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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatofibrosarcoma protuberans &#40;DFSP&#41; is a mesenchymal neoplasm of slow growth&#44; locally aggressive and with low metastatic potential&#46; It has several presentations and can be characterized as a hardened plaque&#44; nodule&#44; or vegetating lesion&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Local trauma has been described as a potential risk factor for tumor onset&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The most common sites of involvement are the trunk &#40;40&#37;&#8211;50&#37;&#41;&#44; the proximal limbs &#40;30&#37;&#8211;40&#37;&#41;&#44; and the head and cervical region &#40;10&#37;&#8211;15&#37;&#41;&#46; In the literature review&#44; 11 reports of tumors located in the plantar region were retrieved&#46; Due to the rarity of the presentation on the distal limbs&#44; the authors believe that reporting this case is relevant&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">Male patient&#44; 35 years old&#44; previously healthy&#44; complained of painful lesion on the left plantar region with progressive growth over six months&#59; he denied trauma&#46; On physical examination&#44; he presented an erythematous&#44; exophytic&#44; vegetating&#44; and ulcerated tumor on the first metatarsal joint &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Histopathological examination of the lesion revealed a fusocellular proliferation with a focal storiform pattern &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In the immunohistochemical study&#44; a diffuse positivity for CD34<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cells was observed&#46; The findings were compatible with low-grade fusocellular mesenchymal neoplasia&#44; favoring the diagnosis of DFSP &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Surgical treatment involved amputation of the hallux and part of the left forefoot&#59; no tumor recurrence was observed after four months of post-operative follow-up&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">DFSP is a rare mesenchymal tumor with low rates of aggressiveness&#46; It presents slow progression&#44; with high rates of local recurrence and rare cases of distant metastases&#46; An American study conducted between 2000 and 2010 found an incidence of 41 cases in 10 million patients&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Some studies observed a higher incidence in women and black people&#46; It mostly affects the trunk &#40;40&#37;&#8211;50&#37;&#41;&#44; the proximal limbs &#40;30&#37;&#8211;40&#37;&#41;&#44; and the head and cervical region &#40;10&#37;&#8211;15&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A literature review published in 2019 described 11 cases of dermatofibrosarcoma that affected the feet&#46; The mean age observed was 41 years&#59; it was more frequent in men than in women &#40;8&#58;3&#41; and the most frequent location of the tumor was the dorsum of the feet&#46; The mean growth period was 3&#46;5 years&#46; The mean DFSP size at diagnosis was approximately 3&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#46; Clinical diagnosis is difficult given the variety of presentations&#46; Dermoscopy has been described as a useful tool to aid diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In a review based on the analysis of 32 dermatofibrosarcomas&#44; the most common features described in dermoscopy were the presence of vessels &#40;81&#37;&#41;&#44; followed by a pigment network &#40;78&#37;&#41; and a pinkish background &#40;66&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Histologically&#44; dermatofibrosarcoma presents monomorphic spindle cells with little atypia and mitotic activity&#44; arranged in irregular and multidirectional &#40;storiform&#41; fascicles&#46; The tumor infiltrates the subcutaneous tissue&#44; creating the characteristic honeycomb pattern&#46; The histological differential diagnoses of other spindle cell tumors are dermatofibroma&#44; malignant fibrous histiocytoma&#44; atypical fibroxanthoma&#44; desmoplastic melanoma&#44; Kaposi&#39;s sarcoma&#44; and solitary fibrous tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Immunohistochemistry becomes an important resource for differential diagnosis&#44; as DFSP is positive for CD34 and negative for S 100 protein&#44; factor XIIIA&#44; and desmin&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> All the cases described in the literature were tested for CD34 and were positive&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The recommended treatment is lesion excision with 2&#8211;3<span class="elsevierStyleHsp" style=""></span>cm of safety margins&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Involvement of margins is associated with local recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Another therapeutic option is Mohs micrographic surgery&#46; Management with radiotherapy and imatinib has been described&#46; The use of imatinib is indicated for metastases&#44; local recurrences&#44; as neoadjuvancy&#44; or when the tumor is unresectable&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Attention should be paid to this disease&#44; even in unusual anatomical areas&#44; as the prognosis depends on the early diagnosis and treatment&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Simone Perazzoli&#58; Conception and planning of the study&#59; elaboration and writing of the manuscript&#59; critical review of the literature&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Renan Rangel Bonamigo&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Renata Heck&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Andr&#233; da Silva Cartell&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dermatofibrosarcoma protuberans is a rare mesenchymal tumor&#59; it is locally aggressive and presents high rates of local recurrence&#46; It may present as a nodular or plaque vegetating lesion&#46; It mainly affects the trunk and proximal limbs&#44; being rare in the distal extremities&#46; Biopsy and immunohistochemistry help confirm the diagnosis&#46; The authors report a case of dermatofibrosarcoma protuberans with plantar region involvement&#44; a rare presentation&#46; To the best of the authors&#8217; knowledge&#44; only 11 cases of involvement of the feet were described in the international literature&#46;</p></span>"
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