Dermatofibrosarcoma Protuberans Sarcoma Cell Apoptosis And Apoptosis Related Protein, Survivin, Fas, Research And Clinical Diagnosis And Treatment Analysis

PartⅠCell Apoptosis and Expression of Survivin and Fas in Dermatofibrosarcoma ProtuberansObjective To investigate the relationship between cell apoptosis and the expression of Survivin and Fas in dermatofibrosarcoma protuberans (DFSP).Methods DFSPs(n=25)were obtained as the experimental groups. Normal skin tissues(n=10)were used for the control group. Cell apoptosis was assessed using terminal deoxynucleotide transferase mediated dUTP nick end labeling (TUNEL). The expression of Survivin and Fas in the paraffin embedded sections were detected by streptavidin-peroxidase immunohistochemical method. Positive expression rate were statistical analysed.Results (1) The apoptosis indexes (AI) of all 25 DFSPs were very high. The average apoptosis indexes of DFSPs was 45%. And the average apoptosis indexes of the normal skins control group was 4%. There are significant difference between them(P<0.01). (2) In the group of DFSPs, positive expression rates of Survivin and Fas were 76%(19/25)and 8%(2/25). The positive expression rates of Survivin and Fas in the normal skins control group were 10%(1/10)and 100%(10/10). (3) In the group of DFSPs, the expression rates of Survivin were negatively correlated with AI(r=-0.898,P<0.01) and the expression rates of Fas were positively correlated with AI(r=0.450,p=0.024).Conclusion It was suggested that there were a lot of apoptotic cells in the sarcoma nest which may play an important role in the slow growth and rare metastasis of DFSP. DFSP resisted apoptosis by expressing Survivin and escaped from immune by decreasing expression of Fas. PartⅡClinical analysis and treatment for dermatofibrosarcoma protuberansObjective To study the reasons of misdiagnosis and postoperative recurrence of dermatofibrosarcoma protuberan(DFSP)and find out effective ways to improve its cure rate.Methods The clinical and pathological data of 36 patients with DFSP was submitted to a retrospective study. All 36 patients underwent wide excisions with intraoperative frozen sections. The surgical margins were between 2.5 and 3 cm. Three patients with relapse history were treated with ¹²⁵I radioactive seeds implantation.Results The clinical misdiagnosis rate at first diagnosis was high to 63.8(23/36). The operative wounds of all 36 extensive resections were covered with skin grafts or flap transplantations and the primary healing rate was 95%. The median follow-up period was 3.4(1～6) years and 4(11.1%)cases recurred. Three patients with ¹²⁵I radioactive seeds implantation were followed up for 1 year to 2 years and none of them had recurrence. There were neither distant metastasis nor death in all cases. Conclusion The high misdiagnosis rate of DFSP is mainly attributed to untypical early symptoms. The diagnosis of DFSP depends on pathological examination. Wide excision is the crucial measure to improve cure rate and interstitial brachytherapy is an effective adjunctive therapy.