Physical examination revealed a 6cm firm erythematous nodular tumor of elastic consistency on the left major labia of the vulva (Figure 1A). The tumor was radically excised with free margins of 5cm reconstruction by a lotus petal flap was performed by the plastic surgeons (Figure 1B,C).
(A) cut section: well delineated and pearl-white tumor; (B) DFSP associated with fibrosarcomatous transformation: abrupt transition of typical DFSP (right) to a fascicular proliferation of spindle cells (left) (HE xx 40); (C) with increased cytologic atypia and mitotic activity in fibrosarcomatous areas (HE x 200); (D) and diffuse CD34 positivity in both areas (IHCx40)
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On sectioning, the tumor was apparently well delineated, pearl-white in color and of firm consistency, measuring 50 x 40 x 35mm (Figure 2A). The neoplastic proliferation was predominantly arranged in short intersecting fascicles with abrupt transition in depth with a herringbone architectural pattern of growth and increased cellularity (Figure 2B). In these deep areas, increased cytologic atypia and mitotic activity were noted (Figure 2C). Immunohistochemical stains (Figure 2D) revealed diffuse CD34 positivity.
(A) Ki-67 staining: IHC, x 200: marked increase in cell proliferation in fibrosarcomatous areas; (B) IHC, x 200: lower Ki67 staining in conventional DFSP
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Tumor cells show higher nuclear positivity to Ki67 in hypercellular areas than in DFSP typical areas (Figure 3A,B).