Dados do Trabalho

Título

Multi-recurrence inguinal dermatofibrosarcoma protuberans (DFSP): wide resection and reconstruction with an abdominal skin flap.

Apresentação do caso

A 61-year-old male patient presented a lesion in the inguinal topography with progressive growth with a diagnosis of DFSP. First surgical resection outside INCA in 2006. Evolved with local recurrence and lymph node progression 1 year after the first surgery, undergoing a new wide resection and inguinal lymphadenectomy, now at INCA, in 2007. Anatomopathological report with diagnosis of relapsed DFSP, with infiltrate of skin and subcutaneous cellular tissue, forming polypoid tumors, 2 reactive lymph nodes and 8 lymph nodes free of neoplasia. Two years later, the patient presented tumor lesions in the right thigh, and a biopsy was performed, confirming a new tumor recurrence. Underwent third wide resection with free margins. He was in clinical follow-up for 3 years, when in 2012, he presented new lesions in the region of the right thigh and right anterior iliac crest, with the same diagnosis of recurrent DFSP and opted for a new surgical resection also with free margins. The condition recurred in 2019, with new resection of the lesion. The fifth and last resection was in June 2021, which underwent extensive surgical excision with circumferential control of margins and reconstruction with an abdominal skin flap.

Discussão

DFSP is a low-grade cutaneous neoplasm, constituting less than 0.1% of all malignancies that microscopically spreads locally in the dermis and subcutaneous tissue and affects young adults between 20-50 years of age. Local recurrence is frequent and less than 3% progresses with distant metastasis, with lymph nodes being the main site of metastasis, followed by the lung. Its gold standard treatment is extensive local excision of the affected area with a surgical margin of at least 3 cm and a deep limit up to the muscle fascia. Main sites of involvement for this pathology: thorax, extremities, head and neck. Cases of inguinal involvement, such as the one mentioned above, are rare. The last resection performed followed the aforementioned criteria, with 3 cm free margins confirmed by freezing in the perioperative period, enabling reconstruction with an abdominal skin flap together with the plastic surgery service

Comentários Finais

A rare case of DFSP in an atypical region (inguinal), with oncological follow-up as planned and five oncological surgical excisions being performed, the last one performed with extensive resection and reconstruction, advocating good oncological, functional and esthetic results for the patient

Palavras Chave

dermatofibrosarcoma protuberans; recurrence; surgery