Treatment of Squamous Cell Carcinoma Incidentally Found in a Chronic Pilonidal Cyst -- A Case Report

慢性藏毛囊腫偶發鱗狀細胞癌的治療－案例報告

Po-Yu Chu(朱柏宇)；Chia-Chun Lee(李嘉駿)；Fu-Yin Hsiao(蕭福尹)

malignant pilonidal cyst ； squamous cell carcinoma ； pilonidal SCC

臺灣整形外科醫學會雜誌

33卷2期（2024 / 06 / 01）

220 - 231

英文;繁體中文

Background: Malignancies associated with pilonidal cyst is rarely reported. Treatment of pilonidal cyst with deep sinus tracts involves extensive ablation of adjacent structures to achieve tumor-free margins. Aim and Objectives: To understand the clinical manifestations and potential malignancy arising from a pilonidal cyst, and to discuss associated surgical treatments and alternative methods for reconstruction. Materials and Methods: Case presentation A 72-year-old woman came to our center for assessment of a cystic fluctuant mass over the sacrococcygeal area. She also noted purulent discharge and erythematous swelling. The findings supported the diagnosis of pilonidal cyst with abscess; thus incision and drainage were performed. However, the lesion showed poor regression with persisted discharge, complicated with deep sinus tract and cutaneous horn formations. After en-bloc excision, histopathological findings confirmed the diagnosis of squamous cell carcinoma. Based on a multidisciplinary team approach, she received tumor wide excision with concurrent laparoscopic abdominoperineal resection of the rectosigmoid colon, and permanent end colostomy. The defect was reconstructed with a superior gluteal artery perforator flap. Results: The patient recovered with no evidence of tumor recurrence or metastasis were found 2 years and 4 months postoperatively at follow-up. Conclusions: This is a rare case of squamous cell carcinoma arising from a chronic pilonidal cyst. A diagnosis of malignancy should be considered for patients with long standing lesions and abnormal clinical patterns. Standard treatment is surgical wide excision. The superior gluteal artery perforator flap can be implemented for such sacrococcygeal defects with good results.

背景：與藏毛囊腫相關的惡性腫瘤屬臨床上罕見病症。目前針對藏毛囊腫合併深竇道的治療為包括廣泛性切除鄰近結構之手術以實現腫瘤完全切除無殘留邊緣。目的及目標：了解藏毛囊腫的臨床表現及潛藏惡性腫瘤之可能狀況與警訊，並探討相關手術治療及重建手術的選擇與替代方式。材料及方法：一位72歲女性因尾骶骨腫塊至門診求診。此腫塊伴隨著皮膚紅斑腫脹和膿性分泌物。經初步診療與評估診斷疑似為伴有膿瘍的藏毛囊腫。從而進行切開引流。但病灶處紅腫消退不佳且持續滲液，並繼發深竇道和皮角形成。經過後續手術切除病灶後，組織病理學結果證實為鱗狀細胞癌之診斷。在多專科團隊的討論與共識，她接受了腫瘤廣泛性切除術，同時進行了腹腔鏡直腸乙狀結腸腹會陰切除術和永久性末端結腸造口術。切除後之軟組織缺損使用上臀動脈穿通支皮瓣重建。結果：患者手術後恢復良好，術後2年4個月於門診追蹤未見腫瘤復發或轉移。結論：這是一罕見鱗狀細胞癌源自慢性藏毛囊腫之病例。對於長期存在病變和異常臨床徵兆的患者，應考慮惡性腫瘤之可能診斷。目前標準治療為手術廣泛性切除。臀上動脈穿通支皮瓣可應用於此類尾骶部軟組織缺損，效果與恢復良好。