Zajonz D, von der Höh N H, Tiemann A H, Zaage J, Brandmaier P, Tiepolt S, Heyde C E, Ghanem M
Klinik und Poliklinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Universitätsklinik Leipzig AöR.
Abt. f. Septische und Rekonstruktive Chirurgie, BG Kliniken Bergmannstrost Halle.
Z Orthop Unfall. 2014 Jun;152(3):265-9. doi: 10.1055/s-0034-1368552. Epub 2014 Jun 24.
Epidermal cysts (atheroma) are the most common benign tumours of the skin with ubiquitous localisation all over the body. However, rupture of the atheroma and formation of an inclusion cyst with additional superinfections are frequently seen. Malignant transformations have rarely been reported. Presented here is the unusual case of a 65-year-old woman with multiple atheromas and a distinctive tumour of the upper limb. Imaging diagnostics showed malignant deformation. Contrary to the imaging findings the histological/microbiological examination showed an enormous superinfected and ruptured epidermoid cyst with multiple abscess formation in the ventral upper limb. Radical surgical restoration with salvage of the limb was frustrated because of honey-combed anterior soft tissue and the changing bacterial spectrum. After resection of the complete ventral compartment, remission was realised approximately. In the follow-up there was a recurring infection with spontaneous fistula formation that histologically impressed as a squamous cell carcinoma. After proximal ablation of the upper limb, total rehabilitation of the infection as well as the malignoma could be achieved.
表皮囊肿(粉瘤)是皮肤最常见的良性肿瘤,全身各处均可发生。然而,粉瘤破裂并形成包涵囊肿伴发额外的继发感染很常见。恶性转化鲜有报道。本文介绍了一名65岁女性的罕见病例,她患有多发性粉瘤,上肢有一个特殊肿瘤。影像学诊断显示为恶性变形。与影像学结果相反,组织学/微生物学检查显示上肢腹侧有一个巨大的继发感染且破裂的表皮样囊肿,并形成多个脓肿。由于前侧软组织呈蜂窝状且细菌谱不断变化,保肢的根治性手术修复受阻。切除整个腹侧腔室后,大致实现了病情缓解。在随访中,出现了复发性感染并自发形成瘘管,组织学表现为鳞状细胞癌。上肢近端切除后,感染以及恶性肿瘤均实现了完全康复。