Colonic metastasis of dermatofibrosarcoma protuberans detected by colonoscopy.
Takahito Shimada, Jun Takada, Kiichi Otani et al.
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Case in brief
A 66-year-old woman with a history of dermatofibrosarcoma protuberans (DFSP) had a lesion detected in the descending colon during colonoscopy. It was a firm, elevated, subpedunculated mass with intact surface epithelium initially; at follow-up 6 weeks later, the epithelium had sloughed off. Endoscopic ultrasonography showed a predominantly submucosal nodule. Endoscopic mucosal resection provided sufficient tissue to diagnose metastatic DFSP.
What made this case unusual
The lesion’s surface changed from intact epithelium to sloughing over 6 weeks, while imaging localized it predominantly to the submucosa. Colonic metastasis from DFSP is described as exceedingly rare.
Diagnostic / clinical pearl
A changing mucosal appearance does not exclude a submucosal metastasis; careful endoscopic follow-up and resection can provide diagnostic tissue.