Malignant Fibrous Histiocytoma Arising in Old Burn Scar on the Anterior Chest.

Choi, Eui Chul; Kwon, In Oh; Park, Eun Soo; Kim, Yong Bae

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Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2008;35(6):743-747.
Published online November 1, 2008.

Malignant Fibrous Histiocytoma Arising in Old Burn Scar on the Anterior Chest.

Eui Chul Choi, In Oh Kwon, Eun Soo Park, Yong Bae Kim

Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Bucheon, Korea. peunsoo@schbc.ac.kr

Abstract

PURPOSE
Malignant changes of Marjolin's ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. METHODS: We report a 58-year-old male patient who was admitted due to 3.5x5cm chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis.
RESULTS
The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence.
CONCLUSION
Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.

Keywords: Marjolin's ulcer; Malignant fibrous histiocytoma

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