Mandal Palash Kumar, Bhattacharyya Nirmal Kumar, Mookerjee Sekhar Kumar, Chaudhuri Bhaskarnarayan
Department of Pathology, Medical College, Kolkata 700073.
J Indian Med Assoc. 2013 Feb;111(2):125-6.
The diabetic foot ulcer is one of the major complications of diabetes mellitus leading to prolonged hospital stay. Non-healing foot ulcers in diabetes may be due to peripheral neuropathy and/or vasculopathy. Non-healing occurs following a trivial trauma due to loss of local immunity and increased infection by bacteria and fungus. Candida and mucormycosis are common fungal infection in diabetic foot ulcer. Squamous cell carcinoma in any non-healing ulcer is a common occurrence. But squamous cell carcinoma in non-healing diabetic foot ulcer is rarely reported. Here, mucormycosis in a diabetic foot ulcer which turned into squamous cell carcinoma is reported in a 62-year-old male with poor glycaemic control for last 21 years who presented with a non-healing ulcer of 8 months' duration over dorsum of left forefoot. Microbiological examination revealed presence of mucormycosis infection and histopathology of ulcer showed infiltrating well-differentiated squamous cell carcinoma. The clinicians and pathologists should be aware of these combinations because only eradication of mucormycosis may not cure the ulcer, rather presence of squamous cell carcinoma may be ignored that may be an immediate threat to the patient's life.
糖尿病足溃疡是糖尿病的主要并发症之一,会导致住院时间延长。糖尿病患者足部溃疡不愈合可能是由于周围神经病变和/或血管病变。由于局部免疫力丧失以及细菌和真菌感染增加,轻微创伤后就会出现溃疡不愈合的情况。念珠菌和毛霉菌病是糖尿病足溃疡常见的真菌感染。任何不愈合的溃疡中都常见鳞状细胞癌。但糖尿病足溃疡不愈合并发鳞状细胞癌的情况鲜有报道。在此,报告一例62岁男性患者,其糖尿病足溃疡发生毛霉菌病并转变为鳞状细胞癌。该患者血糖控制不佳已达21年,左前足背有一个持续8个月不愈合的溃疡。微生物学检查显示存在毛霉菌感染,溃疡的组织病理学检查显示为浸润性高分化鳞状细胞癌。临床医生和病理医生应了解这些情况,因为仅根除毛霉菌病可能无法治愈溃疡,反而可能忽略鳞状细胞癌的存在,而这可能会对患者生命构成直接威胁。