Soft tissue sarcomas apparently arising in chronic tropical ulcers

Of 720 soft tissue sarcomas received from Malawi over a 15 year period, eight had apparently arisen in chronic tropical ulcers which are endemic in that part of Africa. These eight tumours were classified as leiomyosarcoma (three), extraskeletal osteosarcoma (two), malignant fibrous histiocytoma (one), myxoid liposarcoma (one) and unclassifiable (one). All had a history suggestive of malignant change in a long-standing ulcer, in each case clinically thought to be a squamous carcinoma. However, in none was there evidence of an epithelial origin and all were negative for epithelial membrane antigen and cytokeratin. This association has not previously been reported. The validity of this proposed association is discussed.