Department of Plastic and Reconstructive Surgery, National Hospital Organization Mito Medical Center, Ibaraki, 311-3193, Japan.
Department of Plastic and Reconstructive Surgery, National Hospital Organization Mito Medical Center, Ibaraki, 311-3193, Japan.
J Tissue Viability. 2021 Nov;30(4):621-625. doi: 10.1016/j.jtv.2021.01.002. Epub 2021 Jan 8.
Pressure ulcers are the most common complications in bedridden patients or those with spinal cord injuries. Marjolin's ulcer refers to a malignant transformation arising from burn scars or chronic nonhealing wounds-such as pressure ulcers-over many years. Squamous cell carcinoma is the major histopathologic type of Marjolin's ulcer, and the gold standard for diagnosis is tissue biopsy. Medical professionals may have difficulty distinguishing pressure ulcers from Marjolin's ulcer, especially when the latter presents with invasive infections. Thus, malignant transformations arising from pressure ulcers are frequently overlooked. Herein, we describe a case of squamous cell carcinoma arising from pressure ulcers on the left ischium, which was initially identified as a necrotizing soft tissue infection.
A 59-year-old paraplegic patient presented with stage 3 left ischial pressure ulcer, which involves full-thickness skin loss and extends into deep subcutaneous tissue, and arrived at our hospital with suspected sepsis. Upon physical examination, the patient presented with fever and shivering. Initial examination and imaging findings revealed the presence of necrotizing soft tissue infections. Three weeks later, rapid increase in granulation in the deep part of the ulcer was observed. Samples from multiples ulcer sites were collected for tissue biopsy. Finally, histological examination revealed well-differentiated squamous cell carcinoma. The patient received radiation therapy and chemotherapy and died 11 months after the diagnosis.
Malignant transformations arising from pressure ulcers may closely resemble pressure ulcer infections. In these cases, tissue biopsies should be performed during primary care for the infection to exclude malignant transformations.
压疮是卧床患者或脊髓损伤患者最常见的并发症。恶性溃疡是指在多年后由烧伤疤痕或慢性不愈的伤口（如压疮）引起的恶性转化。鳞状细胞癌是恶性溃疡的主要组织病理学类型，诊断的金标准是组织活检。医务人员可能难以将压疮与恶性溃疡区分开来，尤其是当后者出现侵袭性感染时。因此，压疮引起的恶性转化经常被忽视。在此，我们描述了一例左坐骨部压疮继发鳞状细胞癌的病例，该病例最初被诊断为坏死性软组织感染。
一名 59 岁截瘫患者因左坐骨部 3 期压疮就诊，该压疮累及全层皮肤缺失并延伸至深部皮下组织，因疑似脓毒症而入住我院。体格检查时，患者发热、寒战。初步检查和影像学检查发现存在坏死性软组织感染。3 周后，溃疡深部的肉芽组织迅速增加。从多个溃疡部位采集样本进行组织活检。最终，组织学检查显示为分化良好的鳞状细胞癌。患者接受了放疗和化疗，在诊断后 11 个月死亡。
压疮引起的恶性转化可能与压疮感染非常相似。在这些情况下，在感染的初级护理期间应进行组织活检，以排除恶性转化。
