title: A Metastatic Squamous Cell Carcinoma in a Diabetic Foot: Case Report.
abstract: A 72-year-old male was referred to our hospital for a plantar ulceration that had occurred many years earlier. The lesion, with exuberant granulation and large areas of necrosis and fibrin, had long been treated by plastic surgeons with no positive evolution. At admission in our hospital no ischemia was detected, and foot radiograph was negative for bone involvement. The patient underwent a foot magnetic resonance imaging, which showed high vascularization in the plantar region and early capture of the contrast medium. We then performed multiple biopsies of the ulceration that revealed a moderately differentiated squamous cell carcinoma. The total body computed tomography exam raised a systemic involvement. A lymph node biopsy and immunohistochemistry assay on the pleural cytological sample proved the presence of a primary squamous cell carcinoma of the foot with systemic dissemination. Although rare, squamous cell carcinoma could be associated with chronic nonhealing ulcers; therefore, when a lesion does not heal, despite adequate standard treatment, its etiopathogenesis should be challenged.
authors.affiliation: Diabetic Foot Section, Department of Medicine, Pisa University Hospital.
authors.forename: Alessia
authors.initials: A
authors.lastname: Scatena
authors.affiliation: Imaging Department, Pisa University Hospital.
authors.forename: Virna
authors.initials: V
authors.lastname: Zampa
authors.affiliation: Pathology Department, Pisa University Hospital.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fanelli
authors.affiliation: Diabetic Foot Section, Department of Medicine, Pisa University Hospital elisabettaiacopi@gmail.com.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Iacopi
authors.affiliation: Diabetic Foot Section, Department of Medicine, Pisa University Hospital.
authors.forename: Alberto
authors.initials: A
authors.lastname: Piaggesi
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000503:physiopathology; D017719:Diabetic Foot / Q000473:pathology / Q000503:physiopathology; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer; D016523:Foot Ulcer / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D012878:Skin Neoplasms / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Marjolin ulcerations; diabetic foot; squamous cell carcinoma