Spectrum of Malignant Transformation in Marjolins Ulcer: Our Experience of This Rare Phenomenon

Document Type: Original Research

Authors

1 Dept. of Pathology, ESI-PGIMSR, Joka, Kolkata, India

2 Dept. of Plastic and Reconstructive Surgery, R.G.Kar Medical College, Kolkata, India

Abstract

  Background & Objective: Chronic non healing ulcers or scar undergoing malignant transformation is a rare phenomenon with an estimated incidence of 2%. Though, numerous predisposing factors have been identified, still it is rarely diagnosed and commonly mistaken for a benign condition. The objective of this study was to verify the efficacy of the Fine Needle Aspiration Cytology/ Scrape cytology of chronic non healing ulcers, and its use in the early detection of the malignant transformation, thereby facilitating early management. Methods: A total of 10 cases of chronic non healing ulcer with malignant transformation were included in the study where the initial diagnosis was made on Fine Needle Aspiration Cytology/Scrape cytology and later on confirmed on histopathology. Results: Squamous cell carcinoma (7 cases), acantholytic variant of Squamous Cell Carcinoma (1 case), malignant fibrous histiocytoma (1 case) and carcinosarcoma (1 case) was seen. A 100% concordance with histopathology was seen in Squamous cell carcinoma cases. Because of the rarity of the case and unusual transformation, high grade pleomorphic spindle cell carcinoma was the cytological diagnosis in case of Malignant Fibrous Histiocytoma. Conclusion: Marjolin ulcer arising out of chronic non healing ulcers can prove to be a precursor of any different kind of malignancies. Fine Needle Aspiration Cytology/scrape cytology can be used as a first line diagnostic modality for the early diagnosis as it is a fast and safe method with high rate of accuracy, sensitivity and specificity  

Keywords


  1. Agale SV, Kulkarni DR, Valand AG, Zode RR, Grover S. Marjolin’s Ulcer – A Diagnostic Dilemma. J Assoc Physician India 2009;57:593-4.
  2. Da Costa JC. Carcinomatous changes in an area of chronic, ulceration, or Marjolin’s ulcer. Ann Surg 1903;37:496-502.
  3. Aston SJ, Beasley RW, Thorne CHM. Plastic Surgery. 5th ed. Philadelphia: Lippincott-Raven ;1997.
  4. Mohamed SI,  Abdullah BJJ, Singh DA, Heng KS. CT appearances of Marjolin’s ulcer in the left gluteal region of a young man. Biomed Imaging Interv J 2006;2(3):e26.
  5. Agullo FJ. Image of the month- Diagnosis : Marjolin’s ulcer. Arch Surgery 2006;141:1-3.
  6. Nthumba PM. Marjolin's ulcers: theories, prognostic factors and their peculiarities in spina bifida patients. World J Surg Oncol 2010;8:108.
  7. Aydogdu E, Yildirim S, Akoz T. Is surgery an effective and adequate treatment in advanced Marjolin's ulcer? Burns 2005;3(4):421-31.
  8. Ochenduszkiewicz U, Matkowski R,Szynglarewicz B,Kornafel J. Marjolin’s ulcer: malignant neoplasm arising in scars. Rep Pract Oncol Radiother 2006;11(3):135-8.
  9. Malheiro E, Pinto A, Choupina M, Barroso L, Reis J, Amarante J.Marjolin's ulcer of the scalp: case report and literature review. Ann Burns Fire Disasters 2001;14(1):115-8.
  10. KakagiaD, TamiolakisD, Grekou A, Vavetsis S , LambropoulouM , Papadopoulos N. Intraoperative cytological evaluation of Marjolin ulcers. Onkologie 2006;29:21-24.
  11. Duncan KO, Leffell DJ. Fitzpatrick’s dermatology in general medicine. 6th  ed. New York:McGraw-Hill;2003.
  12. Moon YJ, Kim JH, Lee YM, Oh MH, Cho HD. A Case of Carcinosarcoma of Skin Developed on Marjolin's Ulcer. J Korean Soc Plast Reconstr Surg  2010;37(1):79-82.
  13. Nthumba PM. Marjolin's ulcers in sub-Saharan Africa. World J Surg 2010;34(10):2272-7.
  14. Tutela RR Jr, Granick M, Benevenia J: Marjolin’s ulcer arising in pressure ulcer. Adv Skin Wound Care 2004;17:462–7.
  15. Choi EC, Kwon IO, Park ES, Kim YB. Malignant Fibrous Histiocytoma Arising in Old Burn Scar on the Anterior Chest.   J Korean Soc Plast Reconstr Surg 2008;35(6):743-7.
  16. Kim JM, Su WP, Kurtin PJ, Ziesmer S. Marjolin's ulcer: immunohistochemical study of 17 cases and comparison with common squamous cell carcinoma and basal cell carcinoma. J Cutan Pathol 1992;19(4):278-85.
  17. Sabin SR, Goldstein G, Rosenthal HG, Haynes KK. Aggressive squamous cell carcinoma originating as a Marjolin’s ulcer. Dermatol Surg 2004;30(2 Pt 1):229–30.
  18. Copcu E. Marjolin’s ulcer: a preventable complication of burns? Plast Reconstr Surg 2009;124(1):156–64.
  19. Suhag V, Sunita, Singh S, Nimbrian VK, Dimri K and Sharma N. Marjolins ulcer developing in electric burns: A rare case report. Pak J Med Sci 2005; 21(3): 375-6.