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.

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.

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.

Aggressive Squamous Cell Carcinoma Originating as a Marjolin's Ulcer

BACKGROUND

Marjolin's ulcer is an epidermoid carcinoma arising in a scar or chronic wound and can have an aggressive course.

OBJECTIVE

To present a case of squamous cell carcinoma arising in a burn scar with resulting metastases and to discuss Marjolin's ulcer.

RESULTS

The patient continued to have further metastatic disease despite aggressive surgical treatment.

CONCLUSION

In following patients with chronic ulcers and wounds, it is important to evaluate any changes immediately with biopsies and further imaging studies if indicated in order to treat effectively. Even aggressive surgical intervention will sometimes be inadequate in treating these tumors.

[Marjolin ulcer]

Marjolin's ulcers can produce neoplasms. They appear on previous scars produced by old three degree burns. Sometimes they appear after 50 years of the previous accident. Three patients showing squamous cell epitheliomas are presented, and the opportunity and technique of the surgical treatment is discussed.

Marjolin's ulcer on the nose

Malignancies in scars are generally known as Marjolin's ulcer. The majority of these arise from burn injuries. Although Marjolin's ulcer consists of all kinds of skin cancer, squamous cell carcinoma is the main cancer type reported in the literature. The pathogenesis of this tumor is due to chronic irritation of the effected area and mostly involves the extremities and scalp area. This report presents an unusually located and rare type of Marjolin's ulcer: on the nose and baso-squamotic in type. A 54-year-old man, 33 years after burn, presented with an unhealed ulcer on his nose which had been present for 2 years. The case was managed by tumor excision and a naso-labial transposition flap. To our knowledge, this is the first report of Marjolin's ulcer developing on post-burned skin of the nose.

Traumatic neuroma as a cause of obstructive jaundice

A 70-year-old man with previous cholecystectomy developed progressive obstructive jaundice, 3 months before hospitalization. Intraoperatively, a 2 x 2 x 1.5-cm mass in the distal part of the right hepatic duct was excised to release complete obstruction. It was verified as traumatic (amputation) neuroma. Despite rarity, traumatic neuroma of the bile duct should be considered in patients who have antecedent surgical procedure of the biliary tract with subsequent occurrence of extrahepatic biliary obstruction.

Squamous cell carcinoma in chronic ulcerative lesions: a case report and literature review

A case report and literature review are presented involving a fatal case of squamous cell carcinoma of the lower extremity. The unique aspects of this patient include the young age at presentation (35 years old), and the association with both a burn scar (Marjolin's) ulcer and a draining osteomyelitis fistulus tract. Epidemiologic data for Marjolin's ulcers as well as squamous cell carcinoma associated with draining sinus tracts of osteomyelitis are reviewed, in addition to the recommended management of such patients. The case presented is a reminder of the need to maintain a high index of suspicion for malignant transformation within ulcerative lesions.

Marjolin's ulcer arising in a burn scar

Marjolin's ulcer-a term used to describe a malignancy arising in chronic ulcers of the skin, sinuses, scar tissue, and especially burns scars-occurs in two forms: an acute variant in which the malignant changes occur within a year of injury, and a chronic form in which the injury may precede the malignancy by decades. Illustrating the more common chronic form, we present the case of a 32-year old Haitian woman with an extensive squamous cell carcinoma arising from a burn scar on the dorsum of her right hand, with a review of the literature pertaining to burn scar carcinoma.

The development of a Marjolin's cancer in a human immunodeficiency virus-positive hemophilic man and review of the literature

BACKGROUND

The malignant potential of chronic ulcers and scars secondary to a variety of injuries is well characterized in the medical literature. Furthermore, it has been reported that human immunodeficiency virus (HIV)-positive patients have a higher incidence of basal cell carcinoma (BCC) than the general population.

OBJECTIVE

To describe a case of an unusually aggressive morpheaform BCC that developed in a 28-year-old HIV-positive patient. The tumor developed in a scar 25 years after the initial trauma (Marjolin's ulcer).

METHODS

Description of a case and review of the literature of Marjolins ulcer.

RESULTS

The tumor was removed in a seven-stage, 21-section, micrographically controlled excision. Intraoperatively, perineural invasion of the infraorbital nerve was observed. The postoperative defect was repaired using a full-thickness skin graft.

CONCLUSION

Although most malignancies arising within chronic scars are SCCs, BCCs and a number of other tumors have been described. Mohs micrographic surgery was effective in treating this aggressive morpheaform BCC. A high degree of suspicion in any changing healed scar is recommended.

Postburn scar carcinomas in Kashmiris

Seventy-two Kashmiri patients with postburn scar carcinomas seen over a period of 12 years have been reviewed. The incidence of this cancer in the valley appears to be comparatively high (10.4 percent of squamous cell cancers and 7.6 percent of all cutaneous cancers). A Kangri burn was the commonest aetiological agent (44.4 percent). The mean age at presentation was 41.5 years, with a mean latent period of 35.4 years. None of the patients had metastases and all tumours were well differentiated squamous cell carcinomas. Sixty-four patients underwent excisional surgery and six had amputations, with a 5-year survival rate of 68.7 percent, which is better than reported by many other series.

Malignant schwannoma in a burn scar

The malignant potential of a burn scar is well recognized. Epidermal malignancies predominate and sarcomas are a rare finding. The first case of a malignant schwannoma developing in a burn scar is reported, and the management discussed.

Marjolin's ulcer of the foot caused by nonburn trauma

Marjolin's ulcers are malignancies that arise from previously traumatized, chronically inflamed, or scarred skin. We report a case of squamous cell carcinoma arising in a foot wound 42 years after the time of injury. The historical background, epidemiology, pathophysiology, diagnosis, treatment, and prognosis of Marjolin's ulcer are reviewed. Diagnosis is best accomplished by punch biopsy or excision of suggestive lesions. Wide local excision is required and amputation may be necessary to achieve an adequate margin. Regional lymph node dissection should be done if regional nodes are palpable. Elective lymph node dissection is controversial but should be considered if the tumor is poorly differentiated. Lymph node metastases and high tumor grade indicate a poor prognosis. Clinicians should be diligent in the long-term surveillance of all significant scars or areas of chronic inflammation.

Exuberant granulation tissue mimicking vascular tumours associated with burns

A case of simultaneous development of multiple vascular neoplasms in a patient with a previous history of burns and lymphoblastic lymphoma is reported. Microscopic examination revealed angiomatosis made up of diffuse capillary proliferation. We speculate that endogenous factors could have played an important role in the development of these neoplasms. We discuss the clinical and histological differential diagnosis of the case presented: a disseminated variant of lobular capillary haemangioma, Kaposi's sarcoma, bacillary angiomatosis and hyperplastic granulation tissue.

[Post-traumatic subperiosteal chondroma of the hand. Clinical case]

The authors report a case of rapidly developing periosteal chondroma of the fifth metacarpal. No erosion of the bone cortex could be observed radiographically. The development of the tumor appears to follow a violent trauma without skeletal lesions occurred seven months before.

Posttraumatic meningioma: explanation of an epidemiologic dichotomy

A 23-year-old soldier sustained a penetrating gunshot wound to the right frontoparietal region of the head in 1971 while serving in Vietnam. In 1984, he developed headaches and seizures, and a meningioma was found at the cranioplasty site. Recurrent meningiomas, requiring resection, developed at this site in 1988 and 1990. In 1994, he developed right proptosis. An extensive mass involving the right intraorbital region and the anterior and middle cranial fossa was found. Pathological examination of this tumor demonstrated malignant meningioma. Although antecedent head trauma has been implicated as a risk factor for meningioma, epidemiological studies of this association have yielded divergent conclusions. An explanation for this epidemiologic dichotomy is suggested.

Traumatic neuroma. A rare complication following Muller's phlebectomy

BACKGROUND

Complications following ambulatory surgical phlebectomy are rare, and to our knowledge, traumatic neuromas have never been reported.

OBJECTIVE

To present a case of traumatic neuroma in a 48-year-old woman after ambulatory minisurgical phlebectomy.

METHODS

The ambulatory minisurgical phlebectomy as described by Muller.

RESULTS

In a 48-year-old woman who developed persisting nodules after phlebectomy, histopathology confirmed the clinical diagnosis of traumatic neuroma.

Primary post-traumatic intraorbital meningioma

Intraorbital meningiomas are uncommon tumours that usually represent extension from a primary intracranial tumour. Trauma has been proposed by Cushing and Eisenhardt as an etiologic factor in the development of meningioma following head injury. We report a case of primary post-traumatic intraorbital meningioma and discuss its pathogenesis and management.

Malignant fibrous histiocytoma at the site of hip replacement in association with chronic infection

A case of malignant fibrous histiocytoma that developed at the site of an infected metallic implant is presented. The total hip endoprosthesis was composed of a cobalt-chromium alloy. There was a relatively short latency period (less than 2 years) between the initial surgery and the development of malignancy in this patient. The authors urge development of a tumor registry to discover if the association between hip replacement and malignancy is coincidental.

Malignant change in dermatitis artefacta

Dermatitis artefacta is a chronic skin lesion produced by self-trauma. Avoidance of further trauma, topical steroids and psychological therapy all play a part in the treatment of such lesions. Unresolved lesions may become large and disfiguring and subject to infection. We report a case of one such lesion in an elderly woman who persistently excoriated a cholecystectomy scar over 40 years. Malignant transformation occurred in a manner analogous to the neoplastic change observed in other types of chronic ulcer (Marjolin's ulcer). The squamous cell carcinoma presented with widespread metastases from which the patient eventually died. Recent literature concerning Marjolin's ulcers is reviewed and it is noted that this is the first reported case of death caused by malignant change in dermatitis artefacta.

[A recurrent desmoid tumor of the popliteal fossa with vascular compromise]

We report a case of a 18-year-old male patient with his fourth relapse of a desmoid tumour of the left popliteal hollow after a traumatism in this area. Arterial displacement and extrinsic compression were showed by arteriography. Tumoration was extirpated including popliteal artery, in this way a terminal by-pass from distal femoral to peroneo-tibial trunks with contralateral great saphena was made. Diagnosis of intestinal polyposis and of the little osseous malformations, was discarded these pathologies frequently are related with these tumours. The research for 8 years and 4 months doesn't show any relapse, nor local neither multicentral. Furthermore, some considerations about this theme are reported.