Doufekas K, Duncan T J, Williamson K M, Varma S, Nunns D
Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham NG5 1PB, UK.
Obstet Gynecol Int. 2009;2009:547672. doi: 10.1155/2009/547672. Epub 2009 Nov 18.
Introduction. Dermatofibrosarcoma Protuberans (DFSP) is a rare cutaneous tumour of low/intermediate malignant potential, which occasionally arises on the vulva. Historically, the treatment has been wide local excision (WLE). Mohs micrographic surgery (MMS) is now recommended to ensure precise margin control. MMS to treat DFSP of the trunk and extremities is well documented. However, no report to date has described its use in vulval DFSP. Case History. A 39 year old woman presented with a longstanding nodule in the left labium majus. Histology after surgical removal showed an incompletely excised DFSP. MMS was undertaken with primary closure of the defect. Three years following treatment there is no evidence of recurrence. Discussion. The local recurrence rate of DFSP after WLE ranges from 0-75%. Finger-like projections from DFSP into surrounding tissue often results in incomplete excision. Representative vertical sections used in WLE assess less than 1% of the total tumour margin. MMS uses systematic horizontal sectioning. 100% of the tumour margin is microscopically examined. MMS is now advocated to ensure precise margin control.
引言。隆突性皮肤纤维肉瘤（DFSP）是一种具有低/中度恶性潜能的罕见皮肤肿瘤，偶尔发生于外阴。历史上，其治疗方法一直是广泛局部切除（WLE）。现在推荐采用莫氏显微外科手术（MMS）以确保精确的切缘控制。MMS用于治疗躯干和四肢的DFSP已有充分记录。然而，迄今为止尚无关于其在外阴DFSP治疗中应用的报道。病例史。一名39岁女性因左侧大阴唇存在一个长期的结节前来就诊。手术切除后的组织学检查显示为切除不完全的DFSP。采用MMS并对缺损进行一期缝合。治疗三年后无复发迹象。讨论。WLE后DFSP的局部复发率为0 - 75%。DFSP向周围组织的指状突起常导致切除不完全。WLE中使用的代表性垂直切片仅评估不到1%的肿瘤总边缘。MMS采用系统性水平切片。对100%的肿瘤边缘进行显微镜检查。现在主张采用MMS以确保精确的切缘控制。
