Carcinomatous degeneration of pilonidal cyst with sacrum destruction and invasion of the rectum

Nunes, Luiz Fernando; Neto, Antonio Kneipp Pitta de Castro; Vasconcelos, Roberto André Torres de; Cajaraville, Flávio; Castilho, Juliana Galera; Rezende, José Francisco Netto; Noguera, Washington Silva

doi:10.1590/abd1806-4841.20132140

Cited by 22 publications

(27 citation statements)

References 6 publications

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“…Multiple biopsies of the margin of the ulcer provide the histological diagnosis [15, 16]. Occasionally, the lesion is discovered incidentally in an otherwise routine histological examination of a specimen [22].…”

Section: Discussionmentioning

confidence: 99%

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Squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease: a case report

et al. 2017

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BackgroundSacrococcygeal pilonidal disease is a chronic, well-recognized entity, characterized by the recurrent formation of an abscess or draining sinus over the sacrococcygeal area. It is one of the most common surgical problems. Rarely, chronic inflammation and recurrent disease leads to malignant transformation, most commonly to squamous cell carcinoma (SCC).Case presentationWe describe an extremely unusual case of SCC developing in a 60-year-old patient with a chronic pilonidal sinus complicated by an anal fistula. After wide surgical excision of the pilonidal sinus and fistulas and because of the poor healing process 6 months later, colonoscopy and a percutaneous fistulography were performed, revealing an anal canal-pilonidal fistula. Patient was treated with a more radical surgical resection with a prophylactic loop colostomy, but healing was not accelerated. Multiple biopsies were then taken from the surgical site at the time, which revealed the development of SCC. CT and MRI imaging techniques revealed SCC partial invasion of the coccyx and sacrum. As a result, aggressive surgical approach was decided. Histological examination revealed moderately to poorly differentiated SCC, and the patient was treated with adjuvant radiation therapy postoperatively. Nine months later, recurrence was found in the sacrum and para-aorta lymph nodes and the patient died shortly after. We discuss the clinical features, pathogenesis, treatment options, and prognosis of this rare malignant transformation.ConclusionsThe development of SCC in chronic pilonidal disease is a rare but serious complication. Symptoms are usually attributed to the sacrococcygeal pilonidal disease (SPD), and diagnosis is often made late by histological examination of biopsies. Malignant transformation should be suspected in chronic SPD with recurrent episodes of inflammation, repeated purulent discharge, poor healing, and chronic complex fistulas.

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Section: Discussionmentioning

confidence: 99%

“…Presacral fascia, gluteal muscle, a wide margin of skin and subcutaneous tissue, and, if required, the sacrum and coccyx, should be excised [16]. Prophylactic inguinal node dissection is not recommended [15].…”

Section: Discussionmentioning

confidence: 99%

Squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease: a case report

et al. 2017

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“…Surgery appears to provide the only means of cure. In patients with local extent to adjacent structures, a wider excision is necessary, including coccygeal excision, decortication or resection of the sacrum, and total mesorectal excision [ 4 ]. Frequently, it is difficult to determine the margins of the tumor due to severe inflammatory reaction in the area.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the high incidence of the disease, malignant degeneration of a pilonidal cyst is rare. The incidence is estimated at 0.1% and is triggered by a chronic inflammatory process, occurring mostly in neglected primary lesions; therefore, it is most commonly seen in older people with longstanding disease [ 4 ]. In 88% of the cases, the histological type is squamous cell carcinoma [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Is Histological Examination Necessary when Excising a Pilonidal Cyst?

et al. 2015

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Patient: Male, 77Final Diagnosis: Pilonidal cystSymptoms: Severe pain •bleeding massMedication: —Clinical Procedure: Local radiation therapy • neoadjuvant chemotherapy • surgical resectionSpecialty: SurgeryObjective:Rare diseaseBackground:Pilonidal disease is a common inflammatory condition mostly affecting young males. Malignant degeneration of a pilonidal cyst is rare, with incidence estimated at 0.1%. The most common type is squamous cell carcinoma and the treatment of choice remains en block resection of the lesion.Case Report:We present the case of a patient with locally advanced squamous cell carcinoma arising in a pilonidal cyst, due to misdiagnosis of the disease during his first treatment.Conclusions:Detailed histological examination of all excised pilonidal cyst lesions is essential and any histological suspicion should prompt a wider excision.

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“…U literaturi je od 1900. godine objavljeno manje od 70 takvih slučajeva. 11 Postavlja se pitanje je li opravdano slati svaki uzorak tkiva na patohistološku analizu. S obzirom na malen broj ispitanika, ovo istraživanje ne može dati definitivan odgovor.…”

Section: Raspravaunclassified

Surgical Treatment of Chronic Pilonidal Sinus

Dragišić

Šego²,

Galić

et al. 2019

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Chronic pilonidal sinus is an acquired skin disease resulting from chronic inflammation of an affected skin area. It creates a cyst with epithelized subcutaneous channels. The disease mostly affects younger men with elevated BMI and sedentary lifestyle being the main risk factors. The aim of this study was to compare wound healing times, seroma, wound infection and wound dehiscence frequency, average length of hospital stay and recurrence rate in patients undergoing first-time operation for chronic pilonidal sinus at the Surgery clinic of University hospital Mostar from June 2015 to June 2017, with recurrence rate monitoring for one one year after the operative procedure. The patients were divided into three groups by the type of operating procedure: excision with primary closure (23.0%), excision with healing by secondary intention (55.2%) and excision with Limberg flap closure (21.8%). Most of the patients included in this study had elevated BMI (72.4%). Patients who were operated using primary closure and Limberg flap closure had on average shorter wound healing times than patients operated with excision and secondary intention healing. Seroma frequency was highest in patients operated using primary closure (70.6%) and lowest in patients operated using Limberg flap closure (29.4%). Average length of hospital stay was 6.4 days (min 3, max 13; SD 1.919). There were no statistically significant differences in hospital stay between different types of operating procedures used. Patients operated using Limberg flap closure had two (10.5%) cases of recurrence in the one year period after the operation. There were seven (35.0%) recurrences of the disease in patients operated using primary closure and six (12.5%) recurrences in patients operated using healing with secondary intention. The difference in the number of recurrences between patients operated using primary closure, healing by secondary intention and Limberg flap closure was borderline statistically significant. We find that Limberg flap closure reduces postoperative complications and wound healing time which improves postoperative recovery.

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Carcinomatous degeneration of pilonidal cyst with sacrum destruction and invasion of the rectum

Cited by 22 publications

References 6 publications

Squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease: a case report

Squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease: a case report

Is Histological Examination Necessary when Excising a Pilonidal Cyst?

Surgical Treatment of Chronic Pilonidal Sinus

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