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Squamous cell carcinoma over pilonidal chronic disease. A new therapeutic approach

INTRODUCTION: Pilonidal sinus is a very common disease. Malignant transformation occurs in 0,1% of patients. We present a case of squamous cell carcinoma arised from recurrent pilonidal disease, managed by multimodal treatment. PRESENTATION OF CASE: We present a 70-year-old man with chronic pilonida...

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Autores principales: Mayol Oltra, A., Boldó Roda, E., Lozoya Albacar, R., Morillo Macias, V., Nobleja Quiles, N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229405/
https://www.ncbi.nlm.nih.gov/pubmed/32417733
http://dx.doi.org/10.1016/j.ijscr.2020.04.043
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author Mayol Oltra, A.
Boldó Roda, E.
Lozoya Albacar, R.
Morillo Macias, V.
Nobleja Quiles, N.
author_facet Mayol Oltra, A.
Boldó Roda, E.
Lozoya Albacar, R.
Morillo Macias, V.
Nobleja Quiles, N.
author_sort Mayol Oltra, A.
collection PubMed
description INTRODUCTION: Pilonidal sinus is a very common disease. Malignant transformation occurs in 0,1% of patients. We present a case of squamous cell carcinoma arised from recurrent pilonidal disease, managed by multimodal treatment. PRESENTATION OF CASE: We present a 70-year-old man with chronic pilonidal sinus. Inflammation had worsened in previous months and exploration revealed a large ulcerative mass which biopsy showed a squamous cell carcinoma. CT scan and MRI imaging showed tumoral invasion of the coccyx and both gluteus major muscles. Neoadjuvant radiotherapy, chemotherapy as radiosensitizer and surgery with intraoperative radiotherapy was decided in the multidisciplinary tumor committee. Post neoadjuvant therapy MRI showed partial response with a decrease of the mass but persistence of the coccyx infiltration. Surgery consisted in en-bloc resection of the tumor with presacral tissues, coccyx and partial gluteal resection. Intraoperative radiotherapy was administered over the sacrum and in the bed of the coccyx resection. One week later, reconstructive surgery was practiced using a latissimus dorsi free flap, advancement of gluteal flaps and skin graft. Histological examination showed no residual tumor. The patient is currently asymptomatic and he has a satisfactory quality of life. DISCUSSION: Although squamous cell carcinoma is rare, it must be suspected in patients with recurrent pilonidal disease. Diagnosis is done by histological examination of biopsies. This type of tumors have a high local recurrence rate. CONCLUSION: We propose a multimodal treatment that includes neoadjuvant radiotherapy and chemotherapy as radiosensitizer and surgery plus intraoperative radiotherapy with the aim to decrease local recurrence rate.
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spelling pubmed-72294052020-05-20 Squamous cell carcinoma over pilonidal chronic disease. A new therapeutic approach Mayol Oltra, A. Boldó Roda, E. Lozoya Albacar, R. Morillo Macias, V. Nobleja Quiles, N. Int J Surg Case Rep Article INTRODUCTION: Pilonidal sinus is a very common disease. Malignant transformation occurs in 0,1% of patients. We present a case of squamous cell carcinoma arised from recurrent pilonidal disease, managed by multimodal treatment. PRESENTATION OF CASE: We present a 70-year-old man with chronic pilonidal sinus. Inflammation had worsened in previous months and exploration revealed a large ulcerative mass which biopsy showed a squamous cell carcinoma. CT scan and MRI imaging showed tumoral invasion of the coccyx and both gluteus major muscles. Neoadjuvant radiotherapy, chemotherapy as radiosensitizer and surgery with intraoperative radiotherapy was decided in the multidisciplinary tumor committee. Post neoadjuvant therapy MRI showed partial response with a decrease of the mass but persistence of the coccyx infiltration. Surgery consisted in en-bloc resection of the tumor with presacral tissues, coccyx and partial gluteal resection. Intraoperative radiotherapy was administered over the sacrum and in the bed of the coccyx resection. One week later, reconstructive surgery was practiced using a latissimus dorsi free flap, advancement of gluteal flaps and skin graft. Histological examination showed no residual tumor. The patient is currently asymptomatic and he has a satisfactory quality of life. DISCUSSION: Although squamous cell carcinoma is rare, it must be suspected in patients with recurrent pilonidal disease. Diagnosis is done by histological examination of biopsies. This type of tumors have a high local recurrence rate. CONCLUSION: We propose a multimodal treatment that includes neoadjuvant radiotherapy and chemotherapy as radiosensitizer and surgery plus intraoperative radiotherapy with the aim to decrease local recurrence rate. Elsevier 2020-05-11 /pmc/articles/PMC7229405/ /pubmed/32417733 http://dx.doi.org/10.1016/j.ijscr.2020.04.043 Text en © 2020 The Author(s) http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mayol Oltra, A.
Boldó Roda, E.
Lozoya Albacar, R.
Morillo Macias, V.
Nobleja Quiles, N.
Squamous cell carcinoma over pilonidal chronic disease. A new therapeutic approach
title Squamous cell carcinoma over pilonidal chronic disease. A new therapeutic approach
title_full Squamous cell carcinoma over pilonidal chronic disease. A new therapeutic approach
title_fullStr Squamous cell carcinoma over pilonidal chronic disease. A new therapeutic approach
title_full_unstemmed Squamous cell carcinoma over pilonidal chronic disease. A new therapeutic approach
title_short Squamous cell carcinoma over pilonidal chronic disease. A new therapeutic approach
title_sort squamous cell carcinoma over pilonidal chronic disease. a new therapeutic approach
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229405/
https://www.ncbi.nlm.nih.gov/pubmed/32417733
http://dx.doi.org/10.1016/j.ijscr.2020.04.043
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