ISPUB.COM The Internet Journal of Surgery Volume 30 Number 1 1 of 6 Hemorrhaging And Large Dematofibrosarcoma Protuberans With Tumor Recurrence Of The Left Shoulder In An Adult Male: A Rare Complication G D Mukoro, B Tabowei, B Kombo Citation G D Mukoro, B Tabowei, B Kombo. Hemorrhaging And Large Dematofibrosarcoma Protuberans With Tumor Recurrence Of The Left Shoulder In An Adult Male: A Rare Complication. The Internet Journal of Surgery. 2013 Volume 30 Number 1. Abstract Dematofibrosarcoma protruberans (DFSP) is a rare soft-tissue tumor. Massive hemorrhage is not one of its common features. It occurs slightly more often in males than in females and trauma to soft tissue has been implicated in its etiology. Mohs micrographic surgery (MMS) is the treatment of choice for DFSP. Our report reviews a case of DFSP with a rare complication at presentation and its management as well as published literature. A 55-year-old business man and farmer presented with a large mass at the right shoulder with ulceration over the surface, which was bleeding profusely. He was pale and weak, morbidly obese with a BMI of 37.37kg/m2, and his pulse rate was 124bpm. Blood pressure was 130/80mmHg, respiratory rate was 30cpm and the chest was clinically clear. He was resuscitated with two units of blood before a wide excision was carried out. The histopathology report showed features consistent with DFSP. The results revealed a mesenchymal neoplastic tumor with homogenous spindle cells, arranged in radial whorls producing a storiform or Cartwheel pattern. They were infiltrating in-between the adnexa with extension into the subcutis, trapping fat. Mitotic figures and mild atypia was observed. Before discharge, the patient was noticed to have two newly-growing buds of the tumor on the right shoulder. He had had excisions in the past for tumors in the same shoulder. Clinicians need to be aware of re-occurrences of DFSP. Furthermore, DFSP may present very tumorous, large, ulcerated and bleeding profusely, leading to severe anemia, which is not a common clinical presentation, as seen in the reported cases. INTRODUCTION Dermatofibrosarcoma protuberans (DFSP) was originally described in 1924 by Darier and Ferrand.1,2 It accounts for less than five percent of soft-tissue tumors and 0.1 percent of all malignancies with an annual incidence of 0.8 to 4.5 per million.3,4 It is a rare, slow-growing, fibrohistiocytic neoplasm commonly seen among those in their third or fourth decade of life and it is commoner in the trunk (40-60%), followed by the proximal extremities (20-30%) and the head and neck (10%-16%).4,5 DFSP frequently recurs locally after incomplete excision. The general immuno-staining pattern of DFSP is CD34-positive and factor-XIIIa-negative6. Mohs micrographic surgery (MMS) is the treatment of choice for DFSP. DFSP is one of the malignant variants of fibrous tissue tumors; others are malignant fibrous histiocytoma (MFH), low-grade fibromyxoid sarcoma, fibrosarcoma, desmoid fibromatosis, and nodular fasciitis. We report the rare presentation of a hemorrhaging large DFSP in a black African man. CASE REPORT A 55-year-old businessman and farmer presented this year with a mass of the right shoulder of 5 years duration. It progressively increased in size, was painless, and firm to hard in consistency. Four month before presentation, it became associated with pain as the surface began to ulcerate, and has been bleeding spontaneously and profusely till he was weak. Bleeding usually stopped after using hydrogen peroxide and cottonwood, and dressing with gauze and bandage by a chemist, for about 3 to 5 days before a new episode of bleeding. Prior to the bleeding, there was neither history of trauma, nor use of traditional scarifications, nor an attempt at excision by health personnel. He had had excision for recurrent tumor growth in the right shoulder thrice; the first excision was 22 years ago, the second and third were 17 and 3 years before the current excision at other health centres. He also had right inguinal herniorrhaphy 21 years ago.