Three-staged Surgery for Squamous Cell Carcinoma Arising in Chronic Perianal Pyoderma

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  • 三期的に手術を行った臀部慢性膿皮症から続発した有棘細胞癌の1例
  • 症例 三期的に手術を行った臀部慢性膿皮症から続発した有棘細胞癌の1例
  • ショウレイ サンキテキ ニ シュジュツ オ オコナッタ デンブ マンセイ ノウ ヒショウ カラ ゾクハツ シタ ユウキョクサイボウガン ノ 1レイ

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Abstract

A 74-year-old man was evaluated for bleeding, pain, and pustular discharge of the left buttocks. Sixteen years previously he had undergone surgery with incision and drainage for chronic perianal pyoderma. Contrast CT and MRI now showed a large tumor-like lesion in the subcutaneous tissue of the left buttocks, but without any distal metastases. Biopsy showed squamous (prickle) cell carcinoma. Because of the tumor bleeding, refractory abscess, and difficult-to-control pain, tumor resection was planned to improve the patient's quality of life and activities of daily living.<BR>Surgery was performed in three stages. The first stage was a colostomy for local control of infection. The second stage was extensive tumor resection. After histopathology showed that the surgical resection margins were negative, a third stage was performed for reconstruction using gracilis muscle and posterior thigh flaps. Management was complicated because of the buttock and perineal wounds and body position, thus making reconstruction after extensive resection more difficult.<BR>This case of squamous cell carcinoma arising in chronic perianal pyoderma is reported along with a review of the relevant literature on management and reconstructive surgery in these cases.

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