Clinical Features and Expression Patterns for Burn Patients Developed Marjolin Ulcer.

Marjolin's ulcer is a type of skin cancer that generated from chronic nonhealing trauma. For years, its pathogenesis mechanisms remain unclear. Regarding this situation, the authors retrospectively analyze the patients admitted to their department from 2005 to 2019 to present several representative cases and examine the expression patterns of survivin and its role in this process. Among these patients, the latent period ranges from 2 to 25 years, with 8.43 years in average. There is no notable relationship between the latent period and age (P = .643 > .05). Therefore, Marjolijn's ulcer arises from extremities and joints more often compared with other parts (P < .05). The expression ratio of survivin in Marjolin's ulcer is significantly higher than that in skin ulcer (P < 0.05). And the expression ratio of survivin in patients diagnosed with Marjolin's ulcer is also correlated with lymphatic metastasis (P < .05). Frequent follow-ups and prompt diagnosis and management are necessary as the prognosis is poor for patients with metastasis. Survivin may be a potential target for future development of target therapy in order to maximize the efficacy and improve the quality of life for patients suffering from Marjolin's ulcer.

Melanoma arising in chronic ulceration associated with lymphoedema.

Chronic ulceration can be complicated by development of a malignancy. The most frequent associated malignances are squamous cell carcinoma and basal cell carcinoma, although melanoma, leiomyosarcoma and adenocarcinoma are less commonly seen. Chronic lymphoedema may also predispose to development of some malignancies, including lymphangiosarcoma, squamous cell carcinoma and Kaposi's sarcoma. Here, we report the case of a 77-year-old man with primary lymphoedema, who developed melanoma in a chronic foot ulcer of 60 years' duration. The patient underwent wide excision for the melanoma, and remains free from metastases at 1-year follow up.

Ultrasound in diagnosis of retroperitoneal femoral nerve injury: a case report.

We present a case of retroperitoneal femoral nerve injury after cut wounds at the lower abdomen. Electrodiagnostic tests revealed impaired function of nerve and muscles. A mass was observed at the retroperitoneal part of the femoral nerve by ultrasound, indicating that a traumatic neuroma composed of disordered fascicles was configurated after the injury. Postoperative pathology confirmed hypertrophic and hyperplastic nerve bundles of the mass. Great improvements were shown in the patient's symptoms and electrodiagnostic tests in the subsequent 3 months. This case presented a rare position of neuroma formation by ultrasound.

Traumatic neuroma in a patient with breast cancer after mastectomy: a case report and review of the literature.

The incidence of traumatic neuroma is extremely low, especially in those patients with breast cancer after mastectomy. There are only 10 cases reported in the literature. We report a patient who developed a palpable nodular mass near the mastectomy scar. The result of excisional biopsy was traumatic neuroma. Review of the literature reveal 10 cases with breast cancer of traumatic neuromas after mastectomy. Traumatic neuroma is a benign lesion and a reparative response of the nerve to injury, either direct/indirect trauma or chronic inflammation. Benign lesions as traumatic neuromas are more rarely seen after mastectomy. However, in order to manage patients' treatment, the most critical problem is to distinguish it from recurrent breast carcinoma. Although assistant examination methods such as ultrasound and computed tomography are valuable to a certain extent, the final diagnosis can only be confirmed on pathologic examination.

Neuroma of the radial digital nerve of the middle finger following trigger release.

Trigger digit release is a common surgical procedure with a low complication rate. One of the potential complications is digital nerve injury. Though uncommon, digital nerve injury can be significantly symptomatic to the patient. We report a case of radial digital nerve neuroma formation following trigger release of the middle finger, which is considered to be safe, in terms of risk of digital nerve injury. We discuss our management of the complication, possible pitfalls which may have resulted in the complication in our case and offer possible means of overcoming these pitfalls.

Marjolin's ulcer: Sequelae of mismanaged chronic cutaneous ulcers.

OBJECTIVE: This study was to evaluate the current pattern and risk factors of Marjolin's ulcer in the authors' setting. SETTINGS AND PARTICIPANTS: Twenty-one patients with histological diagnosis of skin malignancy at the University of Calabar Teaching Hospital, Calabar, Nigeria. METHODS: Presented are patients with histologic diagnosis of Marjolin's seen in the University of Calabar Teaching Hospital, Calabar, Nigeria from January 2007 through December 2007. RESULTS: Five patients (3 men and 2 women) with Marjolin's ulcer whose ages ranged from 32 to 70 years (mean 46.6 years) accounted for 45.5% of squamous cell carcinoma. All the patients suffered traumatic injuries (4 lower limb injuries from road traffic accidents and 1 puncture wound of the upper limb) and the latency was 21.4 years. CONCLUSIONS: Chronic trauma-induced limb ulceration is the leading risk factor for Marjolin's ulcer. Health education, early detection, and proper management of chronic wounds would improve outcome.

Post-traumatic pseudolipomas--a review and postulated mechanisms of their development.

Post-traumatic pseudolipomas develop in areas of the body that have been subjected to acute, severe, blunt trauma and chronic trauma. This study aimed to review the literature for reports of post-traumatic pseudolipomas on Medline and identify the possible mechanisms of their development. In the literature, 124 such cases were identified relating to case reports and case series; of these, 98 occurred in females and 26 in males. The majority of the cases occurred secondary to severe, acute, blunt trauma. The initial postulated mechanisms for development of post-traumatic pseudolipomas were anatomically and mechanically based. Recently, it was shown that there is a close relationship between inflammation and adipogenesis. Blunt trauma results in an inflammatory process. We postulate that post-traumatic pseudolipoma development occurs as a result of inflammatory triggers and an optimal local milieu at the site of development by making an analogy to an in vivo murine tissue engineering model for neo-adipogenesis.

Traumatic pseudolipoma: herniation of buccal fat pad, a report of two cases.

Traumatic pseudolipoma is a term used to describe intra-oral herniation of the buccal fat pad. A tear of the buccinator muscle and buccal mucosa allows the buccal fat pad to extrude into the oral cavity. Initially, the lesion can suggest a more sinister cause, but a history of trauma, an absence of mass before the accident, anatomical site and fatty appearance should suggest a diagnosis of traumatic herniation of buccal fat pad. This injury is rare, but two cases presented to the authors' hospital over a period of 3 months.

Marjolin ulcer of the scalp: intruder of a burn scar.

Childhood burn accidents are still a problem all over the world. Besides the contractures and hypertrophic scar conditions, malignant transformation in the burn scar is one of the primary concerns later in adulthood. Marjolin ulcer, commonly seen after burn scar, is a neoplastic change in the scar tissue. The scalp region necessitates additional attention because of the inevitable structures it protects. The long-standing ulcers with malignant transformation may cause invasion of different layers of the scalp. As the cranium is invaded, reconstruction after wide excision of these tumors becomes more difficult to deal with. Scalp invasion of Marjolin ulcers with different levels is presented in the following study. Consistent with the literature, histopathology of the tumors was squamous cell carcinoma in most patients. Although rare, mesenchymal tumor is involved in 2 of 9 patients. The latent period of the tumor is inversely proportional to the age at the time of burn injury. As the patient is younger at the time of injury, the occurrence of the ulcer is longer than expected. Lag period as long as 81 years is detected in the study. The delayed diagnosis due to social considerations such as financial limitations increases the likelihood of cranial invasion. A single huge scalp flap is often sufficient for soft tissue defects, and cranioplasty with methyl methacrylate is an appropriate option for reconstruction.

A great Marjolin's ulcer of the scalp invading outer calvarial bone and its different treatment with support of Medpor.

A Marjolin's ulcer arising in a chronic scalp burn scar is reported. Malignant transformation occurred after 1 decade. The tumor had invaded the skull, but not dura mater and its underlined brain tissue. This case illustrates the importance of appropriate and expeditious initial wound management of scar ulcers with high malignant potential to prevent this devastating outcome and also the role of reconstructive surgical techniques in radical surgery for scalp cancers.

Post-traumatic soft tissue tumors: case report and review of the literature a propos a post-traumatic paraspinal desmoid tumor.

BACKGROUND: Antecedent trauma has been implicated in the causation of soft tissue tumors. Several criteria have been established to define a cause-and-effect relationship. We postulate possible mechanisms in the genesis of soft tissue tumors following antecedent traumatic injury. CASE PRESENTATION: We present a 27-year-old woman with a paraspinal desmoid tumor, diagnosed 3-years following a motor vehicle accident. Literature is reviewed. CONCLUSION: Soft tissue tumors arising at the site of previous trauma may be desmoids, pseudolipomas or rarely, other soft tissue growths. The cause-and-effect issue of desmoid or other soft tissue tumors goes beyond their diagnosis and treatment. Surgeons should be acquainted with this diagnostic entity as it may also involve questions of longer follow-up and compensation and disability privileges.

Embryonal rhabdomyosarcoma secondary to an open fracture of the tibia: a case report and review of literature.

Embryonal rhabdomyosarcoma (ERMS) is a highly malignant tumor in children and adolescents. It rarely occurs in adults. A 47-year-old patient presented with ERMS of the muscle flap transplant 20 years after an open type III-comminuted fracture of the lower leg. The affected leg was amputated. The patient refused adjuvant chemotherapy and one year after surgery remains disease-free and in good general condition.

Lipomas after blunt soft tissue trauma: are they real? Analysis of 31 cases.

BACKGROUND: Soft tissue trauma and lipomas are common occurrences in surgical practice. Lipomas are defined as benign tumours of adipose tissue with so far unexplained pathogenesis and aetiology. A link between preceding blunt soft tissue trauma at the site of the tumour and the formation of lipomas has been described earlier. These soft tissue tumours have been named 'post-traumatic lipomas'. OBJECTIVES: In a retrospective review, to analyse all patients with benign adipose tissue tumours treated at our institution between August 2001 and January 2007. METHODS: All cases were reviewed regarding medical history, magnetic resonance imaging findings, intraoperative findings, clinical chemistry and histology. RESULTS: In 170 patients presenting with lipomas, 34 lipomas in 31 patients were identified as post-traumatic. The mean +/- SD age of the patients with post-traumatic lipomas was 52 +/- 14.5 years. The mean time elapsed between soft tissue trauma and lipoma formation was 2.0 years (range 0.5-5). Twenty-five of the 31 patients reported an extensive and slowly resolving haematoma after blunt tissue trauma at the site of lipoma formation. The mean +/- SD body mass index was 29.0 +/- 7.6 kg m(-2). Fourteen of 31 patients presented with an elevated partial thromboplastin time. Eleven of 34 lipomas were found on the upper extremities, five on the lower extremities, 13 on the trunk, and two on the face. All tumours were located subcutaneously, superficial to the musculofascial system. Thirty-three lipomas were removed by surgical excision and one by liposuction following an incisional biopsy. Histological examination revealed capsulated and noncapsulated benign adipose tissue in all 34 tumours. CONCLUSIONS: The existence of a pathogenic link between blunt soft tissue trauma and the formation of post-traumatic lipomas is still controversial. Two potential mechanisms are discussed. Firstly, the formation of so-called post-traumatic 'pseudolipomas' may result from a prolapse of adipose tissue through fascia induced by direct impact. Alternatively, lipoma formation may be explained as a result of preadipocyte differentiation and proliferation mediated by cytokine release following soft tissue damage after blunt trauma and haematoma formation.