Giant Protruding High-Grade Undifferentiated Pleomorphic Sarcoma Arising in a Keloid Scar on the Abdominal Wall

Abstract

Undifferentiated pleomorphic sarcoma (UPS) is a high-grade, aggressive, soft tissue sarcoma that is often fatal. Although there are reports describing associations of sarcoma and skin lesions such as burns, radiation, and trauma, to our knowledge, UPS development in a keloid scar has not been reported. Herein, we present the case of a 76-year-old woman who had undergone surgery for endometrial cancer, 5 years before. She presented with a protruding lesion that was continuous to a keloid scar on the abdominal wall. The tumor appeared clinically malignant as it was protruding and doubled in size within three weeks, reaching approximately 6 × 6 × 2 cm. Since the tumor was diagnosed as UPS after pathological evaluation by needle biopsy, wide resection was performed. Intraoperatively, the tumor was apparently continuous to the keloid, protruding and pedunculated outside the body, and had not invaded the abdominal cavity. Histopathological examination of the resected tumor showed evidence of UPS and no suspicion of metastasis of endometrial cancer. No recurrence, metastases, or other complications were noted 6 months after surgery. The current case study reminds us that keloids may cause high-grade sarcoma such as UPS, and careful follow-up is required.

Scalp Reconstruction in Delayed Diagnosed Dermal Leiomyosarcoma Mimicking Keloid Scar

“…A second clinical case, was published in 2020, reporting a protruding mass on the abdominal wall, which had undergone surgery five years before and had existing keloid scars. The scar, which remained stable, grew larger for four months and was confirmed as undifferentiated pleomorphic sarcoma on histological examination after resection 6 . In the aforementioned reported cases, as in this case, conservative treatment and observation were done first, because the lesions were mistaken for keloid scars because of their initial appearance; this misdiagnosis made it difficult to properly deal with the malignancy immediately.…”

High‐Grade Pleomorphic Sarcoma in Postauricular Keloid Scar After Surgical Excision and Radiation

“…Though this patient was treated with surgery alone, the authors note that postoperative multidisciplinary treatment with chemotherapy and radiation is often required for this aggressive tumor. 4 Additionally, one case report has described a 26-year-old male with a radiation-naïve keloid located on the post-auricular region that transformed into fibrosarcoma. Unfortunately, this patient's sarcoma failed to resolve despite treatment with surgical resection and radiation and he passed away from widespread metastasis.…”

“…She was successfully treated with wide surgical excision only with no recurrence noted 6 months following surgery. Though this patient was treated with surgery alone, the authors note that postoperative multidisciplinary treatment with chemotherapy and radiation is often required for this aggressive tumor 4 . Additionally, one case report has described a 26‐year‐old male with a radiation‐naïve keloid located on the post‐auricular region that transformed into fibrosarcoma.…”