Squamous cell carcinoma arising in chronic osteomyelitis

Diagnostics

Background. The authors describe a series of patients with chronic osteomyelitis associated with squamous cell carcinoma, whilst analyzing its incidence in chronic osteomyelitis, surgical options for treatment and focusing on the role of MRI in differential diagnosis. Methods. The authors reviewed 73 cases of chronic osteomyelitis (CO) treated in their department between 1995 and 2019. Six of these patients (8.2%) had a malignant degeneration in squamous cell carcinoma (SCC). All cases with malignancy were evaluated with preoperative gadolinium-enhanced MRI. Results. In this series, the authors observed an incidence rate of 8.2% (6 cases out of 73); all patients were male with a mean age of 63.5 years. The mean time between the occurrence of chronic osteomyelitis and the diagnosis of squamous cell carcinoma was 36 years (range: 21–66). The treatment consisted of amputation in five patients and limb salvage with vascularized fibula autograft in one case. Conclusions. MRI played a key...

Wiener klinische Wochenschrift, 2009

European Journal of Orthopaedic Surgery & Traumatology, 2011

Background Marjolin's ulcer describes any malignant transformation of a chronic inXammatory lesion. In the majority of cases, a squamous cell carcinoma is diagnosed. Malignant transformation occurs usually after a long period of latency of chronic infection; it takes approximately 35 years on average. There are no typical clinical presentations, but several indirect signs may suggest the malignant transformation, such as increased or changed discharge, pathologic fracture, a slow-growing exophytic mass, or other suggestive signs of malignant transformation, which should prompt to biopsy for histological exam. The diagnosis of chronic osteomyelitis should not prevent to search for carcinoma. Case description We present six patients with chronic osteomyelitis that developed well-diVerentiated squamous cell carcinoma. All patients were older than 50 years (mean 60 years, range 52-77 years). Five Marjolin's ulcers were located on the lower limb and one on the arm. The average time of the chronic discharging osteomyelitis before diagnosis of carcinoma ranged between 12 and 40 years. All patients were treated by amputation of the aVected limb. None had metastasis, and one patient developed local recurrence and received palliative treatment. Clinical relevance Our study emphasizes that Marjolin's ulcer should be considered as a rare but signiWcant longterm complication of chronic osteomyelitis. The Wnding of microorganisms should not prevent from further diagnostic procedures by histopathological examination so that the correct surgical treatment can be performed.

Journal of Cranio-Maxillofacial Surgery, 2004

Introduction: Primary chronic osteomyelitis of the jaw is a rare, non-suppurative, chronic inflammatory disease of unknown aetiology. To date, classification is confusing due to a non-uniform terminology. The aim of this study was to establish a simple (clinical) classification based on patient data from our clinic. Methods: Retrospective analysis revealed 30 cases of which clinical course, radiology, pathology, therapy and outcome were analysed. Results: Both sexes were equally represented. The mean age at onset of disease was 35 years (range 5-76 years). Onset of disease revealed two peaks of incidence, one in adolescence and one after age 50 years. While clinical symptoms were similar in all cases, an increased intensity of these symptoms was noted in younger individuals as well as in the early stages of the disease. Five adults and one adolescent presented with additional non facial bone, joint and skin manifestations consistent with the diagnosis of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, or chronic recurrent multifocal osteomyelitis. Radiology demonstrated sclerosis, osteolysis and periosteal reaction in variable stages in all cases. However, findings were more extensive in younger patients. Histology revealed different stages of chronic inflammation in all cases. Microabscess formation was noted in 11 cases, six of which were children/adolescents. Therapy consisted mainly of surgery, antibiotics and hyperbaric oxygen therapy. At the end of the follow up period, 11 patients demonstrated complete remission, while in 14 cases amelioration and in 5 no significant improvement was noted. Conclusion: Based on differences in age at presentation, clinical appearance and course, radiology and histology, a subclassification into early and adult onset primary chronic osteomyelitis has been established. Cases with purely mandibular involvement should further be distinguished from cases associated with other syndromes. r 2003 European Association for Cranio-Maxillofacial Surgery.

JURNAL BIOMEDIK (JBM)

Abstrak: Infeksi pada tulang dan sendi masih merupakan kasus yang menantang. Kondisi ini memberikan banyak penyulit baik kepada dokter maupun pasien. Meski terapi antibiotika dilaporkan memberikan hasil yang memuaskan pada banyak kasus infeksi, tidak demikian pada kasus infeksi tulang dan sendi. Hal ini berhubungan dengan struktur anatomi dan fisiologi dari tulang. Diperlukan sebuah strategi tata laksana yang baik untuk mencapai hasil yang optimal. Prinsip dasar yang utama dalam mencapai pengobatan yang optimal ialah penegakan diagnosis awal yang tepat, termasuk di dalamnya proses investigasi pemeriksaan mikrobiologi dan patologi. Diperlukan pengertian dasar serta pengenalan kembali anatomi, fisiologi, patofisiologi, dan tata laksana terkini tentang osteomielitis untuk mencapai tatalaksana yang optimal.Kata kunci: diagnosis dan tata laksana osteomielitis: Infection in bone and joint is still a challenging case. It gives a lot of problems and frustration to the physician and patient....

OSTEOMYELITIS: FROM DIAGNOSIS TO TREATMENT (Atena Editora), 2023

This study aimed to carry out a bibliographic review about Osteomyelitis, a bone inflammation caused by an infection. Since 1984, osteomyelitis has been known, which is a bone inflammation due to a constant infection process, which occurs when a pathogen has access to the bone through an exposed wound, or resulting from trauma or a post-surgical procedure. To make the diagnosis, when the individual presents signs and symptoms (fever, chills, abscesses, edema and local erythema), which can be localized or systemic. We identified it through alterations in an X-ray exam, also requiring complementary exams. This pathology has different classifications, but with a standard initial treatment, with the use of drugs and even surgical intervention in more severe cases. The highlight is given to the group most affected by the pathology, men, whites aged over 60 years are the most seriously affected. This way, it is necessary to give due importance to carrying out more research and forms of prevention for this pathology and its consequences.

2011

Osteomyelitis is an inflammatory condition of bone that involves the medullar cavity and has a tendency to progress along these spaces. The isolation of the oral fluids and prevention of contamination is extremely important in the reconstruction of the mandibular defects that are caused by the resistant infections as in osteomyelitis. The purpose of this paper was to describe a case of a 43 years old man having pathologic fracture of the mandible and partial necrosis of inferior alveolar nerve related chronic suppurative osteomyelitis and to report a postoperative complication that was successfully treated. Use of acrylic prosthesis in patients in whom no graft materials are used may be helpful in the healing by partially isolating the wound site from the oral medium.

To date, no evidence-based guidelines for the treatment of chronic osteomyelitis exist. Owing to certain similarities, treatment philosophies applicable to musculoskeletal tumour surgery may be applied in the management of chronic osteomyelitis. This novel approach not only reinforces certain important treatment principles, but may also allow for improved patient selection as surgical margins may be customised according to relevant host factors. When distilled to its most elementary level, management is based on a choice between either a palliative or curative approach. Unfortunately there are currently no objective criteria to guide selection of the most appropriate treatment pathway.

International Journal of Orthopaedics Sciences, 2018

Introduction: The exact definition of osteomyelitis is inflammation of bone or bone marrow or both, but for all practical purposes this inflammation invariably is the result of infection. Various factors responsible for osteomyelitis include vascular insufficiency due to any cause, hematogenous spread of infection from a distant focus and surgery or trauma. Acute Osteomyelitis usually presents with fever, chills, pain or irritability. The classic signs of inflammation, including swelling, or redness and limited joint movement may also occur. Chronic osteomyelitis may present with bone destruction and sequestrum formation and is a difficult form of osteomyelitis to treat. Aims and Objectives: To study demographic details, organisms involved and outcome of treatment in patients with osteomyelitis. Materials and Methods: After obtaining approval from institutional ethical committee we conducted a prospective study of 60 patients diagnosed with either acute, subacute or chronic osteomyelitis on the basis of imaging and culture and sensitivity. Patients were included in this study on the basis of predefined inclusion criteria and were treated by antibiotics and when necessary surgical intervention was done. In cases of skeletal tuberculosis appropriate antikochs treatment was given. Outcome of treatment was studied over a follow up period of 1 year. The data was tabulated and analyzed using SPSS 16.0 version software. Results: Out of 60 cases of either acute, subacute or chronic osteomyelitis there were 38 males (63.33%) and 22 females (36.66%) with a M:F ratio of 1:0.57. Most common age group affected was found to be between 51-60 (36.66%) years. Acute, subacute and chronic osteomyelitis was seen in 71.66%, 11.66% and 16.66% patients respectively. Most common bones involved were Tibia (20%) and Femur (18.33%) followed by iliac bones (15%) fibula (11.66%) and vertebrae (11.66%). In most of the cases (36/60) contagious spread or trauma was the mechanism of infection. Comorbidities like hypertension, diabetes, chemotherapeutic agents or steroid intake and immunosuppression was present in 32 (53.33%) patients. S. Aureus (25/60) followed by Pseudomonas (7/60) and enterococci (7/60) were commonly isolated organisms. Atypical mycobacterial infection was seen in 1 patient who was immunocompromised. 40 patients were completely cured while remaining 10 patients had some or the other problem associated with chronic osteomyelitis. Amputations was done in 4 cases and septic arthritis developed in other 2 cases. 4 patients died during study period due to causes unrelated to osteomyelitis. Conclusion: Diagnosis as well as management of osteomyelitis is a challenge for treating orthopaedician. Knowledge of predisposing factors, presenting complaints, possible complications and proper management is essential for successful management of acute as well as chronic osteomyelitis.

Annals of Surgery, 2005

To characterize the national epidemiology of adult osteomyelitis (OM) and, using a single institutions' experience, test the hypothesis that early surgical therapy as compared with antibiotics alone results in an improved chance of wound healing and limb salvage. Background: Foot and digit OM is a very common problem for which management is variable and for which few guidelines exist. Methods: The Nationwide Inpatient Sample (NIS) and a single institution review from 1993 to 2000 form the basis of this study, using ICD-9CM codes for lower extremity foot and digit OM. Demographics, risk factors, and treatments were analyzed against the outcomes of a healed wound, limb salvage, and death. Results: The NIS included 51,875 patients (incidence ϭ 9/10,000 patients per year) with a mean age of 60 years, and 59% were men. The median length of stay decreased from 9 to 6 days (P Ͻ 0.001), but the average admission charge of $19,000 did not significantly decrease over 7 years. Of these patients, 23% underwent a digit amputation and 8.5% suffered proximal limb loss. Single-institution analysis of 237 consecutive patients with OM confirmed a similar mean age (58 years), gender (67% men), and most presented with a foot or digit ulcer (56%). Wound healing was achieved in 56% and overall limb salvage was 80%. Decreased wound healing was associated with peripheral vascular occlusive disease (odds ratio, 0.