Letter

Abdominoplasty for reconstruction of recurrent

Dermatofibrosarcoma Protruberans (DFSP) of Ante-
rior Abdominal Wall
Sir, unremarkable.
On the lower ab-

A
44 yr old male patient
presented with recur- dominal wall was
rent mass over lower a mass measuring
abdomen progressively increasing 10 X 10 X 8 cm
in size and extending to penis of 2 over suprapubic
months duration. He was oper- area extending to
ated 15 years ago for similar swell- dorsal surface of
ing in left inguinal region, details root of penis [Im-
of which was not available. He had age 1]. Surface
no systemic symptoms; he was was hard, nodu-
well preserved with no comorbid- lar with areas of
ities. His general examination was ulceration. Mass
was freely mobile Image 3: The Defect
over anterior

Image 4: Advancement of flaps

Image 1: The mass in suprapubic region

Image 2: CT Scan Image 5: Final result, aesthetically superior re-

construction.
International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014 24
muscles of abdominal wall. There
was no significant lymphadenopa-
thy. There was old scar in left in-
guinal region extending almost up
to the mass.
A CT Scan showed 8.7 x 10.7 x
9.3 cm size lobulated in homoge-
nously enhancing mass lesion in
anterior abdominal wall over su-
prapubic region involving dorsal
aspect of mid shaft of penis abut-
ting and indenting penile shaft
[Image 2]. Mass was abutting cav-
ernosa with no significant lym-
phadenopathy. A wide local exci-
sion with 2 cm margins and recon-
struction with local advancement
flaps was planned. Intra op there
was mass extending to dorsum of
penis, dorsal vein of penis en-
gulfed by tumour hence ligated,
but Bucks fascia of penis was in-
tact. In addition, the underlying
deep fascia of abdominal wall was
intact. Wide excision was done,
which left behind a large defect
[Image 3]. Using standard tech-
nique of abdominoplasty, flaps
were advanced to cover the defect,
with primary closure of skin over
the shaft of penis, with excellent
cosmetic results [Image 4,5]. His-
topathology examination revealed
it to be spindle cell sarcoma (prob-
ably fibro sarcoma, intermediate
grade). On immunohistochemis-
try the tumour cells expressed CD
34 and Immunonegative for S-100,
confirming dermatofibrosarcoma.
International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014
Dermatofibrosarcoma Protu-
berans (DFSP) is a rare, locally in-
filtrative tumour arising from the
skin. DFSP accounts for 2 to 6% of
all soft tissue sarcomas, most fre-
quently involves trunk.1 DFSP
have potential to infiltrate deep
tissues and recur locally, and
rarely have distant metastasis.
Wide local excision (WLE) with
adequate margins offers the best
chance of cure. Optimal margins
of at least 2-3 cms are needed to re-
duce local recurrences, Wide re-
section of DFSP (whether recur-
rent or primary) with negative his-
tological margins predicts a supe-
rior local recurrence-free survival.2
Reconstruction of large and com-
plex abdominal wall defects after
WLE represent a challenging
problem, and the options include
primary closure, skin grafts, local
and distant flaps, synthetic and bi-
ologic mesh reconstruction. Ab-
dominoplasty as a means of recon-
struction has been reported after
traumatic injuries of abdominal
wall,3,4 but rarely has been used
post sarcoma excision. Using of
abdominoplasty is feasible for
lower abdominal defects, like in
our case. Good cosmetic results
are achieved without the need for
prosthesis or second operative
procedure.
Ranjeetha Shenoy1
Arun Behl1
Boman Dhabhar2
From 1Department of Surgical On-
cology, 2Department of Medical On-
cology, Fortis Hospitals, Mumbai-
400080
Address for Correspondence: Dr
Ranjeetha Shenoy, Clinical Associate
in Surgical Oncology, #3308/1G, 13th
main road, MCC B Block, Davangere-
577004. e-mail: rshenoys-
urgeon@gmail.com.
REFERENCES
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Dermatofibrosarcoma protuber-
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2. Khatri VP, Galante JM, Bold
RJ, Schneider PD, Ramsamooj R,
Goodnight JE Jr.Dermatofibrosar-
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BR, Antonyshyn O. Surgical man-
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Trauma 1995;39:539-44.
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Ann Plast Surg 1996;36:475.
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