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CASE REPORT
Year : 2011  |  Volume : 56  |  Issue : 5  |  Page : 585-586
Epithelioid sarcoma and squamous cell carcinoma arising in a burn scar


Department of Pathology, T N Medical College and BYL Nair Ch Hospital, Mumbai Central, Mumbai - 400 008, India

Date of Web Publication4-Nov-2011

Correspondence Address:
Kusum D Jashnani
8 Aashirvad, First Floor, Opposite Kakad Industrial Estate, Lady Jamshedji Cross Road 3, Mahim, Mumbai - 400 016
India
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DOI: 10.4103/0019-5154.87164

PMID: 22121287

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   Abstract 

Development of a malignant tumor is a well known complication of a chronic burn scar. Most of these tumors are squamous cell carcinomas and only 28 cases of burn scar sarcomas have been reported in literature. We report the first occurrence of the combination of squamous cell carcinoma and epithelioid sarcoma arising in a burn scar.


Keywords: Burn scar, burn scar cancer, epithelioid sarcoma, squamous cell carcinoma


How to cite this article:
Jashnani KD, Dhume VM, Bahal NK. Epithelioid sarcoma and squamous cell carcinoma arising in a burn scar. Indian J Dermatol 2011;56:585-6

How to cite this URL:
Jashnani KD, Dhume VM, Bahal NK. Epithelioid sarcoma and squamous cell carcinoma arising in a burn scar. Indian J Dermatol [serial online] 2011 [cited 2014 Jul 25];56:585-6. Available from: http://www.e-ijd.org/text.asp?2011/56/5/585/87164



   Introduction Top


Chronic burn scar developing into a malignant neoplasm is a well known complication.Most of these tumors are squamous cell carcinomas followed by basal cell carcinoma, melanoma and sarcoma. We report the first occurrence of the combination of squamous cell carcinoma and epithelioid sarcoma arising in a burn scar. Metastatic spread to the inguinal lymphnodes, lungs and breast was also seen in this case.


   Case Report Top


A 29-year-old female presented with an exophytic tumor mass at left ankle since 3 months. She gave history of burns at the same site 9 years back, for which skin grafting had been done. Bilateral axillary and right inguinal lymphnodes were palpable apart from a right thigh soft tissue mass. Computed tomography (CT) scan examination of thorax and abdomen showed metastatic nodules in bilateral lungs, both breasts and right adrenal gland. Below knee amputation was performed. Gross examination revealed an exophytic mass at ankle measuring 11 × 9 × 9 cm, which was whitish and friable with areas of hemorrhage and necrosis on cut surface. The subcutaneous tissue showed tumor invasion [Figure 1]. A separate thickened plaque was present 1 cm lateral to the exophytic growth. The intervening skin was thick and discolored but not ulcerated.
Figure 1: Exophytic mass at the ankle

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Histopathologic examination of this thick plaque showed features of well-differentiated squamous cell carcinoma (SCC) [Figure 2]. However, the exophytic growth showed large round to polygonal tumor cells arranged in islands and nests with large areas of necrosis and nuclear debris in the center [Figure 3]. Overlying skin showed hyperkeratosis but was spared of tumor. Individual cells had moderate eosinophilic cytoplasm, and round to oval enlarged vesicular nuclei with prominent nucleoli [Figure 4]. Tumor cells were positive for vimentin [inset of [Figure 4]] and pancytokeratin on immunohistochemistry. The cells were negative for S-100 protein, HMB 45, Desmin, EMA, CD 34, LCA and Myo D1, thereby favoring epithelioid sarcoma. Fine needle aspiration cytology performed on breast mass, pulmonary nodule (under CT guidance) and axillary lymphnodes revealed metastasis of a sarcoma with a cell morphology resembling that of exophytic mass. Epithelioid sarcoma is known to have a high rate of recurrence and metastasis predominantly to the lymphnodes, lungs and scalp. The patient self-discharged against medical advice and was lost to follow-up.
Figure 2: Well-differentiated SCC (H and E, ×100)

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Figure 3: Large round to polygonal tumor cells arranged in islands and nests with large areas of necrosis and nuclear debris in the centre (×100 H and E)

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Figure 4: Individual cells had moderate eosinophilic cytoplasm, round to oval enlarged vesicular nuclei with prominent nucleoli. Tumor cells were positive for vimentin on immunohistochemistry (inset) (H and E, ×200)

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   Discussion Top


In a large review of burn scar neoplasms, Kowal Vern [1] reported SCC as commonest neoplasms in up to 7%, followed by basal cell carcinoma (BCC; 12%), melanoma (6%) and sarcoma (5%). Double tumors comprising SCC and BCC (2%) and SCC with melanoma [2] (1%) have also been reported. A rare report of three malignancies developing in the same patient [3] has been described. Literature reports only two cases of epithelioid sarcoma in a burn scar [4] and the present case is the first case report of epithelioid sarcoma along with SCC in a burn scar. The diagnosis of SCC was obvious. However, the exophytic growth posed a diagnostic challenge due to its varied histomorphology. Acantholytic squamous carcinoma or even melanoma (amelanotic) was considered on light microscopy. The overall histopathologic and immunohistochemical features were consistent with a diagnosis of epithelioid sarcoma [5] in addition to the metastatic spread to the inguinal lymphnodes, lungs and breast. Prognosis is primarily related to the local extent of the disease, its anatomical location and the presence or absence of lymphnode metastasis.

 
   References Top

1.Kowal - Vern A, Criswell BK. Burn Scar neoplasms: A literature review and statistical analysis. Burns 2005;31:403-13.  Back to cited text no. 1
    
2.Akiyama M, Inamoto N, Nakamura K. Malignant melanoma and Squamous cell carcinoma forming one tumor on a burn scar. Dermatologica 1997;194:157-61.  Back to cited text no. 2
    
3.Alconchel MD, Olivares C, Alvarez R. Squamous cell carcinoma, malignant melanoma and malignant fibrous histiocytoma arising in burn scars. Br J Dermatol 1997;137:793-8.  Back to cited text no. 3
[PUBMED]    
4.Steven K, Ingrid W, Michael H, Helmut K. Epithelioid sarcoma with angiomatoid features: Report of an unusual case arising in an elderly patient within a burn scar. J Cutan Pathol 2008;35:324-8.  Back to cited text no. 4
    
5.Miettinen M, Julie C. Epithelioid sarcoma - An immunohistochemical analysis of 112 classical and variant cases and discussion of differential diagnosis. Hum Pathol 1999;30:934-42.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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    Abstract
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