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Age / Sex : /
Age / sex: 57/F
C.C.: left lower leg swelling (2MA)
PMHx: flame burn (+) frequent pus discharge at burn site after that
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
* Send Application Answers to Ja-Young Choi, MD ([email protected])
Courtesy : Jang Gyu Cha, MD., Soonchunhyang University Bucheon Hospital
Diagnosis: Majolin's ulcer
Discussion
Findings:
1. Plain radiography : Swelling with obliteration of adjacent tissue planes in calf area Exuberant periosteal thickening in diaphysis of fibula.
2. CT : Well enhanced soft tissue mass lesion with skin ulceration Chronic osteomyelitis with broad based periosteal reaction of fibula : ulcer ostema .
3. MR : Soft tissue mass originated from skin layer involve lateral gastrocnemius muscle. Skin defects along the calf area.
Discussion:
Marjolin's ulcer refers to an aggressive ulcerating squamous cell carcinoma presenting in an area of previously traumatised, chronically inflamed, or scarred skin. Dr. Jean Nicolas Marjolin first described the occurrence of ulcerating lesions within scar tissue in 1828. They are commonly present in the context of chronic wounds including burn injuries, venous ulcers, ulcers from osteomyelitis, and post radiotherapy scars. The average age at diagnosis is in the fifth decade of life with a range of 18–84 years, and men are three times more frequently affected than women.The commonest malignancy in this group of patients is squamous cell carcinoma, but more rarely basal cell carcinomas are found. The precise mechanism whereby chronic ulcers (wounds) develop malignancy is not certain, but chronic irritation and infection with resulting degeneration and regeneration may be instrumental in malignant transformation of either an epithelial or sarcomatous type.
Key points - Skin ulceration - Chronic osteomyelitis with periosteal reaction; ulcer osteoma - Bulky tumor mass lesion originated from skin layer
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