The Usefulness of Ultrasonography for Supporting the Differentiation, Diagnosis, and Treatment of Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma.
Diana CrisanLars Alexander SchneiderKarin Scharffetter-KochanekLukas BernhardMaria CrisanXimena WortsmanPublished in: Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine (2024)
Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are rare histomorphological variants of a disease spectrum. After ruling out other tumor entities by immunohistochemistry, PDS can be differentiated from AFX by infiltration into the subcutis, while AFX remains confined to the dermis. The therapeutic approach is more aggressive in PDS as it can potentially metastasize. We assessed the usefulness of preoperative sonography in differentiating between the two tumor entities by identifying a potential subcutaneous infiltration. In our patients (n = 13), preoperative sonography identified and differentiated AFX and PDS with 100% accuracy and even changed the initial histological suspicion of AFX to PDS in 3 cases (23%), which was confirmed after tumor resection. Preoperative sonography of these tumors could strengthen the clinical diagnosis, avoid a delay in therapy initiation and improve patient counseling. While for AFX, micrographic-controlled surgery suffices, for PDS, resection with 2 cm safety margins and lymph node sonography to rule out lymphonodal involvement is necessary. Hence, ultrasonography can improve clinical practice by providing helpful information for dermatosurgeons, which cannot be obtained during clinical examination.
Keyphrases
- contrast enhanced
- lymph node
- magnetic resonance imaging
- patients undergoing
- clinical practice
- end stage renal disease
- computed tomography
- magnetic resonance
- ejection fraction
- chronic kidney disease
- newly diagnosed
- stem cells
- prognostic factors
- coronary artery bypass
- gene expression
- copy number
- acute coronary syndrome
- bone marrow
- radiation therapy
- smoking cessation
- men who have sex with men
- sentinel lymph node
- hepatitis c virus
- hiv testing
- patient reported