J Korean Soc Radiol.  2011 Jun;64(6):593-598. 10.3348/jksr.2011.64.6.593.

Imaging of a Marjolin's Ulcer: A Case Report

• Cha JG
• Yoo JH
• Kim HK
• Paik SH
• Hong HS
• Lee HK

• KMID: 1443510
• DOI: http://doi.org/10.3348/jksr.2011.64.6.593

Abstract

A Marjolin's ulcer refers to malignancies that developed in chronic venous ulcers, scars, or sinuses. We report three-dimensional computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT findings in a patient who developed skin cancer from a chronic leg ulcer. Although rare, on MR, a Marjolin's ulcer should be considered when a well-enhanced soft-tissue mass with a broad based skin ulcer shows a mass effect and invasion of the adjacent bone. CT angiography and PET-CT complement MRI for evaluating the nature of Marjolin's ulcers and may provide essential anatomical information, enabling the physician to design the optimal surgical approach or determining cancer staging.

MeSH Terms

Angiography
Cicatrix
Complement System Proteins
Humans
Leg Ulcer
Magnetic Resonance Imaging
Neoplasm Staging
Positron-Emission Tomography
Skin Neoplasms
Skin Ulcer
Soft Tissue Neoplasms
Tomography, X-Ray Computed
Ulcer
Varicose Ulcer
Complement System Proteins

Figure

• 

  Fig. 1 Anteroposterior radiograph of the left lower leg shows cortical thickening of the fibular diaphysis (arrowheads) beneath the skin ulcer (arrow). Note the cortical hypertrophy on the opposite side of the skin ulcer.

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  Fig. 2 Computed tomography. A. Axial CT with bone setting reveals cortical hypertrophy of the left lateral fibula (arrows) extending anteroposteriorly parallel to the skin ulcer (arrowheads). A soft tissue mass (asterisk) is also seen between the skin ulcer and fibula. B. Sagittal reformatted contrast-enhanced CT shows a thickened cortex (arrows), which is extrinsically eroded by a soft-tissue mass (asterisk) with a broad base on the skin ulcer (arrowheads). C. CT angiography with color-coded volume-rendering demonstrates a well-enhanced soft-tissue mass (asterisk) surrounded by numerous supplying arteries.

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  Fig. 3 Magnetic resonance imaging. A-C. The soft tissue mass (arrowheads) shows slightly greater signal intensity than muscle on (A) coronal T1weighted images [repetition time (TR) 1466, echo time (TE) 15], (B) high signal intensity on fat-saturated T2-weighted images (TR 3550, TE 65), and (C) strong enhancement on contrast enhanced fat saturated T1-weighted images (TR 833,TE 13). Note the cortical involvement of the soft tissue mass and abnormal signal intensity lesions in the bone marrow (arrows). D. The axial contrast-enhanced T1-weighted image (TR 900, TE 11) shows a highly homogenous enhanced mass bulging out from the skin scar.

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  Fig. 4 PET/CT. Transverse PET/CT shows intense FDG uptake by the soft tissue mass (arrowheads), which is seen as a highly enhanced mass on CT and MR images. There was no abnormal FDG uptake in the bone marrow where abnormal signal intensity was seen on MRI.

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  Fig. 5 Microscopically, nests of atypical squamous cells with keratinization spread from the ulcerated epidermis (arrows) into the deep dermis (hematoxylin and eosin staining; original magnification, × 40).

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