A case of Dermatofibrosarcoma Protuberans (DFSP) with Homoeopathic Management

A case of Dermatofibrosarcoma Protuberans (DFSP) with Homoeopathic Management

DR AHSAN K A 

Dermatofibrosarcoma protuberans (DFSP) is a locally invasive tumour arising in the dermis and likely to shoe fibroblastic differentiation.

Incidence and Aetiology
It is uncommon, with equal frequency in males and females. Most patients present in the third and fourth decades of life, some cases develop at the site of previous trauma.

 Patient presented with the complaints of chest wall swelling,itching and pain on the right mammary area since 1 month, the pain is of splinter type and there is serous discharge from the scar on the right mammary area. There is no history of radiation of pain, bleeding, pus discharge, itching, local rise of temperature, fever.

HISTORY OF CHIEF COMPLAINT

On July 2017 patient started  noticing pain and swelling in the right mammary area and patient was  taken to nearby hospital and advised for Ultrasonogarphy of chest and found that large thin walled hypo echoic cystic lesion in right mammary area on 09-07-2016 and also advised for biopsy and the  report showed  Dermatofibrosarcoma protubrens on 20-07-2016 , after correlating with biopsy report, patient was advised for excision of tumor on 30-07-2016 and patient was advised to continue  Tab.Veenat 400Mg  one tablet daily for 1 year.

On January 2018 patient again started with pain and swelling on the right mammary area and consulted doctor and advised for biopsy on 25-01-2018 which showed  Dermatofibrosarcoma protubrens Recurrence of Right Chest Wall and advised for surgery but patient was not willing for surgery and continued with anticancerous tablet(Tab.Veenat 400mg).

On 06-02-2018 patient came to Father Muller Homoeopathic medical college and hospital with the complaints of chest wall swelling, itching and pain on the right mammary area since 1 month, the pain was of splinter type and there was serous discharge from the scar on the right mammary area. Along with these complaint patient had reduced appetite, reduced thirst. Weakness, Weight loss. There is no history of radiation of pain, bleeding, pus discharge, itching, local rise of temperature, fever.

PAST HISTORY

MEDICAL HISTORY: Dermatofibrosarcoma protubrens 20-07-2016

TREATMENT HISTORY: Tab.Veenat 400Mg

SURGICAL HISTORY:Excision of Dermatofibrosarcoma on 30-07-2016

GENERAL PHYSICAL EXAMINATION

Temperature: Afebrile at the time of examination.

Pulse: 80/Minute.

B.P: 150/80mmHg

P⁰Cy⁰C⁰I⁰Ly⁰

Weight: 60 Kg (reduced 5 kg since 6months)

INVESTIGATION DONE

USG (DATE: 09-07-2016)

IMPRESSION: Large thin walled hypoechoic cystic lesion in right mammary area.

BIOPSY (DATE: 20-07-2016)

• MORPHOLOGY –  Section shows skin involved by Dermatofibrosarcoma protubrens. Mitosis is 5-4/10hpf. No subcutaneous fat is seen.

• IMPRESSION 

            Dermatofibrosarcoma protubrens – Right chest wall

IHC Markers (20-07-2016)

• Vimentin – Positive
• Ki67 – 10%
• CD34 – Negative

BIOPSY: 25-01-2018

• Impression

• Dermatofibrosarcoma protubrens Rcurrence of Right Chest Wall 
• Radical margins are free
• Base shows tumors.

IHC Markers (25-01-2018)

• Vimentin – Positive
• Ki67 – 5%
• CD34 – +++

MANAGEMENT OF THE CASE

• Hopeless++
• Splinter like pain++ over the lesion
• Raw edges of the lesion
• Syphilitic miasm
• Pain aggravates in the night

Rx;

1. Nitric acid 30 (4-4-4) for 1Week

2. Anona muricata Q 15⁰-15⁰-15⁰ for one Week.

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