I X removal and causes local recurrence in about 20 per cent of cases. T h e y do not consider radiographic treatment to be of any value for large lesions, though small ones may obtain some benefit. Adequate surgery is the treatment of choice.
CASE REPORT
R. P., aged 40 years, was admitted on Nov. 12, 1959, on account of a growth in the lower part of the neck and upper part of the left side of the chest, present for one year. This started as a small, painless, bluish-pink nodule on the left side of the neck. It gradually enlarged, and similar nodules appeared on the same side of the chest. These also increased in size and ulcerated about 15 days before admission. The lesion had been painful for the last 15 days and there had been a fair amount of bleeding.
ON ExAMINATION.-Patient thin, very anaemic, and in great distress because of pain. A nodular growth was seen on the left side of the neck in the supraclavicular fossa.
It had two small nodules on its surface, was firm, tender, and freely mobile in all directions, though fixed to the overlying skin. No glands in the neck were enlarged. The growth on the left side of the chest was much larger. It was ulcerated on the surface over an area approximately 4 in. x I in. The floor of the ulcer was covered with unhealthy granulations and bled very freely from the surface. There were prominent veins elsewhere over the tumour, which was tender, and in its other features resembled the tumour in the neck (Fig. 496).
The glands in the left axilla were enlarged, firm, tender, and freely mobile, No abnormality was noted in the heart, lungs, or abdomen. Haemoglobin 5 g. per cent, R.B.C. 2.3 million/c.mm. Radiographs of chest and ribs showed soft-tissue swelling, but no evidence of affection of bones or lungs. Biopsy from the edge of the ulcer revealed chronic granulation tissue but no evidence of malignancy. After repeated blood transfusions the haemoglobin was increased to 10 g. per cent. Free bleeding from the ulcerated growth still continued, controlled only by pressure dressings.
D Y S P E P S I A
437
AT OPERATION.-The growth in the neck was removed under general anaesthesia. It was well encapsulated, and though there was a fair amount of bleeding, it shelled out easily from the surrounding tissues.
Histological examination was consistent with dermatofibrosarcoma (Fig. 497). Fifteen days after the first operation, and after further blood transfusions, the rest of the growth of the chest wall was also easily removed, with a fair amount of bleeding at the time of operation. The surrounding skin was mobilized to cover the defect. No skin-grafting was required, though complete healing was delayed by sepsis until about 2 weeks after removal of the stitches (Fig. 498). Two months after discharge there was no local recurrence.
SUMMARY
A brief review of the literature concerning dermato-fibrosarcoma protuberans is given. A case of this condition is reported and the need for clinical diagnosis is stressed.