Tariq Mufti, M Saeed Khan, Muzher U Dua, Farah Waqar.
Dermatofibrosarcoma Protuberans - A Rare Variant of Soft Tissue Sarcoma of Skin. An Experience of Two Cases at Ayub Teaching Hospital Complex (ATHC), Abbottabad.
J Ayub Med Coll Abottabad Jan ;13(4):32-4.

Case 1: An old lady of 58 years age presented with a huge soft tissue mass over left pectoral region which was gradually increasing in size over the last 5-years. Patient also gives history of recent appearance of constant dull pain and low grade fever (<100F) For the last 3-4 months. CT Scan revealed a soil tissue sub Cutaneous mass extending from the dermis downwards without rib erosion. X-Ray chest clear and USG abdomen was normal. Excisional biopsy revealed Dermato-fibrosarcoma protuberans. After wound healing, external radiation on 10Mev electron beam (Varianclinac-20) with direct anterior field encompassing nearly upper 2/3 of left chest wall and delivering a tumor dose of 48 grays at I cm depth in 16 treatments, 3-1/2 weeks time as c 300 cgys daily. The tumor bed can be radiated on cobolt -60 (Mega voltage beam) with tangential fields to mid line dose of 60 grays in 30 fractions for 6 weeks time (if facility of linac is not available).

Case 2: A middle age women of 40 years, presented with painless soft tissue swelling over antero-lateral aspect of upper 3rd of left thigh with gradual increase in size for the last 3-1/2 years. On examination there was Lt firm, non-tender, hardly mobile (from side to side) soft tissue mass measuring approx 5cm in its greater diameter and overlying skin of normal colour. Accessable lymph nodes were not palpable. Liver and spleen were not palpable. C.T scan of thigh revealed a soft tissue s/c mass with increased vascularity without involvement of underlying bone (femur). Ultrasonography abdomen was normal and x-ray chest clear. Excisional biopsy revealed Dermato-fibrosarcoma protuberans. External radiation was planned on cobolt -60 with lateral opposing fields to midline dose of 60 grays in 30 fractions for 6 weeks time.

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