Squamous cell carcinoma
in sequel of leprosy
Natalia Regina Martins, Nurimar Fernandes
Federal University of Rio de Janeiro - Brazil
BACKGROUND
CASE REPORT
Leprosy is an infectious disease caused by Mycobacterium leprae that affects both the skin and
the nerve. It is chronic evolution with periods of
exacerbation called reverse reactions. Remains
a very disabling illness with much psychological impact and much prejudice associated even
after therapy and etiologic knowledge has been
stablished.
A male 64-year-old first seen in primary health
unit complaining of small lesion in the plantar region after burn with fire. This occasion he
was diagnosed as having paucibacillary leprosy being treated with chemotherapy regimen for
paucibacillary (PB-MDT). Made use of Dapsone
100 mg/day and Rifampin 600 mg/month for 06
months. Even after completing treatment of leprosy and with topical and oral antibiotics wound
persists. Thus, transferred to a university hospital for evaluation of an ulcerated lesion in the
right plantar region (Fig I e II) It had extensive lesion with involvement of hallux and second right
toe plus local infection and palpable bilateral
inguinal nodes. Patient referred for hospitalization, starting intravenous antibiotics, skin biopsy
was performed in the lesion, the material sent to
microbiology, and histopathology, Nuclear Magnetic Resonance of right foot and study of inguinal lymph node. Histopathology shows hyperplasia pseudoepitheliomatous and no neoplastic
cells at inguinal lymph node excision. After clinical stabilization and interdisciplinary discussion
with Orthopedics, we opted for the below-knee
amputation because there is high involvement
of bone invasion. The final Histopathological results of surgical specimen: well differentiated
Squamous Cell Carcinoma with up periosteal infiltration.
CONCLUSION
Pseudoepitheliomatous hyperplasia is by definition a reactive state of the squamous epithelium
that may extend to the reticular dermis simulating
carcinoma. It is found in cancers, chronic inflammation followed trauma or irritative processes.
Because of a possible malignant transformation
and the large bone involvement amputation was
considered the best treatment option with subsequent placement of infra patellar prosthesis.
Squamous cell carcinoma is an uncommon sequel of ulcers secondary to leprosy neuropathy.
Most tumors occurs after long years of evolution of chronic ulcers with slow growth and rare
metastasis. Our case shows the early malignant
transformation of plantar ulcer alerting the basic
health service about the importance of monitoring these wounds, emphasizing the necessity of
constant histopathological study of wounds even
when the result of histopathology is only pseudoepitheliomatous hyperplasia. We must carry
out prevention campaigns and orientation of the
population for early diagnosis of ulcers of the
lower limbs are associated or no leprosy.
The authors have no conflict of interest
dranataliamartins@gmail.com
HUCFF-UFRJ