Squamous Cell Carcinoma Arising in Hidradenitis Suppurativa -A Case Report

化膿性汗腺炎惡變為鱗狀細胞癌－病例報告及文獻回顧

陳依凡(Yi-Fan Chen) ； 彭成康(Cherng-Kang Perng) ； 陳呈峰(Cheng-Feng Chen)

《臺灣整形外科醫學會雜誌》 26卷4期 (2017/12) Pp. 434-440

摘要

Background: Hidradenitis suppurativa (HS) is a relatively common chronic inflammatory condition affecting apocrine gland-bearing skin. Follicular occlusion, chronic relapsing inflammation, mucopurulent discharge, and progressive scarring characterize the disease. Malignant change rarely occurs, and squamous cell carcinoma (SCC) is the most common type. Failure to recognize the condition may lead to poor results. Aim and Objective: The purpose of this study is to highlight the poor prognosis of SCC arising from HS, and raise awareness of the potential for malignant transformation of chronic HS. Case presentation: A 32-year-old man with a 12-year history of biopsy-proven HS of the bilateral buttocks noted that the lesion had enlarged rapidly in 2 months. The patient went to a local hospital and granuloma with wound infection was diagnosed. He received antibiotic treatment but there was no improvement. The patient was then transferred to our hospital. Initial incisional biopsy showed acute and chronic inflammation with acanthosis and hyperkeratosis, but excisional biopsy confirmed SCC. Wide excision was performed with a safe margin of 3 cm. Six weeks after his initial presentation, the patient was diagnosed with left inguinal metastatic lymphadenopathy. He then underwent left inguinal radical lymph node dissection. The patient complained about severe progressive left lower leg pain and numbness after the surgery, and metastatic lymphadenopathy in the left gluteal region near the sciatic notch was diagnosed later. He received post-operative radiotherapy for the gluteal lesion and is now under regular follow-up. Conclusion: Several cases of SCC arising from chronic HS have been reported, and death rates are high. Early recognition and appropriate management should be the goals of both patients and physicians. Metastatic lymphadenopathy should be considered once the disease is diagnosed.

關鍵字

hidradenitis suppurativa ； squamous cell carcinoma ； metastatic lymphadenopathy ； sciatic nerve

並列摘要

背　景：化膿性汗腺炎是相對常見的慢性發炎疾病，多發生於具有頂漿腺的皮膚。症狀包含毛囊阻塞、慢性反覆發炎、黏液膿性分泌物、及持續惡化的瘢痕。少數病例可能出現惡性變化，其中鱗狀細胞癌最為常見。無法早期辨識此變化可能導致不良預後。目的及目標：強調化膿性汗腺炎惡變為鱗狀細胞癌的預後，並提醒臨床醫師此狀況的潛在可能，並回顧相關文獻。病例報告：一位32歲的男性患者，過去有十二年的雙側臀部化膿性汗腺炎病史，並曾以活組織切片診斷。他表示病灶近二個月以來病灶持續快速擴大，且曾至地區醫院就醫。當時診斷為肉芽腫併傷口感染，於是接受抗生素治療但無效。轉診至本院後，最初活組織切片病理報告為急性併慢性發炎與黑棘皮及角質過度增生，但切除性切片手術之病理報告為鱗狀上皮細胞癌。於是患者接受了廣泛性切除，安全距離為三公分。距患者初次至本院門診的六週後的追蹤，診斷左側腹股溝淋巴結轉移，患者於是接受左側腹股溝淋巴廓清術。術後患者感到嚴重左下肢疼痛與麻木症狀，而經由切除左坐骨切跡附近的淋巴結診斷了該處淋巴轉移，患者後續並接受左臀大肌區的放射線治療。結　論：過去許多文獻曾提出由化膿性汗腺炎惡變之鱗狀細胞癌的病例，其死亡率較高。因此早期辨識並正確治療應為患者與臨床醫師的共同目標。一旦疾病診斷，應立即評估是否有淋巴結轉移。