Sarcoma pleomórfico em úlcera de Marjolin / Pleomorphic sarcoma in Marjolin's ulcer

Úlcera de Marjolin é uma transformação maligna em tecido cutâneo cronicamente inflamado ou traumatizado, que ocorre especialmente após queimaduras. O carcinoma de células escamosas é o tipo histológico mais encontrado nas úlceras de Marjolin, seguido de carcinoma basocelular e melanoma maligno. Sarcomas em úlcera de Marjolin são raros, correspondendo a aproximadamente 5% dessas degenerações malignas. Neste artigo é descrito o caso de paciente do sexo feminino, vítima de queimadura há 42 anos, com grande ulceração em dorso. A biópsia dessa ulceração evidenciou sarcoma pleomórfico de alto grau em úlcera de Marjolin. A paciente foi submetida a ressecção da ulceração e enxerto de pele no local, seguidos de radioterapia e quimioterapia adjuvantes. Em 3 anos de seguimento, a paciente não apresentou recidiva da neoplasia. Úlceras de Marjolin são neoplasias malignas de comportamento agressivo, com alto índice de metástases regionais. A importância de seu entendimento está na necessidade de prevenção das mesmas, com o tratamento adequado dos pacientes queimados, evitando-se a cicatrização por segunda intenção. Sarcomas em úlcera de Marjolin são considerados raros, com poucos casos relatados na literatura, o que demonstra a importância deste relato.

Marjolin's ulcer is a malignant transformation of traumatized or chronically inflamed cutaneous tissue that occurs after burns. The most common histological type of carcinoma found in Marjolin's ulcers is squamous cell carcinoma, followed by basal cell carcinoma and malignant melanoma. Sarcomas in Marjolin's ulcers are rare, representing approximately 5% of these malignant degenerations. In this report, we describe the case of a female patient who was burned 42 years prior, with a large ulceration on her back. Biopsy of the ulceration showed a high-grade pleomorphic sarcoma in the Marjolin's ulcer. The patient underwent resection of the ulceration and a skin graft followed by radiation therapy and adjuvant chemotherapy. In 3 years of follow-up, the patient had no tumor recurrence. Marjolin's ulcers are aggressive and have a high rate of regional metastases. It is important that clinicians develop an understanding of their prevention by properly treating burns. Sarcomas in Marjolin's ulcers are rare and few cases have been reported in the literature, which demonstrates the importance of this report.

Benign vs malignant soft tissue neoplasms: Limitations of magnetic resonance imaging.

Aims: Various features have been described in the literature to differentiate benign from malignant lesions. The aim of the present study was to study the accuracy of each of these features and that of magnetic resonance imaging (MRI) in diagnosing malignant lesions. Materials and Methods: Fifty-five consecutive patients presenting with neoplastic (both benign and malignant) lesions diagnosed clinically and on ultrasound were studied and their MRI features were compared with the findings on surgical exploration and histopathologic examination. Results: There were 32 (58%) benign and 23 (42%) malignant masses. Malignant masses were more common in patients older than 20 years (83%), and these had symptoms of less than 6 months duration (75%), as against benign lesions. The swelling was painful in 8 malignant masses and these were more common in the upper limbs (61%). Various features of malignant lesions were size more than 5 cm in 83%, change in signal intensity from homogenous on T1-weighted images to heterogenous on T2-weighted images in 74%, irregular margins in 74%, and heterogenous contrast enhancement in 91%. The accuracy of these features was 76%, 58%, 78%, and 60%, respectively. Most benign and malignant lesions were intramuscular in location. A significant number (38%) of benign lesions were located in the intermuscular facial plane. Definitive diagnosis was made in 42% of the lesions. Conclusions: MRI is an excellent modality for evaluating soft tissue neoplasms; however, prediction of a specific diagnosis and differentiation of malignant and benign lesions is not always possible.