Marjolin Ulcer

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Marjolin Ulcer MCQ – Most Common Histological Type

📘 Theme: Plastic Surgery – Chronic Ulcers & Malignant Transformation (NEET SS / INI-CET High Yield)

Clinical Surgery MCQ

A 35-year-old male presents with a Marjolin ulcer involving the leg. Which of the following statements regarding Marjolin ulcer is true?

A. Lymphatic spread is common
B. They are painful
C. They are aggressive and fast-growing tumors
D. Squamous cell carcinoma is the most common type

Answer: D. Squamous cell carcinoma is the most common type

Explanation

Marjolin ulcer refers to the development of a malignancy, most commonly squamous cell carcinoma (SCC), within a long-standing scar, burn scar, sinus tract, or chronic ulcer. Basal cell carcinoma may also occur but is much less common.

Scar tissue is relatively avascular and lacks normal lymphatic channels. As a result, these tumors typically exhibit slow growth initially. However, once the tumor extends into surrounding normal tissue, lymphatic spread and metastasis may occur.

Marjolin ulcers are classically associated with chronic burn scars but may arise in any long-standing ulcer, including venous ulcers.

Why other options are incorrect

  • A. Lymphatic spread is common: False. Scar tissue lacks lymphatics; lymphatic spread usually occurs only after invasion into adjacent normal tissue.
  • B. They are painful: False. Scar tissue lacks nerve endings, therefore pain is typically a late feature.
  • C. They are aggressive and fast-growing tumors: False. Marjolin ulcers are generally slow-growing because of the avascular nature of scar tissue, although they possess metastatic potential.

High-yield teaching points

  • Marjolin ulcer = malignant transformation in a chronic scar or ulcer.
  • Most common histology: Squamous cell carcinoma. ⭐
  • Classically develops in long-standing burn scars.
  • Can also occur in venous ulcers, pressure sores, osteomyelitic sinuses, and chronic wounds.
  • Pain and lymphatic spread are usually late features.
  • Scar tissue is relatively devoid of lymphatics and nerve endings.
  • Although slow growing, these lesions can metastasize once they invade surrounding healthy tissue.
  • Bailey & Love 28th Edition, Page 625.

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Contrast hazards in radiology

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Q1. Not true about hazards of contrast medium use in radiological interventions?

a) Use of newer agents have improved the risk of sudden death

b) Low osmolar contrast agents are better than previously used high contrast medium

c) After contrast injections, patients should be observed for 30 mins

d) Metformin can be continued in patients with normal renal function
Answer 1

Squamous cell cancer of upper esophagus

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Q) A 65-year-old male presents with grade IV dysphagia and is diagnosed with squamous cell carcinoma of the upper third of the esophagus. What is the most appropriate next step in management?

a) Definitive chemoradiotherapy
b) Neoadjuvant chemotherapy followed by transhiatal esophagectomy
c) Systemic chemotherapy alone
d) Neoadjuvant chemoradiotherapy followed by three-field esophagectomy

✅ Correct answer: a) Definitive chemoradiotherapy

💡 Explanation:

  • Upper third esophageal squamous cell carcinoma poses a challenge for surgical resection due to its proximity to the pharynx and larynx.

  • In resectable upper esophageal SCC, especially in older patients or when the tumor is very proximal, definitive chemoradiotherapy (CRT) is often the preferred treatment to avoid morbid surgery like laryngopharyngoesophagectomy.

  • Multiple guidelines, including NCCN and ESMO, recommend definitive CRT for upper esophageal SCC unless there’s a compelling reason for surgery.

❌ Why other options are incorrect:

  • b) Neoadjuvant chemo + THE:
      THE (transhiatal esophagectomy) is not suitable for upper esophageal tumors. It doesn't provide good access to cervical/upper thoracic esophagus.

  • c) Chemotherapy alone:
      Not standard. Chemotherapy without radiation is inadequate for curative intent in localized esophageal cancer.

  • d) Neoadjuvant CRT + three-field esophagectomy:
      Though this is an option for mid/lower third esophageal cancers, especially in younger patients, it's more morbid and rarely used for upper third SCC in older patients.

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Radical Cholecystectomy

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 Q) Radical cholecystectomy includes all except

a) Segment IVb and Va

b) 2cm wedge resection

c) Rt Extended Hepatectomy

d) Paraaortic lymphnodes

Answer and Explanation here

History of Radical Cholecystectomy

  1. Early 20th century removal of gall bladder and wedge of liver ( No lymphadenectomy) 
  2. In 1954, Glenn et al - radical resection procedure with intended regional lymphadenectomy (portal lymph node dissection), designated as “radical cholecystectomy” (Glenn operation)
  3.  Fahim et al in 1962 advocated radical resection consisting of hepatectomy and portal lymph node dissection

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Borderline resectable pancreatic malignancy

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Q)False in Borderline resectable Pancreatic malignancy

a) Solid tumor contact with the IVC <180

b) Solid tumor contact with the SMA of ≤180 degree

c) Solid tumor with CHA involvement of 2.5 CM

d) Solid tumor contact with the SMV or PV of >180 degrees

 

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Blood transfusion

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Surgery MCQ | mcqsurgery.com
Q81) In trauma what is the ratio of PRBC: FFP to be transfused?
a) 1:1
b) 1:2
c) 1:3
d) 1:4
Correct Answer: a) 1:1

When there is requirement of more than 6 units of PRBC, FFP and other blood products are required. FFP and platelets should be transfused first and then PRBC. For every 7–12 Units of PRBC, ideally 6 units of FFP and one unit of platelets should be given.
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Benign polyps of esophagus

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Q ) False regarding Benign lesion of esophagus

a) Fibrovascular  polyps are seen in mid and lower two third

b) Leiomyoma  and Leiomyosarcoma have same distribution.

c)Leiomyoma enucleation is sufficient

d) Leiomyoma are the most common benign tumors of esophagus

Ans- 

 

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