title: Squamous cell carcinoma developed on chronic venous leg ulcer.
abstract: Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC). Malignant transformation of a VLU is a rare finding and the relative risk of carcinomatous transformation is quite low (about 5.8). SCC arising in the context of a VLU has a particularly aggressive behavior. A 76-year-old male patient with no relevant medical familial history, with chronic venous insufficiency CEAP C6 for 10 years [recurrent leg ulcers with favorable outcome (healing) after specific local and systemic treatment], showing for about three years one ulcerated lesion located on the anterior upper third of the right calf non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology showed epidermal acanthosis, papillomatosis, intense parakeratosis, pseudoepitheliomatous hyperplasia, dysplasia and moderately differentiated squamous cell carcinoma with areas of acantholysis. Immunohistochemistry (Ki67, EMA, cytokeratin 34βE12 and p63) was performed and all types of immunostaining were moderately to intense positive. Above-knee leg amputation and specific oncologic treatment were proposed as possible curative solutions but the patient refused. Ten months after diagnosis and discharge form the Department of Dermatology, the patient died. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal.
authors.affiliation: Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Romania; dr.mariusflorea@gmail.com.
authors.forename: Adelina Gabriela
authors.initials: AG
authors.lastname: Sîrbi
authors.forename: Marius
authors.initials: M
authors.lastname: Florea
authors.forename: Virgil
authors.initials: V
authors.lastname: Pătraşcu
authors.forename: Maria
authors.initials: M
authors.lastname: Rotaru
authors.forename: Dan Gabriel
authors.initials: DG
authors.lastname: Mogoş
authors.forename: Claudia Valentina
authors.initials: CV
authors.lastname: Georgescu
authors.forename: Nicolae Dragoş
authors.initials: ND
authors.lastname: Mărgăritescu
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology* / Q000601:surgery; D002471:Cell Transformation, Neoplastic; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000378:metabolism; D019394:Ki-67 Antigen / Q000378:metabolism; D007866:Leg / Q000473:pathology / Q000601:surgery; D007871:Leg Ulcer / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008297:Male; D018396:Mucin-1 / Q000378:metabolism; D012307:Risk Factors; D012878:Skin Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D014157:Transcription Factors / Q000378:metabolism; D025521:Tumor Suppressor Proteins / Q000378:metabolism; D014647:Varicose Ulcer / Q000150:complications / Q000473:pathology* / Q000601:surgery
chemical_list: C121278:CK-34 beta E12; D019394:Ki-67 Antigen; D018396:Mucin-1; C115051:TP63 protein, human; D014157:Transcription Factors; D025521:Tumor Suppressor Proteins; D007633:Keratins