Dermatofibrosarcoma Protuberans Presenting as a Breast Mass: a Case Report

Dermatofibrosarcoma protuberans is a rare tumor that accounts for a negligible percentage (approximately 0.1%) of all malignancies. It usually occurs on the trunk and upper and lower limbs. Its occurrence in the breast is uncommon. A 46-year-old Nigerian woman presented with a left breast mass of 3 years duration without clinical and radiological evidence of metastasis. Initial histological diagnosis revealed a malignant phyllodes tumour. However, immunohistochemistry showed a diagnosis of dermatofibrosarcoma protuberans. She subsequently had a wide local excision with axillary clearance and has shown no clinical and/or radiological signs of recurrence of the lesion one year following surgical removal. This case helps reiterate the need for immunohistochemistry and not only histology of all malignant breast tumours, irrespective of the nature of the presentation, mode of occurrence, and initial diagnosis. Dermatofibrosarcoma protuberans, however rare, should be considered an important diagnosis of breast malignancies. Indeed, considering the high rate of misdiagnosis of dermatofibrosarcoma protuberans, early histopathological evaluation of breast lesions is of utmost importance. Our case also demonstrates that a wide local excision that is readily available in resource-poor settings remains an extremely important option in the absence of the preferable and technical Mohs micrographic surgery (MMS).