Neoplasia maligna en cicatriz de quemadura: úlcera de Marjolin: informe de dos casos y revisión de la literatura / Malignant neoplasm in burn scar: Marjolin's ulcer: report of two cases and review of the literature

BACKGROUND: Marjolin's ulcer forms part of a group of neoplasms that originate in a burn scar, a phenomenon associated with superficial tissue trauma. The frequency of Marjolin's ulcer is low and represents between 2 and 5% of all squamous cell carcinomas of the skin. This condition is found three times more frequently in men than in women and is thought to be more aggressive than conventional squamous cell carcinoma of the skin. CLINICAL CASES: We present two cases of squamous cell carcinoma that originated on a burn scar. 41 year old woman with gasoline burn on the left foot, 3 months old, in whom an exofitic ulcerated lesion on the right calcaneum region has evolved since she was 32 years old. Left transtibial amputation was decided. Another woman who started its suffering 9 years after a thorax burn with a progressive fungus lesion on the scar area. For its size and as it was a high degree neoplasia, surgical resection and radiotherapy to the zone of the primary with 50 Gy in 25 fractions was decided. CONCLUSIONS: Marjolin's ulcer usually occurs in old burn sites that were not skin grafted and were left to heal secondarily. Although it is believed that there is a latency period of 25-40 years after burn injury before the occurrence of malignancy, this may occur in a period as short as 3 months. Recurrence after radical surgery is 14.7%. Nonetheless, because of the aggressive behavior of this type of cancer, appropriate radical treatment allows an adequate control of the disease. Early grafting of the burn site can prevent the formation a malignant neoplasm. This condition should be suspected in a non-healing chronic ulcer on a burn scar.

Fibromatosis de mama: una lesión simuladora de cáncer / Breast fibromatosis: a lesion mimicking cancer

BACKGROUND: Breast fibromatosis (BF) is a rare benign pathological entity. Its etiology is unknown, but it has been associated with surgical trauma and certain genetic disorders. CLINICAL CASES: Case 1. The patient was a 17-year-old female with a 20 x 15 cm firm and fixed mass in the right breast. A core-needle biopsy was taken with a pathology report of a phyllodes tumor. Mammography revealed a well-differentiated lesion with no evidence of muscle invasion. The patient underwent wide surgical resection with thoracotomy and chest wall resection of the affected ribs. Pathology reported a 19 x 18 x 9 cm BF with a positive surgical margin. Oral colchicine was administered and at 3 months of follow-up the patient is disease free. CASE 2. The patient was a 49-year-old female with a 7 x 5 cm solid right breast mass located at the medial-upper quadrant and fixed to the pectoralis major muscle. Mammography and magnetic resonance imaging revealed a mass infiltrating thoracic muscles. Wide surgical resection was performed with immediate latissimus dorsi reconstruction. Pathology report showed a BF with muscle invasion. At 3 months postsurgery, the patient is disease free. CONCLUSIONS: BF is a rare entity with a locally aggressive behavior. The infiltrative nature of this disease is associated with a tendency to recur locally. Its clinical and imaging features can mimic breast cancer. Differential diagnosis should be made before attempting treatment. The standard therapeutic modality is wide surgical resection, and radiotherapy is reserved for some cases with positive surgical margins.