Burn scar sarcoma

Post-Traumatic Sarcomas: Do They Exist?

Patients often cite a history of trauma prior to the diagnosis of a sarcoma. Sparse literature suggests that there may be a link between sarcoma development and trauma. A 10-year review of academic tertiary-referral sarcoma center database was examined to identify patients who developed a sarcoma after having a history of a significant musculoskeletal trauma. A total of 501 patients were treated for a sarcoma during this time period. Six patients were identified as previously having a significant musculoskeletal trauma at the site of sarcoma development. Half of the sarcomas arose in bone and the other half in soft tissue. Five (83%) patients had multiple operations for the injury with 3 (50%) patients having a postoperative wound infection. The average time from injury to development of the sarcoma was 19.8 years. Survival after diagnosis was poor, and 4 (67%) of the patients died due to their metastatic disease within 3 years of diagnosis. Our findings suggest the possibility of post-traumatic sarcomas.

A/T gap tolerance in the core sequence and flanking sequence requirements of non-canonical p53 response elements

The canonical core sequence of the p53 response element, CATG, has a two-base A/T gap. Previously, we found that p53 can also activate a non-canonical four-base A/T gap CATATG core sequence. In this study, we investigated the possible number of A/T bases used by p53 and showed that a six-base A/T gap CATATATG core sequence was the maximum A/T gap in the p53 response element that could be upregulated by p53 and p63. Canonical and non-canonical p53 response elements also have three-base flanking sequences. A/T bases could be substituted by G/C bases, including CACACG and CGTGTG, but not CGCGCG. We found that the SV40 promoter with functional six- and two-base A/T gap core sequences could be activated by TAp63γ and that TAp63γ could upregulate SV40 small and large T antigens expression in COS7 cells. We also found that the distal region of PUMA promoter with functional two six-base A/T gap core sequences could be activated by TAp63γ in 293T cells. These new findings could provide novel rules for the non-canonical p53 family response element and could extend the entire p53 family regulation network.

Dermatofibrosarcoma protuberans arising in a decorative tattoo

Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally aggressive cutaneous tumour of intermediate grade malignancy. A number of reports have linked local trauma of varying aetiology with the later development of DFSP. In addition, a variety of skin disorders and, in rare cases, cutaneous tumours, have been described in association with decorative tattoos. This is often associated with delayed diagnosis. We report the first case of DFSP arising in a tattoo and discuss the available evidence for a causative link between DFSP and local trauma of this nature.

Primary giant congential infantile fibrosarcoma of the scalp: case report and review of literature

CASE REPORT

A primary giant infantile fibrosarcoma of the scalp in a 6-month-old boy is reported. He presented with a rapidly enlarging right paramedian parietal scalp swelling since birth. There were no signs of raised intracranial tension. Magnetic resonance (MR) imaging of the brain revealed a large vascular scalp tumor extending over the posterior frontal and parietal region bilaterally crossing the midline. There was no intracranial extension. Carotid angiography revealed an extremely vascular tumor supplied by the external carotid artery branches. The tumor was completely resected through a curvilinear scalp incision. Histology was consistent with diagnosis of an infantile fibrosarcoma. The patient had an uneventful course and received no postoperative adjuvant therapy. MR imaging of the brain at follow-up after 5 years showed no evidence of recurrence of tumor. At follow-up after 10 years, he is asymptomatic and leading an active life.

DISCUSSION

The pathology and management of primary scalp fibrosarcoma is discussed, and the relevant literature is briefly reviewed.

Late Paraplegia After Scoliosis Treatment

We report the case of a young girl treated at age 16 for a progressive scoliosis by posterior instrumented arthrodesis. Ten years later, she suddenly developed lumbar pain and paraplegia. The surgical procedure showed a mass infiltrating the vertebral canal and the dural sheath following a supralaminar hook. Histology revealed a diagnosis of leiomyosarcoma. The outcome was poor with a rapid and fatal extension of the tumor. There is nothing to justify a causal link between the scoliosis and the late onset of a malignant tumor. Nevertheless, we discuss the potential role of diagnostic irradiation consecutive to scoliosis monitoring during growth and the potential role of environmental carcinogens like metallic biomaterials. Finally, rapid intrusion of this extraspinal tumor into the dural sheath resulted in a confusing clinical picture and delayed the diagnosis and treatment of the tumor.

Burn scar neoplasms: a literature review and statistical analysis

BACKGROUND

Although squamous cell carcinoma (SCC) is the most common burn scar neoplasm, other neoplasms have also been reported.

OBJECTIVE

To compile the burn scar neoplasm cases in the literature and to analyze their frequency and demographic characteristics.

MATERIALS AND METHODS

Cases were obtained through literature searches.

RESULTS

There were 412 cases gleaned from 146 articles between 1923 and 2004. Seventy-one percent (293) of the tumors were squamous cell carcinoma, 12% (48) were basal cell carcinoma (BCC), 6% (23) were melanoma, 5% (21) were sarcoma, 4% (16) were other neoplasms, 1% (6) were squamo-basal cell carcinoma, and 1% (5) squamous cell-melanoma. The mean age at tumor diagnosis was 50 years, the mean age at the time of burn injury was 20 years, the mean latency interval was 31 years. Only 5% of the reported cases were excised and grafted at the time of injury (p<0.001). BCC occurred at a significantly later age compared to SCC and sarcoma groups (p<0.02) and had a shorter latency period compared to SCC and sarcoma groups (p<0.004) and melanoma (p<0.008). Local recurrence was present in 16% of the cases, while regional lymph node involvement was seen in 22% of the cases and distant metastases was present in 14% of the patients. The mortality rate was 21%.

CONCLUSIONS

Although the main burn scar neoplasm was SCC, other neoplasms contributed to the morbidity and mortality of burn patients. Excision and grafting of deep burns, and close follow-up of non-healing ulcerated burn scars is essential for the prevention and early detection of burn scar neoplasms.

Dermatofibrosarcoma protuberans arising from a burn scar of the axilla

It is well-known that the development of a malignant tumor in a chronic burn scar is one of the long-term complications of a severe burn. Most of these tumors are squamous cell carcinomas, and sarcomas are much rarely seen in chronic burn scars. In the previous literature, 24 cases of burn scar sarcomas were reported. The authors report the second case of dermatofibrosarcoma protuberans arising in a chronic, severe burn scar. A 68-year-old woman with a reddish tumor in the right axilla was referred to the authors' hospital. The patient had sustained severe burns in the right axilla, upper arm, and trunk at the age of 6 years. A biopsy specimen revealed dermatofibrosarcoma protuberans. There was no evidence of distant metastasis. The tumor was excised widely to include the surrounding burn scar. Two years after the operation, there was no evidence of tumor recurrence. As surgeons, we should recognize the possibility of the occurrence of various malignant tumors including sarcomas on burn scars.