Thomas M. Bauer

Double localisation à la cheville d’un ostéome ostéoïde : traitement par forage percutané: À propos d’un cas

A 26-year-old woman presented a rare double localization of an osteoid osteoma of the ankle. The first focus was situated in the tibial metaphysic, bordering the distal tibiofibular joint. The second focus was also superficial, located in the neck of the homolateral talus. Percutaneous drilling was performed for both localizations under computed tomographic (CT) guidance. The postoperative period was uneventful and the patient has remained symptom-free at four years follow-up. Compared with disphyseal localizations, it is often more difficult to recognize an osteoid osteoma located in the foot or ankle. Scintigraphy and CT are necessary and sufficient for diagnosis. Progress in imaging techniques has greatly facilitated the treatment of osteoid osteomas, allowing excellent outcome with limited morbidity.

Ulcère de Marjolin sur ostéite chronique

PURPOSE OF THE STUDYnMalignant degeneration of chronic wound inflammation is a rare complication which almost always develops late. Unstable wounds and scar tissue related to chronic osteitis can degenerate after a long period of chronic inflammation. We report seven cases.nnnCASE REPORTSnSeven patients presented squamous-cell carcinoma of the skin which had developed on wounds related to deep bone infections. Three patients had chronic bone infections subsequent to posttraumatic osteitis, two after hematogenous osteomyelitis, one after osteitis which developed on a zone of radiation-induced necrosis, and one after a deep burn was complicated by osteitis. The skin lesions developed over a period of 43 years on average before the diagnosis of malignant degeneration was established. Most of the lesions presented as budding malodorous ulcers. The pathological diagnosis was spinocellular squamous-cell carcinoma in five cases and verrucous squamous-cell carcinoma in two. Conservative treatment with wide resection and flap cover was attempted in all seven patients.nnnRESULTSnTreatment failed in four patients and three required amputation. One patient died two years after amputation with local recurrence and metastatic dissemination to the brain.nnnDISCUSSIONnThe diagnosis of malignant degeneration requires pathological proof. Biopsy material should be obtained whenever there is a modification leading to the development of a fistula or the formation of a scar tissue over a focus of chronic osteitis. Prevention requires adapted treatment of chronic bone infections, avoiding directed wound healing which can lead to fragile unstable scar tissue subject to degeneration.Resume Les plaies et cicatrices instables en regard de foyers d’osteite chronique peuvent se compliquer de degenerescence maligne apres une longue evolution. Sept cas de carcinomes epidermoides sur lesions cutanees chroniques en rapport avec des infections osseuses sous-jacentes sont rapportes dans cette etude. Les lesions sont survenues sur des infections osseuses chroniques avec 3 cas d’osteite post-traumatique, 2 cas d’osteomyelite hematogene, un cas d’osteite sur radionecrose et un cas de brulure profonde compliquee d’osteite. Ces lesions cutanees evoluaient depuis 43 ans en moyenne avant le diagnostic de degenerescence maligne et se presentaient generalement sous la forme d’ulcerations bourgeonnantes et malodorantes. La variete anatomo-pathologique etait un carcinome epidermoide spino-cellulaire 5 fois et un carcinome epidermoide verruqueux 2 fois. Dans tous les cas, un traitement conservateur avec excision large et couverture par lambeau a ete tente. Chez 4 patients, ce traitement a echoue et 3 patients ont ete amputes. Un patient est decede 2 ans apres amputation, avec une recidive locale et une diffusion metastatique cerebrale.

Ulcère de Marjolin sur ostéite chronique: Diagnostic et résultats du traitement : 7 cas

PURPOSE OF THE STUDYnMalignant degeneration of chronic wound inflammation is a rare complication which almost always develops late. Unstable wounds and scar tissue related to chronic osteitis can degenerate after a long period of chronic inflammation. We report seven cases.nnnCASE REPORTSnSeven patients presented squamous-cell carcinoma of the skin which had developed on wounds related to deep bone infections. Three patients had chronic bone infections subsequent to posttraumatic osteitis, two after hematogenous osteomyelitis, one after osteitis which developed on a zone of radiation-induced necrosis, and one after a deep burn was complicated by osteitis. The skin lesions developed over a period of 43 years on average before the diagnosis of malignant degeneration was established. Most of the lesions presented as budding malodorous ulcers. The pathological diagnosis was spinocellular squamous-cell carcinoma in five cases and verrucous squamous-cell carcinoma in two. Conservative treatment with wide resection and flap cover was attempted in all seven patients.nnnRESULTSnTreatment failed in four patients and three required amputation. One patient died two years after amputation with local recurrence and metastatic dissemination to the brain.nnnDISCUSSIONnThe diagnosis of malignant degeneration requires pathological proof. Biopsy material should be obtained whenever there is a modification leading to the development of a fistula or the formation of a scar tissue over a focus of chronic osteitis. Prevention requires adapted treatment of chronic bone infections, avoiding directed wound healing which can lead to fragile unstable scar tissue subject to degeneration.Resume Les plaies et cicatrices instables en regard de foyers d’osteite chronique peuvent se compliquer de degenerescence maligne apres une longue evolution. Sept cas de carcinomes epidermoides sur lesions cutanees chroniques en rapport avec des infections osseuses sous-jacentes sont rapportes dans cette etude. Les lesions sont survenues sur des infections osseuses chroniques avec 3 cas d’osteite post-traumatique, 2 cas d’osteomyelite hematogene, un cas d’osteite sur radionecrose et un cas de brulure profonde compliquee d’osteite. Ces lesions cutanees evoluaient depuis 43 ans en moyenne avant le diagnostic de degenerescence maligne et se presentaient generalement sous la forme d’ulcerations bourgeonnantes et malodorantes. La variete anatomo-pathologique etait un carcinome epidermoide spino-cellulaire 5 fois et un carcinome epidermoide verruqueux 2 fois. Dans tous les cas, un traitement conservateur avec excision large et couverture par lambeau a ete tente. Chez 4 patients, ce traitement a echoue et 3 patients ont ete amputes. Un patient est decede 2 ans apres amputation, avec une recidive locale et une diffusion metastatique cerebrale.

MémoireUlcère de Marjolin sur ostéite chronique: Diagnostic et résultats du traitement : 7 casMarjolin's ulcer in chronic osteomyelitis: seven cases and a review of the literature

PURPOSE OF THE STUDYnMalignant degeneration of chronic wound inflammation is a rare complication which almost always develops late. Unstable wounds and scar tissue related to chronic osteitis can degenerate after a long period of chronic inflammation. We report seven cases.nnnCASE REPORTSnSeven patients presented squamous-cell carcinoma of the skin which had developed on wounds related to deep bone infections. Three patients had chronic bone infections subsequent to posttraumatic osteitis, two after hematogenous osteomyelitis, one after osteitis which developed on a zone of radiation-induced necrosis, and one after a deep burn was complicated by osteitis. The skin lesions developed over a period of 43 years on average before the diagnosis of malignant degeneration was established. Most of the lesions presented as budding malodorous ulcers. The pathological diagnosis was spinocellular squamous-cell carcinoma in five cases and verrucous squamous-cell carcinoma in two. Conservative treatment with wide resection and flap cover was attempted in all seven patients.nnnRESULTSnTreatment failed in four patients and three required amputation. One patient died two years after amputation with local recurrence and metastatic dissemination to the brain.nnnDISCUSSIONnThe diagnosis of malignant degeneration requires pathological proof. Biopsy material should be obtained whenever there is a modification leading to the development of a fistula or the formation of a scar tissue over a focus of chronic osteitis. Prevention requires adapted treatment of chronic bone infections, avoiding directed wound healing which can lead to fragile unstable scar tissue subject to degeneration.Resume Les plaies et cicatrices instables en regard de foyers d’osteite chronique peuvent se compliquer de degenerescence maligne apres une longue evolution. Sept cas de carcinomes epidermoides sur lesions cutanees chroniques en rapport avec des infections osseuses sous-jacentes sont rapportes dans cette etude. Les lesions sont survenues sur des infections osseuses chroniques avec 3 cas d’osteite post-traumatique, 2 cas d’osteomyelite hematogene, un cas d’osteite sur radionecrose et un cas de brulure profonde compliquee d’osteite. Ces lesions cutanees evoluaient depuis 43 ans en moyenne avant le diagnostic de degenerescence maligne et se presentaient generalement sous la forme d’ulcerations bourgeonnantes et malodorantes. La variete anatomo-pathologique etait un carcinome epidermoide spino-cellulaire 5 fois et un carcinome epidermoide verruqueux 2 fois. Dans tous les cas, un traitement conservateur avec excision large et couverture par lambeau a ete tente. Chez 4 patients, ce traitement a echoue et 3 patients ont ete amputes. Un patient est decede 2 ans apres amputation, avec une recidive locale et une diffusion metastatique cerebrale.