ONKOLOGIE / Onkologie. 2025;19(1):42-45 / www.onkologiecs.cz 42 SDĚLENÍ Z PRAXE Pleomorfný dermálny sarkóm Pleomorfný dermálny sarkóm Vladimír Bartoš1, Dagmar Hurtová2 1Martinské bioptické centrum, s. r. o., Martin, Slovenská republika 2Dermatovenerologická ambulancia, Púchov, Slovenská republika Úvod: Pleomorfný dermálny sarkóm (PDS) je zriedkavý malígny mezenchýmový nádor kože. Klinicky aj histogeneticky zdieľa podobné črty s atypickým fibroxantómom (AFX) a predpokladá sa, že tieto dva nádory predstavujú morfologické spektrum jednej neoplázie. Kazuistika: 60-ročný muž s anamnézou karcinómu hlasivky pozoroval niekoľko mesiacov rast ulcerovaného tumoru na koži kapilícia. Odstránený bol chirurgickou excíziou. Histologicky išlo o solídne rastúci mezenchýmový nádor pozostávajúci z atypických buniek epiteloidného a histiocytoidného vzhľadu. Na spodine infiltroval podkožný tuk a zasahoval až po hlbokú fasciu. Prítomná bola krvná cieva vyplnená nádorovým trombom. Imunohistochemicky exprimoval CD68, CD10, CD163, CD99 a sčasti aj αSMA a CD31. Nález zodpovedal PDS. Pacient absolvoval PET/CT vyšetrenie s negatívnym výsledkom. Krčné lymfatické uzliny neboli zväčšené. Vykonaná bola široká reexcízia miesta jazvy bez nádorových reziduí. Pacient je ďalej sledovaný, aktuálne bez známok recidívy. Záver: PDS predstavuje pre patológov diagnostickú výzvu. Najčastejšie vzniká u starých mužov na vlasatej časti hlavy a v tejto lokalite, typickej pre nemelanómovú rakovinu kože, predstavuje významnú diferenciálnu diagnózu. Jeho odlíšenie od histogeneticky a štrukturálne príbuzného, ale klinicky omnoho priaznivejšieho AFX môže byť veľmi obtiažne, ale z hľadiska ďalšej prognózy a klinického manažmentu pacienta zásadné. Kľúčové slová: pleomorfný dermálny sarkóm, atypický fibroxantóm, sarkómy kože. Pleomorphic dermal sarcoma Introduction: Pleomorphic dermal sarcoma (PDS) is a rare malignant mesenchymal tumor of the skin. It clinically and histogenetically shares similar features with atypical fibroxanthoma (AFX) and they are thought to represent the morphologic spectrum of one neoplasia. Case report: A 60-year-old man with a history of vocal cord carcinoma had observed an ulcerated skin tumor in the scalp growing for several months. It was removed by surgical excision. Histology revealed a solid mesenchymal tumor consisting of atypical cells population of epithelioid and histiocytoid appearance. At the base, it infiltrated the subcutaneous fat and extended into the deep fascia. A blood vessel filled with a tumor thrombus was found. The tumor was positive for CD68, CD10, CD163, CD99 and partly reactive for αSMA and CD31. The diagnosis of PDS was established. The patient underwent PET/CT examination with a negative result. The cervical lymph nodes were not enlarged. A wide re-excision of the scar region was performed without evidence of residual tumor. The patient continues to be monitored, currently without signs of recurrence. Conclusion: PDS represents a diagnostic challenge for pathologists. It mostly occurs in old men in the capillitium and in this location, which is typical for non-melanoma skin cancer, represents an important differential diagnosis. Its differentiation from the histogenetically and structurally related but clinically much more favorable AFX can be very difficult, but essential in terms of further prognosis and clinical management of the patient. Key words: pleomorphic dermal sarcoma, atypical fibroxanthoma, cutaneous sarcomas. DECLARATIONS: Declaration of originality: The manuscript is original and has not been published or submitted elsewhere. Ethical principles compliance: The authors attest that their study was approved by the local Ethical Committee and is in compliance with human studies and animal welfare regulations of the authors’ institutions as well as with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects adopted by the 18th WMA General Assembly in Helsinki, Finland, in June 1964, with subsequent amendments, as well as with the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, updated in December 2018, including patient consent where appropriate. Conflict of interest and financial disclosures: None. Funding/Support: None. Cit. zkr: Onkologie. 2025;19(1):42-45 https://doi.org/10.36290/xon.2025.010 Článek přijat redakcí: 30. 9. 2024 Článek přijat k tisku: 10. 10. 2024 MUDr. PhDr. Vladimír Bartoš, PhD., MPH vladim.bartos@gmail.com
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