Fibrosarcoma Presenting as Marjolin Ulcer – A Rare Case Report

Abstract

Marjolin ulcer is a rare malignancy that arises in previously traumatised or chronically inflamed skin, particularly after burns, with an average latency period of 36 years. Nearly 75-90% marjolin ulcers are diagnosed as squamous cell carcinoma but other neoplasms like basal cell carcinoma, melanoma, fibrosarcoma etc have also been rarely reported. In this case, a 52-year-old male presented with a painless bleeding mass over lower chest wall rapidly increasing in size from last 2 years. He had suffered burn at the same site 20 years ago. Biopsy was reported as spindle cell neoplasm. Wide local excision revealed a poorly circumscribed subcutaneous spindle cell neoplasm exhibiting variable cellularity, fascicular to storiform architecture, mild to moderate nuclear atypia and scattered gaping thin-walled blood vessels. The neoplastic cells showed diffuse strong staining with CD34 in the less cellular area and patchy positivity in the cellular more mitotically active areas. The tumor cells were immunonegative for EMA, p63, SMA, CD99 and STAT6. The final diagnosis rendered was Dermatofibrosarcoma Protuberans dedifferentiating in to fibrosarcoma. Although sarcoma presenting as a Marjolin ulcer is exceedingly rare, it should be kept in mind in differential diagnosis of spindle cell malignancy arising at a burn site.