title: Squamous cell carcinoma arising in an unhealed wound in Crohn's disease.
abstract: A 49-year-old black woman with a 23-year history of Crohn's disease came to our clinic; she had a squamous cell carcinoma arising in an unhealed perineal wound 16 years after abdominoperineal resection (APR). We report this case to show the potential for malignant degeneration in such wounds. This patient had had multiple procedures for fistulotomies and incision and drainage of abscesses and, ultimately, an APR. After the APR, she had a persistent perineal wound, which did not fully heal despite extensive local and systemic therapy. Our examination revealed a chronic wound involving the entire perineum and vagina, including the labia, both inguinal folds, and the intergluteal cleft. Biopsies showed moderately differentiated squamous cell carcinoma throughout. We believe healing may be impaired in patients who have Crohn's disease, with a significant risk of unhealed perineal wounds after APR. Chronic unhealing wounds may progress to carcinoma, and this propensity toward transformation may be increased by immunosuppression. Complaints of persistent pain and unhealing wounds in the absence of infection in patients with Crohn's disease suggest the possibility of malignancy and biopsy is recommended.
authors.affiliation: Department of Surgery, George Washington University, Washington, DC, USA.
authors.forename: B
authors.initials: B
authors.lastname: Sarani
authors.forename: B A
authors.initials: BA
authors.lastname: Orkin
mesh_terms: D000005:Abdomen / Q000601:surgery; D000038:Abscess / Q000601:surgery; D001706:Biopsy; D002081:Buttocks; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D002908:Chronic Disease; D003424:Crohn Disease / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007264:Inguinal Canal; D007410:Intestinal Diseases / Q000601:surgery; D007412:Intestinal Fistula / Q000601:surgery; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D010146:Pain; D010166:Palliative Care; D010502:Perineum / Q000473:pathology* / Q000601:surgery; D012086:Reoperation; D012878:Skin Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D014625:Vaginal Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D014945:Wound Healing
chemical_list: D007166:Immunosuppressive Agents