I have a black and white photo of myself when I was four or five years old, which was taken in my hometown. In the photo, I pursed my lips and smiled carefree, wearing a tank top and shorts, with short hair, like a little boy. Every time my mother sees that photo, she always says, “It was that time when I went back to my hometown, there was such a small bump…”
Little bump on stomach grows little by little
I don’t remember it anymore, but my mother said that the red, hard, and protruding lump on my left abdomen grew out after returning to my hometown, and it hasn’t subsided since then.
At first it was as big as a grain of rice, it was painless and existed all the time. When I was in high school, I suddenly discovered that the small pimple seemed to gradually grow bigger , and it grew to the size of a broad bean. Later, during college, it slowly grew to the size of a one-yuan coin, and the surface became uneven, redder in color, and occasionally itchy.
But because it has been with me for too long, I still didn’t take it seriously. I just went to the local hospital to have a look. The doctor said it was a keloid, and there was no good way, and there was no need for treatment.
After graduating from university, I went to work in Beijing. It’s still growing and there are two or three smaller bumps around it that don’t feel right to me. From 2003 to 2007, I went to the dermatology departments of several hospitals in Beijing one after another. Some doctors said it was keloids; one doctor diagnosed it as cutaneous neurofibroma, but did not give any treatment advice.
I searched for neurofibroma on the Internet, and the pictures that came out made me feel disheartened and hopeless for a while. But I’m still quite a humorous person, I told my mother that it’s okay, the big deal is that I will be covered with pimples and turn into a toad in the future.
The only good thing is that, apart from being ugly, the pimple has no other impact for the time being. And the pimple grows on the abdomen, and I am relatively thin, so although it is slightly raised, as long as I don’t wear a bikini, others can’t see that I am “pregnant” with this secret.
But it has been growing slowly and tenaciously, getting bigger and bigger . I felt that something had to be done, so I went home.
After three surgeries, the pimple started to wreak havoc again
In the hospital in my hometown, a doctor suggested surgical resection, but because the lesion was relatively large, the plan was to resect it first, then resect it half a year later, and do it again if it was still not clean.
I still clearly remember the first surgery, which was performed under local anesthesia. I don’t know if it was because the anesthetic didn’t work or it was a psychological effect. I could feel the heart-wrenching pain. I was so scared that I delayed the second surgery for a year.
During this time, it continues to grow, spreading across the abdomen. The second operation was spinal anesthesia, but it was not completely removed. Half a year later, I had the third operation, and a local infection occurred after the operation. The wound was slow to heal, and a hole was rotten. It took more than a month to heal slowly. Although it has been a long time, the memory of that time is still unforgettable.
Multiple surgeries left me with a long, centipede-like scar on my stomach . Many friends envy me for having a very flat stomach, and every time I hear this, I can only smile slightly.
After the surgery, the pimple disappeared temporarily for a while. During this period, I completely bid farewell to Beijing and returned home, got married, conceived and had children. During the caesarean section, the chief surgeon said that I had made more cuts on purpose to remove my hypertrophic scar tissue.
The days went on like this, but I know it’s never gone. Sure enough, it started to wreak havoc again, and I never gave up fighting against it. I went to many hospitals, took various medicines, and applied various ointments, but it became more and more, bigger, and more hideous .
Then, a large pimple at the top started to burst, producing pus every day. I went to many hospitals again, and some doctors suggested that I go to the big hospitals in Beijing and Shanghai.
Pimples become more and more, bigger and more ferocious.丨Photo courtesy of the author
After another operation, the pimple grew again
In desperation, I went to a provincial cancer hospital. The director of surgery said, I should be dermatofibrosarcoma protuberans , and the only treatment is surgical resection, but the recurrence rate is high after surgery .
In November 2021, I was lying on the operating table again. The doctor adopted the surgical plan of flap repair. After the operation, I had three shocking and long scars on my abdomen.
Postoperative abdominal scar丨Photo courtesy of the author
The recovery process after surgery is long and painful. I was afraid that the skin on my abdomen would be too tense, so I could only keep bending at about 90 degrees for more than a month. But despite being careful, two places were torn apart. But in any case, this is much better than the previous appearance of a ghost lying on the stomach.
The pathological results came out, it was dermatofibrosarcoma protuberans, low-grade malignancy . After a few tears, it was nothing.
From the surgery to now, I will review it every three months. It has been fine before, but a few days ago, I found a slightly raised protrusion on the scar on the right side of my abdomen …
There is another slightly raised protrusion at the scar on the right abdomen.丨Photo courtesy of the author
Having struggled with this disease for so many years, I am not afraid, but feel very owed to my family. Every once in a while, I may have to have an operation, and they will take care of me meticulously. I often think that maybe I was a heinous villain in my previous life, and I need to suffer this kind of torture in this life. On my stomach, there isn’t much intact skin anymore.
I have been paying attention to “Gutshell patients” for a long time, and I have seen many stories of lucky and not-so-lucky people. Everyone’s life and destiny may be different, but the same thing is that we are all working hard to live .
I also want to use your platform to ask if anyone else has the same experience as me?
doctor reviews
Wang Fang | Attending Physician of Department of Dermatology, Taiyuan Hospital, Peking University First Hospital
The author’s dermatofibrosarcoma protuberans is a low-grade soft tissue tumor that arises from fibroblasts or histiocytes in the dermis. Clinically, it is characterized by slow local invasive growth, easy recurrence after surgical resection, and rarely metastases .
The disease can occur at any age, and the peak incidence is between 20 and 50 years old. The etiology is unknown at present, and it may be related to the translocation of homologous chromosomes 17 and 22 . Some patients have a history of trauma, surgery, insect bites or local injection of drugs, but whether it is related is not yet clear.
The tumor is more likely to occur in the trunk, followed by the extremities, head and neck. At the beginning, it can appear as an asymptomatic hard patch with multiple hard nodules, which are light red or light blue. Later, as the tumor grows, the scope gradually increases, manifested as a raised hard mass with a slightly smooth surface, which may be accompanied by purulent exudates and ulcers. Due to the slow growth of the tumor, patients generally have no subjective symptoms , and some may have mild pain, and the pain gradually becomes more obvious as the damage expands.
Currently, the diagnosis of this tumor relies on pathological examination . According to histopathological characteristics, the disease is mainly divided into 4 types, namely classic type, myxoid type, fibrosarcomatous type and pigmented type, and there are some rare types. Among them, the fibrosarcoma subtype is more aggressive and has the possibility of distant metastasis.
Surgical resection is the treatment of choice . The tumor can grow slowly locally in a “crab-like” manner, so if it is not completely removed, it is very easy to relapse after surgery. Therefore, the operation must remove the tumor as completely as possible to reduce recurrence .
The current mainstream surgical methods include wide local excision (WLE) and Mohs microsurgery (MMS). With regard to WLE surgery, it is currently recommended that the resection margin should be at least 3 cm away from the lesion tissue ; in terms of resection depth, if conditions permit, it should be as deep as the muscle envelope fascia and pericranium to obtain a negative resection margin. For recurrent tumors, try to keep the resection margin more than 5 cm away from the tumor.
As for MMS surgery, the basic method is to continuously resect the tumor and its surrounding tissues in layers, and each resected layer is sent for histopathological examination , so as to preserve normal tissues to the greatest extent and improve the tumor clearance rate. It has been reported that the postoperative recurrence rate of MMS is lower than that of WLE, but it requires higher equipment and techniques.
In addition to surgical treatment, adjuvant radiotherapy and targeted therapy may reduce the incidence of local recurrence and metastasis of this tumor , but it is generally believed that traditional chemotherapy has poor effect on this tumor.
Compared with other malignant tumors, dermatofibrosarcoma protuberans grows slowly. If the tumor can be detected early and completely removed by surgery, the treatment effect can be improved . We hereby call for vigilance against recurrent small tumors, skin pathological examination as soon as possible to reduce misdiagnosis, and achieve early detection and early treatment.
References:
[1 ]Iwasaki T, Yamamoto H.Current Update on the Molecular Biology of Cutaneous Sarcoma: Dermatofibrosarcoma Protuberans[J].Current treatment options in oncology, 2019, 20(4):29.
[2] Chen Youxin, Cai Zhen. Pathogenesis and treatment progress of dermatofibrosarcoma protuberans [J]. Chinese Journal of Plastic Surgery, 2022, 38(10): 1193-1198. DOI: 10.3760/cma.j.cn114453-20210607 -00251.
The sharing of personal experience does not constitute a diagnosis and treatment recommendation, and cannot replace the doctor’s individualized judgment on a specific patient. If you need to see a doctor, please go to a regular hospital.
Author: Dorothyma
Editors: Xiaoai, Li Xiaoqiu
Cover image: Tuchong Creative
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