Squamous cell carcinoma developed in a chronic radiation-induced chest wall ulcer that is difficult to undergo thorough preoperative histological examination
| Autor: | Masayuki Harada, Riyo Miyata, Mika Takeuchi, Masamitsu Kuwahara, Junji Ando, Saori Kanagawa, Satoshi Yurugi, Yasumitsu Masuda |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Fistula Article 03 medical and health sciences 0302 clinical medicine Biopsy medicine Pericardium Radiation induced skin cancer Radiation injuries Debridement Lung medicine.diagnostic_test business.industry Cancer Radiation ulcer medicine.disease Radiation therapy medicine.anatomical_structure Cardiothoracic surgery 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Surgery Radiology business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2020.05.081 |
| Popis: | Highlights • Squamous cell carcinoma (SCC) arose in a large chronic radiation-induced thoracic ulcer which exposing the lung and pericardium after flap surgery. • Preoperative histopathological examination point indicated Inflammation. But after flap surgery, squamous cell carcinoma was diagnosed from a fistula at the margin of the flap. • We should have asked a thoracic/cardiac surgeon to conduct a biopsy at the pericardium during the debridement operation before flap covering. • It is necessary to consider the best method for performing the most thorough histological examination possible, even in areas where histological examinations are difficult, as all ulcers can contain tumors. Introduction We report a case in which squamous cell carcinoma (SCC) developed in a large chronic radiation-induced thoracic ulcer after flap surgery in areas where preoperative histological examinations are difficult. Presentation of case The patient was a 75-year-old female. She had undergone resection and radiotherapy for left breast cancer 15 years earlier. Six years ago, the ulcer expanded from the subclavian to xiphoid levels, exposing the lung and pericardium. A histopathological examination, which avoided the lung and pericardium, was performed. Inflammation was diagnosed. We reconstructed the chest wall with a pedicled rectus abdominis flap. Eighteen months later, three verrucous tissue-lined fistulas formed. A histological examination revealed well-differentiated SCC. Six months later, the patient died of massive bleeding from a fistula. Discussion It is unclear exactly when the SCC occurred. As three fistulas formed at the margins of the flap around the pericardium, we suspect that the cancer developed within or near the pericardial region. We need to reflect on the lack of a thorough biopsy. As no pericardial biopsy was performed, we should have asked a thoracic/cardiac surgeon to conduct a biopsy during the debridement operation. If the tumor had been localized to the pericardium, it could have been removed. Conclusion It is necessary to consider the best method for performing the most thorough histological examination possible, even in areas where histological examinations are difficult, as all ulcers can contain tumors. |
| Databáze: | OpenAIRE |
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