Joglekar Kiran, Jackson Christopher, Kadaria Dipen, Sodhi Amik
Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA.
Am J Case Rep. 2016 Dec 28;17:989-992. doi: 10.12659/ajcr.900829.
BACKGROUND Squamous cell carcinoma (SCC), also known as Marjolin ulcer, is a rare complication of hidradenitis suppurativa (HS). Metastatic SCC from HS typically involves the axial skeleton or abdominopelvic viscera. Metastatic disease to the lungs is a rare phenomenon with only three reported cases of lung parenchyma. We present a biopsy proven case of metastatic SCC to the pleura from gluteal HS. CASE REPORT A 46-year-old male with a history of recently diagnosed Marjolin ulcer secondary to gluteal HS was transferred to our intensive care unit for acute hypoxemic respiratory failure secondary to recurrent pleural effusion. On examination, patient was febrile (38.3 °C), normotensive (blood pressure 98/65 mm Hg), tachycardic (116 beats/minute) and tachypneic (40 breaths/minute) with oxygen saturation of 93% on room air. He was in moderate distress requiring endotracheal intubation and mechanical ventilation. Chest examination revealed decreased breath sounds bilaterally and skin examination was significant for 18 cm wide sacral lesion. CT thorax showed bilateral pleural effusions, pleural thickening, and scattered nodular densities within both lungs concerning for metastatic disease. Thoracentesis showed lymphocyte predominant exudate with negative cytology for malignant cells. A video-assisted thoracoscopic surgery (VATS) illustrated thickened pleural rind with histopathology and positive p40 stain consistent with invasive well-to-moderately differentiated keratinizing SCC. CONCLUSIONS SCC arising from HS is rare and metastatic disease to the pleura has not been reported previously. Strong clinical suspicion for malignancy is warranted in patients with advanced HS and evolving pulmonary symptoms despite negative cytology.
背景 鳞状细胞癌（SCC），也称为Marjolin溃疡，是化脓性汗腺炎（HS）的一种罕见并发症。HS转移的SCC通常累及中轴骨骼或腹盆腔脏器。转移至肺部的疾病是一种罕见现象，仅有3例肺实质受累的报道。我们报告1例经活检证实的臀肌HS转移至胸膜的SCC病例。病例报告 一名46岁男性，有近期诊断为继发于臀肌HS的Marjolin溃疡病史，因反复胸腔积液继发急性低氧性呼吸衰竭转入我们的重症监护病房。检查时，患者发热（38.3℃），血压正常（血压98/65mmHg），心动过速（116次/分钟），呼吸急促（40次/分钟），室内空气下氧饱和度为93%。他中度不适，需要气管插管和机械通气。胸部检查显示双侧呼吸音减弱，皮肤检查发现骶部有一个18cm宽的病变。胸部CT显示双侧胸腔积液、胸膜增厚，双肺内散在结节状密度影，怀疑为转移瘤。胸腔穿刺抽出以淋巴细胞为主的渗出液，恶性细胞的细胞学检查为阴性。电视辅助胸腔镜手术（VATS）显示胸膜增厚，组织病理学检查及p40染色阳性，符合浸润性高分化至中分化角化型SCC。结论 HS引起的SCC罕见，此前尚未有转移至胸膜的报道。对于晚期HS且有肺部症状进展的患者，尽管细胞学检查阴性，仍需高度怀疑恶性肿瘤。
