engleski

Rapidly progressing carcinoma as a complication of a chronic venous ulcer

Introduction: Venous ulcer is the final stage of chronic venous disease. It affects up to 3% of the general population, primarily older than 65. Venous ulcers are associated with various complications, the most dangerous of which is the possibility of malignant transformation. Materials and methods: Case report Results: A 72- year-old patient who had been treated for a left lower leg venous ulcer on an outpatient basis since 2018, presented to our Dermatovenereology Clinic in early 2020. During his follow-up visits in phlebology office, we treated the ulcer with an enzymatic gel and modern dressings, which resulted in an improvement of the local status. In addition, hyperbaric oxygen treatment was performed at the Hyperbaric medicine department. In December 2021, the ulcer base became greenish and malodorous, thus intravenous antimicrobial therapy was introduced. However, the local status showed further deterioration. A 13x6 cm ulceration was located on the medial surface of the middle and distal third of the left lower leg. Osteomyelitis was ruled out radiologically, while microbiological analysis confirmed P. aeruginosa infection, so therapy with piperacillin-tazobactam was initiated. Yet, the verrucous growths, noticed at the base of the ulcer, raised clinical suspicion of malignant transformation, and the histologic analysis of a biopsy confirmed a poorly differentiated carcinoma. Ultrasound showed inguinal lymphadenopathy, while magnetic resonance imaging of the lower extremity revealed involvement of the skin and subcutaneous tissue without invasion of the muscles and bones. Nevertheless, due to the unusually rapid tumour growth, amputation of the left lower leg amputation was eventually performed. Conclusion: Squamous cell carcinoma is a rare but possible complication of chronic venous ulcer. Clinical suspicion is raised by the appearance of hypertrophic ulcer growths that do not respond to chronic wound therapy. It is necessary to take a biopsy in time, because if it not diagnosed and treated promptly, it has a poor prognosis and can cause a fatal outcome.

Venous Insufficiency ; Leg ulcer ; Skin cancer

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